Accidental Detection of Tuberculous Empyema at Health Check-Up.

BACKGROUND: Patients with tuberculous empyema (TE) can have a serious impact on lung function as their disease progresses, and, if left untreated, can cause damage to other parts of the body such as the thorax and spine, causing pain and inconvenience to the patient. Early diagnosis and the search for appropriate treatment are key to improving the survival rate of the disease. METHODS: We report a case of a young patient with an unexpected finding of right pleural effusion on physical examination, who was eventually diagnosed with TE using next-generation sequencing of pleural tissue. We analyzed the literature to improve clinicians' understanding of TE and how to properly diagnose and treat the disease. RESULTS: Laboratory results of the pleural effusion suggested a possible Mycobacterium tuberculosis infection, but pathogen-related tests were negative, and the diagnosis was eventually successfully confirmed by thoracoscopic pleural biopsy. CONCLUSIONS: The diagnosis of TE should be considered in young patients with pleural thickening of the empyema. Adenosine deaminase may provide diagnostic direction in patients with unexplained thorax abscess. Pleural biopsy, although an invasive procedure, is an essential diagnostic tool in some cases.

[Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall].

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall / 中华外科杂志

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Angiosarcoma of breast and chest wall complicated with tuberculous empyema: A case report.

Angiosarcoma is a highly malignant endothelial tumor, accounting for 1% to 2% of soft tissue sarcomas. The most common site of the disease is the skin, accounting for approximately 60% of cases, especially the skin of the head. It can also occur in soft tissue, bone, and retroperitoneum. However, angiosarcomas of the breast and chest wall are rare. Here, we report a 44-year-old woman who was admitted to hospital with encapsulated empyema. She was subsequently diagnosed with angiosarcomas of the breast and chest wall with tuberculous empyema. At the same time, we also reviewed the current research progress in angiosarcoma of the breast and chest wall to explore better treatment options for these patients.

Surgical outcomes and the factors affecting lung expansion following open window thoracostomy in chronic tuberculous empyema with destroyed lung.

BACKGROUND: Patients with chronic tuberculous empyema and destroyed lung on a prolonged intercostal tube with failed lung expansion considered unsuitable for single-lung ventilation have poor outcomes. The study's objective was to analyze the surgical outcomes and lung expansion factors in these patients following the open window thoracostomy (OWT) procedure. METHODS: In a prospective study, patients (males = 63, females = 12) diagnosed with tuberculosis who underwent OWT were analyzed between 2017 and 2018. Factors including age, sex, side, comorbidities, body mass index (BMI), bacteriological culture, and patency of OWT site were evaluated for lung expansion. RESULTS: Mean preoperative weight 40.96 ± 5.70 kg increased significantly postoperatively. Pseudomonas aeruginosa (30.66%) was the most typical organism isolated and smoking (21.3%) was the common risk factor. At 6-month follow-up, complete lung expansion was noted in 60% of patients, while partial and no expansion is seen in 17.3% and 22.3% patients. Similarly 82.4% patients with pre-operative BMI>18.5 kg/m2 had complete lung expansion, while with BMI < 18.5 kg/m2, 41.7% and 45.8% had partial and no-expansion. Complete lung expansion was seen in 97.1%, 18.2%, and 23.1% of patients with obliterated OWT, sputum, and pleural pus positive for acid-fast bacilli (active disease), while in 57.9% of patients with comorbidities, complete lung expansion was absent. CONCLUSION: The analysis of various factors concludes that lung expansion is not affected by age, sex, side of the disease, and co-morbid conditions; however, extensively diseased lungs with low BMI and positive bacteriological culture, especially P. aeruginosa, active disease, smoking, and patent OWT, interfered with the expansion of the lung.

CAUSES OF SUPERINFECTIONS: DEADLY BACTERIA OF TUBERCULOSIS.

OBJECTIVE: The aim: To improve early diagnosis of drug-resistant superbacteria and interrupt the ways of its formation through molecular technological and surgical methods. PATIENTS AND METHODS: Materials and methods: The operated patients were divided into two groups: group 1 - 351 (51.25 %) patients, who were operated with the use of minimally invasive technologies, and this was the main group; group 2 - 334 (48.75 %) patients who were operated on open wide thoracotomy, which was the comparison group. Among 351 patients in the main group, in 301 - acute pleural tuberculous empyema was detected, and in 50 - chronic one. Among patients in the comparison group, acute pleural empyema was observed in 284 patients and chronic in 50 patients. RESULTS: Results: According to our data, video thoracoscopy is a highly informative method of diagnosis of pleural effusions, detection of pleural tuberculous empyema in the first, second and third stages of its development. CONCLUSION: Conclusions: The introduction of modern molecular-geneticand surgical technologies will allow to accurately establish the etiology process, to conduct the identification of pathogen microorganisms and to determine the phenotymetric and genotytypical sensitivity of bacteria to Antimycobacterial drugs. Such diagnostics will promote effective treatment of patients who are already infected with persistent strains of bacteria and viruses.

[Hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis: one case report].

Hepatic cystic echinococcosis is a chronic parasitic disease caused by the infection with the larvae of Echinococcus granulosus in human or animal liver tissues. As a chronic active infectious disease, tuberculous empyema mainly invades the pleural space and then causes visceral and parietal pleura thickening. It is rare to present comorbidity for hepatic cystic echinococcosis and tuberculous empyema. This case report presents a case of hepatic cystic echinococcosis complicated with tuberculous empyema misdiagnosed as hepatic and pulmonary cystic echinococcosis, aiming to improve clinicians' ability to distinguish this disorder.

Empiema de necesidad / Empyema of Necessity

Introducción: El empiema de necesidad o empiema necessitatis (del latín) es un hallazgo raro en la actualidad y la tuberculosis es la causa más común, sobre todo en pacientes inmunodeprimidos. Objetivo: Presentar un caso con un empiema de necesidad como complicación de la tuberculosis extrapulmonar Caso clínico: Paciente de sexo femenino de 47 años de edad, sin antecedentes de enfermedad conocidos. Ingresa por una neumonía de la base derecha y como complicación un empiema de necesidad de naturaleza tuberculosa. Es tratada de forma médica y quirúrgica, tuvo una evolución favorable. Conclusiones: El conocimiento de la epidemiología de la zona donde se diagnosticó la enferma y la medicina personalizada contribuyeron a un diagnóstico rápido y a un tratamiento médico y quirúrgico acorde a los protocolos establecidos para la tuberculosis extrapleural(AU)

Introduction: Empyema of necessity (or empyema necessitatis) is, at present, a rare finding, of which tuberculosis is the most common cause, especially in immunosuppressed patients. Objective: To present a case of empyema of necessity as a complication of extrapulmonary tuberculosis. Clinical case: 47-year-old female patient, without known history of disease, who was admitted due to pneumonia of the right base and, as a complication, an empyema of necessity of a tubercular nature. She was treated medically and surgically, and had a favorable evolution. Conclusions: Knowledge of the epidemiology of the area where the patient was diagnosed, together with personalized medical care, contributed to a rapid diagnosis, as well as to the medical and surgical treatment provided according to the protocols established for extrapleural tuberculosis(AU)

Deterioration of chest wall depression causing congestive hepatopathy after an open thoracostomy window in a patient with pectus excavatum and tuberculosis empyema.

A 27-year-old man with severe pectus excavatum, dextrocardia and spinal scoliosis underwent thoracoscopic pleural decortication due to failure of 1-month medical treatment for tuberculous empyema. One month after the pleural decortication, he again underwent open thoracostomy window for repetitive pleuro-cutaneous fistula with tuberculosis empyema. He was subsequently referred to our clinic for progressive dyspnea and bilateral leg edema 4 months after the open thoracostomy window. Evaluations revealed deterioration of the chest wall depression and further compression of the inferior vena cava, which were considered an aggravation of the pectus excavatum after the open thoracostomy window. Herein, we present an extremely rare case of deterioration of chest wall depression causing congestive hepatopathy after an open thoracostomy window in a patient with pectus excavatum and tuberculosis empyema.

Salmonella houtenae-induced Empyema Complicated with Chronic Tuberculous Empyema.

Salmonella spp. are food-borne pathogens that usually cause gastroenteritis, although bacteremia and subsequent focal metastatic infection can also occasionally occur. Of the known Salmonella spp., Salmonella houtenae is a rare subspecies, comprising less than 1% of all Salmonella strains. We herein report the first case of S. houtenae-induced empyema complicated with chronic tuberculous empyema, which was successfully treated by antibacterial agents alone. We wish to highlight the importance of being aware that Salmonella spp. can cause empyema in cases suffering from chronic tuberculous empyema; moreover, despite the successful completion of treatment with antibacterial agents, periodical follow-up is mandatory in such cases.

Derrames pleurales benignos persistentes / Persistent benign pleural effusion

En esta revisión narrativa se describen las principales etiologías, características clínicas y tratamiento de los derrames pleurales de naturaleza benigna que, característicamente, pueden persistir en el tiempo: quilotórax y derrames de colesterol, pulmón no expansible, derrame pleural reumatoide, empiema tuberculoso, derrame pleural asbestósico benigno y síndrome de las uñas amarillas (AU)

In this narrative review we describe the main aetiologies, clinical characteristics and treatment for patients with benign pleural effusion that characteristically persists over time: chylothorax and cholesterol effusions, nonexpansible lung, rheumatoid pleural effusion, tuberculous empyema, benign asbestos pleural effusion and yellow nail syndrome (AU)

Lung Cancer in Patients With Tuberculous Fibrothorax and Empyema: Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography Findings.

OBJECTIVE: The aim of this study was to describe the characteristics of lung cancers in patients with tuberculous fibrothorax or empyema. METHODS: We retrospectively evaluated 138 consecutive patients with a diagnosis of lung cancer combined with fibrothorax (n = 127) or empyema (n = 11) from January 2005 to May 2015. All patients underwent computed tomography, and 105 underwent F-fluorodeoxyglucose positron emission tomography. Clinical, pathologic, and computed tomography characteristics and maximum standardized uptake values on positron emission tomography of 76 cancers ipsilateral to the fibrothorax or empyema (group 1) were compared with those of 62 contralateral cancers (group 2). RESULTS: The median age at diagnosis of patients was 70 years, with a male-to-female ratio of 8.9:1. The most common type was squamous cell carcinoma (41.3%) followed by adenocarcinoma (39.1%). Most were in the peripheral lung (70.3%), and half abutted the pleura. The median maximum standardized uptake value was 8.9. Tumors in group 1 were larger (median, 48.5 vs 42.8 mm, P = 0.036) and more advanced (T3 or T4) (P = 0.014) than those in group 2. CONCLUSIONS: Lung cancers ipsilateral to tuberculous fibrothorax or empyema presented larger and advanced T stages, and the diagnosis could be delayed. The most common type cancer was squamous cell carcinoma.

Endoscopic Bronchial Occlusion with Silicon Spigots for the Treatment of an Alveolar-pleural Fistula during Anti-tuberculosis Therapy for Tuberculous Empyema.

A prolonged air leak caused by pulmonary tuberculosis is difficult to treat, and little is known about optimal treatment strategies. We herein report the case of a 60-year-old man who demonstrated tuberculous empyema with a fistula. An air leak from a tuberculous cavity in his left upper lobe persisted for approximately 4 months; surgical repair could not be performed due to a poor physical status and undernourishment. However, the air leak was successfully treated with endobronchial occlusion using two silicone spigots in left B3b and B4, without any adverse effects or aggravation of the infection.

Unusual cause of chest pain: empyema necessitans and tubercular osteomyelitis of the rib in an immunocompetent man.

A 33-year-old man, born in India but resident in the UK for 5 years, presented to the emergency department with a 4-week history of a dry cough and right-sided pleuritic chest pain. He reported systemic features, including fever and unintentional weight loss. His medical history included vitamin D deficiency. He had travelled to India 10 months previously and denied any exposure to tuberculosis (TB). He was an ex-smoker with a 20 pack history. Respiratory examination confirmed decreased air entry of the right lower lobe and stony dullness on percussion. His C reactive protein was 178 mg/L. A chest radiograph identified a moderate-sized right-sided pleural effusion and destruction of the lateral aspect of the right fifth rib, strongly suggestive of underlying malignancy. Further investigation with a CT of the thorax identified a focal lytic lesion in the right fifth rib, at its lateral aspect, with expansion of the rib observed. Ultrasound-guided pleural aspiration confirmed an exudative pleural effusion. Gram stain revealed no organisms or polymorphs. Four days post admission, the patient was transferred to the regional thoracic surgery unit and underwent video-assisted thoracic surgery, bronchoscopy and drainage of his empyema. His Mantoux tuberculin skin test and his TB Elispot were negative, suggesting that TB infection was unlikely. Culture confirmed no growth after 48 h incubation. Histology of his pleural biopsy identified multiple non-confluent necrotising granulomatous inflammation with very occasional acid-alcohol-fast bacilli-like organisms, highly suspicious for mycobacterial infection. The isolate, Mycobacterium tuberculosis, was identified by Accuprobe and HAIN tests, respectively. MPT64 erythrocyte sedimentation rate (ESR) results from the fifth rib were positive for M. tuberculosis. This case report discusses the aetiology, clinical presentation and pathophysiology of both empyema necessitans and tubercular osteomyelitis of the rib.

Pleuropulmonary angiosarcoma involving the liver, the jejunum and the spine, developed from chronic tuberculosis pyothorax: Multidisciplinary approach and review of literature.

Pleuropulmonary angiosarcomas are very rare, with less than fifty cases reported in the literature. In most cases, the etiology is unknown but the presence of a chronic tuberculous pyothorax has been reported in several Asian case reports as a possible risk factor. We report the case of a Caucasian 68-year old man who presented with a pleuropulmonary angiosarcoma that arose from a chronic tuberculous pyothorax and which involved the ribs and the vertebrae, the psoas muscle, and the jejunum. The patient received adapted anti-tuberculosis treatment, embolization of the mass in the small bowel, palliative external beam radiotherapy on the spine and systemic chemotherapy with liposomal non-pegylated doxorubicin and ifosfamide. With this multidisciplinary approach the patient's symptoms were well controlled and he achieved a complete metabolic response after six cycles of chemotherapy. Unfortunately, the patient died after eight months from the beginning of chemotherapy due to an acute lung injury secondary to extensive bilateral interstitial infiltrates. Opportunistic pathogens or drug-induced lung toxicity were the most probable causes. Treatment with liposomal non-pegylated doxorubicin and ifosfamide could be a reasonable option in pleuropulmonary angiosarcoma but it should be validated in clinical trials. Chronic pyothorax seems to be a predisposing factor for the development of pleural angiosarcoma but further investigations are required to assess a causal association.

[A case of rapidly ruptured pericostal tuberculosis from calcified pleural mass].

A 25-year-old Chinese man with no medical history of pulmonary tuberculosis visited to a hospital for an evaluation of chest X-ray abnormal findings of routine health checkup. Chest computed tomography (CT) demonstrated chest wall mass surrounded by calcified walls in the right anterior chest wall. Eighteen months later, he found subcutaneous mass lesion in the right hypochondriac lesion, and this mass became painful in 5 days. Therefore he visited our hospital, and his chest CT showed low density mass with thickened calcified walls in the right anterior thoracic space, small amount of right pleural effusion and subcutaneous localized mass. A needle aspiration of the right subcutaneous mass demonstrated that the specimen were all negative for acid-fast bacilli smear, culture and PCR for M. tuberculosis. On the contrary, right pleural effusion showed positive for PCR for M. tuberculosis, in spite of negative results of acid-fast bacilli smear and culture. Pericostal tuberculosis that was progressed by the rupture of old calcified tuberculous empyema in the chest wall was confirmed. Antituberculous chemotherapy, chest tube drainage for right subcutaneous mass and pleural decortication and empyema were successfully performed. Pericostal tuberculosis should be differentially considered when the calcified mass in the chest wall changes its shape.