[An unusual mediastinal opacity]

Area of Science:

• Infectious Diseases
• Radiology
• Thoracic Surgery

Background:

• Tuberculosis (TB) can present with rare intrathoracic complications.
• Pott's disease, typically affecting the spine, can rupture into the mediastinum.
• Mediastinal abscesses pose diagnostic and therapeutic challenges.

Observation:

• A 36-year-old immunocompetent male presented with a posterior mediastinal bullous collection.
• Multifocal tuberculosis was diagnosed, with imaging suggesting a ruptured intrathoracic Pott's abscess.
• A probable esophageal fistula was also suspected.

Findings:

• Computed tomography (CT)-guided drainage successfully removed 600 cc of caseous material.
• The patient experienced a rapid clinical improvement post-drainage.
• Mediastinal fibrosis developed later, a known sequela of such infections.

Implications:

• Interventional radiology offers a minimally invasive approach for managing complex mediastinal collections.
• This case underscores the importance of considering unusual presentations of tuberculosis.
• The development of interventional radiology services in Dakar, Senegal, enhances the management of such rare conditions.