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Tuberculous empyema presenting as a persistent chest wall mass: case report.
Jennifer Madeo1, Rinal Patel2, Wondwossen Gebre3
1DO, PhD, Department of Medicine, Nassau University Medical Center, East Meadow, New York, USA.
Germs
|January 17, 2014
Summary
Empyema necessitatis, a chest wall infection often caused by tuberculosis (TB), presents a diagnostic challenge due to subtle symptoms. Early recognition and treatment are crucial for patient outcomes and public health, especially in TB-endemic areas.
Area of Science:
- Pulmonology
- Infectious Diseases
- Radiology
Background:
- Empyema necessitatis is an extension of pleural space infection into the chest wall.
- Tuberculosis is the most frequent etiology, affecting diverse patient populations.
- Delayed diagnosis is common due to insidious onset and nonspecific symptoms.
Observation:
- A rare case of pulmonary tuberculosis presenting as empyema necessitatis in a 72-year-old immigrant is detailed.
- The patient exhibited a chronic, painless chest wall swelling with minimal systemic signs.
- Diagnostic challenges included necrotic tissue on histopathology and negative acid-fast stains, yet positive sputum cultures for TB.
Findings:
- Sputum cultures confirmed tuberculosis despite negative initial histopathology and staining.
- Imaging was essential in identifying the empyema necessitatis.
- This case underscores the diagnostic difficulties associated with TB-related empyema necessitatis.
Implications:
- Highlights the critical need for high clinical suspicion for empyema necessitatis, particularly in endemic regions.
- Emphasizes the importance of considering tuberculosis in patients with unexplained chest wall masses.
- Timely diagnosis and intervention are vital to prevent severe morbidity and control TB transmission.
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