Sudden death due to tension pneumothorax associated with pulmonary tuberculosis

A man in his seventies who lived alone was found dead in his home. Postmortem computed tomography (CT) performed prior to autopsy showed right-sided tension pneumothorax. Autopsy revealed an active pulmonary tuberculosis (TB) lesion. Macroscopic and histopathological findings showed pleural infiltration by TB lesions, suggesting that tension pneumothorax developed in association with TB infection. Routine postmortem CT performed prior to autopsy is useful in screening for TB because the presence of TB lesions can be confirmed from characteristic pulmonary findings. However, it may be difficult to identify tuberculous pulmonary lesions on CT if pneumothorax occurs and the lung collapses completely as in this case. Thus, forensic pathologists and radiologists should be cognizant of this rare complication of TB.