Breaking Free: Managing Trapped Lung in Tubercular Empyema

Tuberculosis (TB) remains a significant global health concern, particularly in high-burden countries. Pleural involvement, such as pleural thickening and trapped lung, is a common complication of tuberculous empyema, often leading to respiratory compromise and reduced quality of life. In this case report, a 58-year-old male farmer presented with progressive breathlessness and orthopnea, indicative of pleural pathology. Diagnostic thoracocentesis confirmed an exudative effusion positive for Mycobacterium tuberculosis complex using the cartridge-based nucleic acid amplification test (CBNAAT), which is a molecular test that can detect M. tuberculosis in two hours only. Prompt initiation of anti-TB therapy (anti-Koch's treatment (AKT)) and intercostal drain insertion were performed to manage the tuberculous empyema. Imaging studies revealed pleural thickening and trapped lung, necessitating further intervention. The patient underwent lung decortication, involving extensive removal of fibrous pleural tissue, which resulted in symptomatic improvement. After the procedure, the patient successfully weaned off mechanical ventilation and achieved near-complete resolution over time. This case highlights the effective management of pleural thickening and trapped lung resulting from tuberculous empyema. The timely initiation of AKT, along with interventional procedures like lung decortication, can lead to significant improvement in symptoms and quality of life for patients with TB-related pleural complications. By addressing these complications promptly, healthcare providers can mitigate disability-adjusted life years (DALYs) associated with TB, particularly in regions with a high burden of the disease.