Massive spontaneous pneumothorax with mediastinal shift in a 14-year-old with pulmonary tuberculosis: A case report

Spontaneous pneumothorax is a life-threatening complication of pulmonary tuberculosis (TB), particularly in endemic regions. Secondary spontaneous pneumothorax (SSP) occurs due to underlying lung pathology, such as cavitary lesions in TB. This case highlights the presentation, diagnosis, and management of SSP in a TB-endemic setting.

A 14-year-old male, presented with acute dyspnea, pleuritic chest pain, and a history of chronic cough and weight loss. Clinical examination revealed diminished breath sounds and hyperresonance on the left hemithorax. Imaging confirmed a massive left-sided pneumothorax with cavitary lesions. Sputum analysis confirmed Mycobacterium tuberculosis. Immediate chest tube insertion and antitubercular therapy (ATT) were initiated, resulting in clinical improvement.

SSP in TB patients is a rare but serious complication, often resulting from rupture of subpleural tuberculous cavities into the pleural space. Delayed diagnosis can lead to tension pneumothorax, respiratory failure, and increased mortality. Imaging, particularly chest X-ray and computed tomography (CT), plays a crucial role in diagnosis. Management includes prompt chest tube insertion for lung re-expansion and ATT to address the underlying TB infection. In resource-limited settings, where advanced surgical interventions such as pleurodesis and video-assisted thoracoscopic surgery (VATS) may not be readily available, early medical intervention remains the cornerstone of treatment.

This case underscores the importance of early recognition and management of SSP in TB patients, particularly in resource-limited settings. Prompt chest tube insertion and ATT are critical to preventing morbidity and mortality.