A Rare Case of Tubercular Pyo–Pneumothorax Herniating through the Inter-Costal Drainage Site
Peter George1, Maroli Roshan2, Swapna Ponmaleri Koroth3
1 Associate Professor,Department of Medicine, Father Muller Medical College, Mangalore – 575002, India.
2 Professor,Department of Medicine, Father Muller Medical College, Mangalore – 575002, India.
3 Assistant Professor,Department of Medicine, Father Muller Medical College, Mangalore – 575002, India.
Name, Address, E-Mail Id of The Corresponding Author: Dr Peter George, Associate Professor, Department of Medicine, Father Muller Medical College, Father Muller Road, Mangalore, Karnataka, India.
Phone: +91-9845177660, +91-824 2238000 Fax: +91-824 2436352
E-mail: drpetergeorge2002@yahoo.com
A 53 year old diabetic male, who was on anti – tubercular treatment, presented with an expansile swelling on his chest, at the intercostal drainage (ICD) site. He was diagnosed to have a left sided tubercular hydro – pneumothorax, about six weeks earlier. He had noticed the swelling at the ICD site, 5 days ago and he had no pain. Clinically, an expansile swelling of size 5 x 4 cm, was seen at the 6th ICS, in the mid axillary line, which was partially reducible, with palpable crepitations [Table/Fig-1]. The left hemi – thorax showed reduced movements and breath sounds. Contrast enhanced computer tomographic (CECT) images of thorax showed left upper lobe consolidation, with cavities and a hydro – pneumothorax. The left pleural space was seen to extend through the dehiscence on lateral chest wall, forming an air – filled subcutaneous swelling. [Table/Fig-2]. Anti-tubercular therapy was continued and a fresh ICD was inserted at the lower intercostal space, which drained the purulent fluid. After a week, repair and layered suturing was done at the site of dehiscence. The wounds approximated and healed over the next 3 – 4 weeks. A pyo-pneumothorax which is caused by tuberculosis is common in endemic areas [1]. There is one report in the literature on herniation of an emphysematous bulla through an ICD site [2]. However, herniation of a pyo-pneumothorax through a closed ICD site was not found in our literature review.
Serial photographs demonstrating an expansile swelling with expiratory and inspiratory movements in left infra axillary area(marked with black arrows)
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Transverse and coronal images by CECT of thorax showing pleural space extending through the left lateral chest wall dehiscence forming an air-filled subcutaneous swelling(marked with white arrows)
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