Malang Respiratory Journal

Recurrent Pneumothorax in a Patient with Post-Tuberculosis Sequelae: A Case Report

Bagus Brama, Wayan Wahyu Semara Putra — Mon, 25 Mar 2024 00:00:00 +0000

Introduction: Tuberculosis and its complications could lead to a condition with a high mortality and morbidity in which those complications include hemoptysis, pleural effusions, post tubercular lung disease and spontaneous pneumothorax. Pneumothorax in one possible complication in pulmonary tuberculosis with an incidence rate up to 1.5%.

Case: A 46 years old man came to emergency room due to shortness of breath that had been felt since one week before and worsened after lifting some weight things 30 minutes prior the admission, the shortness of breath was described as heavy sensation whenever patient breaths, this complaint was accompanied by pain in the right lung, he has a history of lung tuberculosis and had completed his treatment, radiology examination showed right pneumothorax and later patient was hospitalized for a week with Water Seal Drainage (WSD) placed in his right lung. One month later, patient came back to emergency room with the same symptoms and was hospitalized again, but this time, pleurodesis was done.

Discussion: Tuberculosis causes damage to lung structure, and disturb its function leaving a sequelae and causing disability called post-tuberculosis lung disease (PTLD). Secondary spontaneous pneumothorax is pneumothorax that occurring in a setting of underlying lung disease. Patients with SSP tolerate pneumothorax less well and display heavier symptoms, even if the pneumothorax is relatively small in size.

Conclusions: The inflammation and fibrosis process on Tuberculosis infection leaves a sequelae damage and increased the vulnerability of someone lung’s that could lead to many complications such as pneumothorax.

Key words: Pneumothorax, Post-Tuberculosis Sequelae, Recurrent.

A Case Report : Thymoma Mimicking Teratoma Clinically and Radiographic Appearance

Mon, 25 Mar 2024 00:00:00 +0000

Background: Thymoma is a rare tumor of thymic epithelial cells in anterior mediastinum. The etiology of thymoma is not known with certainty. Thymomas are difficult to distinguish from teratomas or other mediastinal tumors. Diagnosis of thymoma or teratoma is based on clinical symptoms, CXR, Thorax CT Scan, biopsy for definite diagnosis, and requires IHC examinations to be able to differentiate it from other mediastinal tumors.

Case Presentation: A 62-year-old female, came with complaints of shortness of breath since 5 months when walking long distances accompanied by a dry cough for 1 week, and weight loss of 4 kgs in 10 months. Patient came from Lawang Hospital with results of AFP 1.59, B-HCG 3.8, CXR showed mediastinal mass, CT Scan Thorax showed solid mass with fat component and calcification in the right side of anterior mediastinum, suspected of a mature teratoma. Patient then underwent Tumor Excision Per Median Sternotomy by Cardiothoracic Surgeon on October 19, 2022, sampled a round tissue sized 7.5x7x6 cm with smooth surface, intact capsule likes teratoma.

Discussion: PA examination was performed, with result of Germ Cell Tumor, we continued with Calretinin, CD99, SMA, S100, and Melan A IHC examinations. The results of the last IHC examination found, Type A Thymoma Cells. Patient is currently stable and recommended for radiotherapy.

Conclusion: A patient with a thymoma mimicking a mature teratoma macroscopically and radiographically is an interesting case based on the results of thymoma type A from Immunohistochemistry examination but perform macroscopic likes teratoma.

Keywords: Thymoma, Teratoma, Clinically, Radiographic

Successful Autologous Blood Patch Pleurodesis: A Safe and Useful Treatment for Persistent Pneumothorax in Former Pulmonary Tuberculosis and Aspergillosis in Pregnant Women

Mon, 25 Mar 2024 00:00:00 +0000

Background: Autologous Blood Patch Pleurodesis (ABPP) is one of the treatment options for persistent pleural air leaks especially in patients who are not suitable for surgical intervention. Persistence pneumothorax is defined as pneumothorax of more than five days duration. It is associated with increased morbidity and cost of care. The most widely accepted treatment for it is pleurodesis. Several types of pleurodesis have been proposed, including surgical approaches and the instillation of different chemicals in the intrapleural space. ABPP has proven to be a simple, inexpensive, efficacious and safe method. We present the case of the first patient with Persistent Pneumothorax we have treated Successfully with ABPP. ABPP is currently rarely and uncommonly used, but it provides benefits especially in special conditions with easier, cheaper, and quite effective procedures.

Case: A female 35-year-old pregnant women patients with Former Tuberculosis (FTB) come to our hospital with complaints breathlessness and chest pain worsening since 3 days before admitted to our hospital. Chest radiography showed spontaneous pneumothorax with GeneXpert (GE) sputum Mtb Not Detected but there is Aspergillosis from Fungal Culture. Water Sealed Drainage (WSD) was inserted in right pleural for almost 1 month and this patient discharge with pneumostat. One month after that she come again with Persistence Pneumothotax, so that we do the pleurodesis with Blood Patch and get the improvement from clinical status. Antifungals are continued for an initial 4-6 weeks while an outpatient evaluation is conducted.

Conclusion: ABPP is a safe, inexpensive and efficacious treatment for persistent pleural air leak. Autologous Blood Patch administration may be considered for patients with Persistent Pneumothorax.

Case Report Recurrent Hemoptysis Post Re-Embolization in a 49 Year-Old Male with Post Tuberculosis Lung Disease (PTLD) and Bronchiectasis

Cindy Carrissa Primaputri, Suryanti Dwi Pratiwi, Ahmad Bayhaqi Nasir Aslam — Mon, 25 Mar 2024 00:00:00 +0000

Introduction: Hemoptysis is a symptom of lung disease, could be caused by lung infections, structural disorders of the lung, malignancy or disorders from outside of the lung. One of the pulmonary intervention for hemoptysis is embolization with a success rate > 70%, but the recurrence rate reaches 10-55%. The prognosis is poor depending on the amount of bleeding (untreated cases can have a mortality risk of over 50%), etiology and presence of recurrences.

Case Illustration: A 49-year-old Male came to the policlinic with recurrent hemoptysis for a year. Non-smoker. History of Lung Tuberculosis (TB), completed treatment 15 years ago. Imaging result showed widening of the right subcostal artery, right posterior intercostal artery, bronchiectasis, active lung tuberculosis and left pulmonary emphysema. First embolization was done during Anti-Tuberculosis Drug (ATD) treatment for 6 months. Symptom of hemoptysis reappeared, then second embolization and fiber optic bronchoscopy (FOB) was performed. From the evaluation, he was diagnosed with infected bronchiectasis and PTLD, therefore given antibiotic medications for 2 weeks.

Discussion: Embolization had been done twice in this case, no significant result. Based on literature, recurrent hemoptysis can still occur with a percentage about 10-55% after embolization and in this case, it might be caused by previous lung structural disorder and lung infections (Lung TB and Infected bronchiectasis).

Conclusion: Although embolization has a success rate of > 70% for hemoptysis treatment, recurrence can still occur and highly dependent on the cause itself and patient's previous lung condition.

Keywords: Hemoptysis, Embolization, Bronchiectasis, FOB, Lung TB, PTLD, ATD

Giant Intrapulmonary Mature Teratoma with Thoracostomy Intervention: A Rare Case Report

Mon, 25 Mar 2024 00:00:00 +0000

Background: Teratoma usually found in mediastinum and rarely found in the lung. Mature teratomas are the most common histological type of germ cell tumours, followed by seminoma. First case reported by Mohr in 1839 and until now only few cases of intrapulmonary teratomas have been reported.

Case: A man, 64-years old man, nonsmoker complains of shortness of breath since 6 months and worsened in a week. Patient had history medication for tuberculosis in 2019. Chest Contrast CT-Scan showed hypodense mass and suggestive for benign left lung tumor. TTNA were performed and suggestive for teratoma. Joint conference with several department agree to proceed with thoracostomy. Thoracostomy with wide excision been done to remove the mass and examined for anatomic pathology then confirmed for mature teratoma. During thoracostomy, we cannot removed 100% of the tumor because it adhesive with aorta and parietal pleura. Patient treated in ICU and worsens. Unfortunately, patient passed away four days later.

Conclusion: Teratoma is rarely found inside of the lung. Early diagnosis and resection of intrapulmonary teratoma is critical to prevent complications and provide definitive treatment.