A cannonball through the chest: disseminated tuberculosis, threatening the aortic arch. Tunis Med 2014 Jan;92(1):34-7
Date
06/01/2014Pubmed ID
24879168Scopus ID
2-s2.0-84896892495 (requires institutional sign-in at Scopus site) 1 CitationAbstract
BACKGROUND: In 2012 the World Health Organization reported 8.7 million new cases of Tuberculosis worldwide, causing 1.4 million deaths (1). Despite modern drug therapy, this disease continues to present in novel ways and mimic other diseases causing misdiagnosis.
AIM: We report this case to educate on the reason to suspect atypical Tuberculosis presentation, even if a common disease is diagnosed, when Tuberculosis remains in the differential. We also demonstrate that with globalization and patient moving between countries, that these presentations can occur in locations, where such atypical manifestations are very uncommon.
CASE: We report on a 48 year old man with one month of malaise, fever, productive cough, night sweats, chills, pleuritic chest pain, weight loss and progressive non-painful swelling on his thorax. Initial diagnoses of interstitial pneumonia and a thoracic subcutaneous abscess were made. Needle drainage was attempted, with thick purulent material returned. When the sternum was not struck with the needle, a thoracic computed tomography scan was performed. A milliary pattern was noted in the lungs, with a large abscess present anteriorly, completely obliterating the manubrium, approaching the aorta with distant lesions. Subsequent analysis showed the material to be pan-sensitive M. Tuberculosis.
CONCLUSION: The issue that this case raises is that when tuberculosi is in the differential, even common diseases may in fact be atypical manifestations of tuberculosis. In addition, when a shallow surgical procedure is going to be performed on the thoracic soft tissues, particularly when tuberculosis is suspected, imaging of the thorax should be obtained.
Author List
Feldman HJ, Somai M, Dweck EMESH terms used to index this publication - Major topics in bold
AbscessAorta, Thoracic
Aortic Diseases
Diagnosis, Differential
Humans
Male
Middle Aged
Sternum
Thoracic Wall
Tomography, X-Ray Computed
Tuberculosis, Miliary
