Anjum Shahzad, Tahir Ramsha, Pathan Sameer A
Accident and Emergency Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Qatar Med J. 2015 Jul 2;2015(1):8. doi: 10.5339/qmj.2015.8. eCollection 2015.
Nontuberculous mycobacterial infection in an immunocompetent young patient complicated with empyema and pneumothorax is rarely reported. A 36-year-old man presented to the emergency department with a history of worsening dyspnea and pleuritic chest pain. The patient had unstable vital signs on presentation, and was referred to the resuscitation area on a monitored bed. The patient had a chest x-ray (CXR) performed on a prior occasion at a primary health clinic, revealing pneumothorax and some fluid at the left costophrenic angle. On arrival at the hospital, bedside ultrasound was performed which confirmed the diagnosis of pneumothorax. His vital signs were pulse 153, BP 88/62, RR 50 breaths per minute and his oxygen saturation on air was 92%. Tension pneumothorax was diagnosed based on clinical presentation and given vital signs. It was managed immediately with needle decompression followed by chest tube insertion. The patient improved dramatically after needle decompression with stabilization of vital signs. A CXR was repeated post-needle decompression which showed an incompletely resolved pneumothorax with an increase in the size of the effusion. Iatrogenic haemothorax was a possible explanation for this increase in effusion size. Chest tube was successfully inserted in the fourth intercostal space just anterior to the midaxillary line under full aseptic precautions. The chest tube drained 1.4 liters of blood, which on analysis showed a low pH and elevated adenosine deaminase level. Two out of three sputum samples sent from the medical ward were positive for mycobacteria other than tuberculosis as confirmed on culture. The patient's symptoms improved with percutaneous tube drainage of hemopneumothorax and antituberculous medications.
免疫功能正常的年轻患者发生非结核分枝杆菌感染并伴有脓胸和气胸的情况鲜有报道。一名36岁男性因呼吸困难加重和胸膜炎性胸痛病史就诊于急诊科。患者就诊时生命体征不稳定，被转至复苏区并安置在监测床上。该患者曾在一家基层医疗诊所进行过胸部X光检查（CXR），显示气胸以及左侧肋膈角有一些积液。入院时进行了床边超声检查，证实了气胸的诊断。他的生命体征为脉搏153次/分，血压88/62，呼吸频率50次/分钟，空气中的氧饱和度为92%。根据临床表现和生命体征诊断为张力性气胸。立即进行了针吸减压，随后插入胸腔引流管。针吸减压后患者生命体征稳定，病情显著改善。针吸减压后复查胸部X光显示气胸未完全缓解，积液量增加。医源性血胸可能是积液量增加的原因。在充分的无菌预防措施下，于腋中线前第四肋间成功插入胸腔引流管。胸腔引流管引出1.4升血液，分析显示pH值低且腺苷脱氨酶水平升高。从内科病房送检的三份痰标本中有两份经培养证实为非结核分枝杆菌阳性。经皮引流血气胸并给予抗结核药物治疗后，患者症状改善。
