Pulmonary Medicine, KS Hegde Medical Academy, Deralakkate, Mangaluru, Karnataka, India.
Pulmonary Medicine, KS Hegde Medical Academy, Deralakkate, Mangaluru, Karnataka, India
BMJ Case Rep. 2024 Sep 12;17(9):e259049. doi: 10.1136/bcr-2023-259049.
A man in his early 50s with previously treated pulmonary tuberculosis (TB) presented with a 3-month history of cough, expectoration and progressive breathlessness, accompanied by significant weight loss. Examination revealed tachycardia, tachypnoea, hypoxaemia and unilateral diminished breath sounds. Investigations showed anaemia, leucocytosis and a homogeneous opacity on the left side of the CXR. ECG and echocardiography suggested pulmonary thromboembolism (PTE). A CT pulmonary angiogram confirmed a chronic embolus and a severely fibrosed left lung. A comprehensive thrombophilia workup yielded normal results and the PTE was attributed to his history of TB. Sputum analysis confirmed reactivated TB, leading to the initiation of antitubercular therapy. The patient improved clinically with plans for a repeat CT pulmonary angiography to assess the need for pulmonary thromboendarterectomy after completing TB treatment. This case highlights the possible association of TB and PTE, its management and why it should be considered as a differential diagnosis in patients with a history of TB presenting with exacerbated breathlessness.
一位 50 多岁的男性，患有既往治疗过的肺结核（TB），出现了 3 个月的咳嗽、咳痰和进行性呼吸困难，伴有明显的体重减轻。检查发现心动过速、呼吸急促、低氧血症和单侧呼吸音减弱。检查显示贫血、白细胞增多和 CXR 左侧均匀不透明。心电图和超声心动图提示肺血栓栓塞症（PTE）。CT 肺动脉造影证实为慢性栓塞，左肺严重纤维化。全面的血栓形成倾向检查结果正常，PTE 归因于他的 TB 病史。痰分析证实复发性 TB，开始抗结核治疗。患者的临床状况有所改善，计划在完成 TB 治疗后重复进行 CT 肺动脉造影，以评估是否需要进行肺动脉血栓内膜切除术。本病例强调了 TB 和 PTE 之间可能存在的关联，其治疗方法以及为什么在有 TB 病史的患者出现呼吸困难加重时应将其作为鉴别诊断。
