Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis

It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis [EPTB] compared to those of pulmonary tuberculosis [PTB] among adult immunocompetent patients. A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period [2007-2012]. Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. Of the 372 patients, 227 [61%] were males and 168 [45.2%] had EPTB; 204 [54.8%] patients had PTB. The most frequent sites of EPTB were the lymph nodes [n = 45, 12.1%], pleura [n = 40, 10.7%] and brain [n = 7, 1.8%]. The most common symptoms were cough [n = 174, 46.7%], night sweats [n = 127, 34.1%] and fever [n = 123, 33%]. Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guerin vaccination [odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001]. Eighty-one [48.2%] of the EPTB and 146 [71.6%] of the PTB patients were males. Pulmonary involvement was more common among men [n = 146, 71.6%] than among women [n = 58, 28.2%; p = 0.000]. There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB

rare bronchopulmonary malformation in adulthood: bronchial atresia

Bronchial atresia is a congenital anomaly characterized by focal obliteration of a part of the bronchus, which causes an accumulation of secretions and a bronchocele with absence of ventilation of the corresponding distal pulmonary area which is seen radiologically as hyperlucent. Approximately 50% of the patients are asymptomatic at the time of diagnosis, and this condition is more frequent in men than in women [ratio 2:1], and usually affects young people. Chest computed tomography is diagnostic, and makes it possible to differentiate between congenital anomalies, bronchiectasias and other types of bronchial obstruction. Treatment of asymptomatic patients is conservative, and surgery is only necessary if there should be symptoms such as recurrent respiratory infections, chronic cough or dyspnea. Herein we report a case of asymptomatic bronchial atresia with radiological features and differential diagnosis

Embolization of ruptured hepatic hydatid cyst to pulmonary artery in an elderly patient. Multidetector computed tomography findings

Pulmonary embolism due to hydatid disease is an unusual condition resulting from the rupture of a hydatic heart cyst or the opening of liver hydatidosis into the venous circulation. A 78-year old male patient complaining of dyspnea, cough and severe chest pain was admitted to our emergency department. A multidetector computed tomography of the chest revealed the presence of multiple nodules in both lungs especially in left and multiple hypodense filling defect in left main pulmonary artery and its branches. In addition, coronal reformatted multidetector computed tomography images also showed two hypodense cystic parenchymal masses on the left lobe of the liver with a cystic embolus in the right atrium. Pulmonary embolism should be kept in mind in patients who have hepatic hydatidosis if suddenly chest pain and dyspnoea occurs, especially in regions where hydatidosis is endemic