Bilateral spontaneous Pneumothorax in Miliary Tuberculosis.

Pneumothorax is a common complication in pulmonary tuberculosis that is usually seen with underlying cavitary lesion. However, it is uncommonly seen in patients with miliary tuberculosis. This communication describes bilateral spontaneous pneumothorax in an 18 years’ old female patient having miliary tuberculosis.

Giant primary pulmonary fibrosarcoma.

A rare case of primary fibrosarcoma in a 48-year-old male is described who presented with a huge pulmonary mass on the left side. The diagnosis was established on fine needle aspiration cytology (FNAC) and percutaneous transthoracic lung biopsy, supported by immuno-histochemistry.

Clinical profile of patients having splenic involvement in tuberculosis.

Background: Tuberculosis of spleen is very rare, usually seen in disseminated or miliary form of the disease and in patients having HIV infection. Splenic tuberculosis is currently described poorly in available literature. Objectives: In this series, we analyzed the clinical profile of patients having splenic involvement in tuberculosis. Methods: Patients of tuberculosis (pulmonary and/or extra-pulmonary) with abnormal splenic parenchymal lesion on ultrasound were scanned in the light of demographic, clinical, radiological features, response to treatment and co-morbid illnesses. In selected eligible cases, CT scan abdomen and ultrasound guided FNAC of spelnic lesion was also done. Results: Most of the patients (62%) were in the age group of 25-50 years with male/female ratio of 3:1. Constitutional symptoms such as fever (75%), anorexia (50%), and weight loss (10%) were common presentations apart from other symptoms such as pain abdomen (62%) and distention (12%). Half of these patients also had HIV infection. 62% patients had associated pulmonary tuberculosis. Other body sites involved were ascites (50%), intraabdominal lymph nodes (37%), pleural effusion (37%), cervical lymph nodes (12%), intestine (12.5%), etc. Ultrasonographic findings were multiple splenic abscess (62%), multiple diffuse, hypo-echoic foci (25%), solitary abscess and calcified granuloma (6%). About 44% patients became asymptomatic after receiving Category I treatment under RNTCP with complete clearance of initial sonographic abnormality in splenic parenchyma. Conclusion: The splenic involvement in tuberculosis seems to be more frequent in patients with HIV infection and in disseminated form of disease. Ultrasonography of the spleen is simple, easily available, affordable, non-invasive, imaging technique highly useful for the diagnosis of splenic involvement in tuberculosis. The sonographic findings should be correlated with overall clinical presentation with demonstration of tuberculosis at other body sites and image guided FNAC may be considered in cases with isolated splenic involvement.

Tuberculosis of the middle ear with post auricular abscess.

A case of tuberculous otitis media with post auricular abscess is being described in a 14 year old female patient in view of its rare occurrence. The diagnosis was made on demonstration of acid fast bacilli (AFB) in the ear discharge and characteristic cytological features of post auricular abscess aspirate.

Recurrent haemoptysis following sildenafil administration.

Sildenafil is widely used in the treatment of male erectile disorder and is generally well-tolerated. Its adverse effects are reported to be mild and include flushing, headache, dyspepsia and visual disturbances. We document a case of recurrent haemoptysis observed soon after self administration of sildenafil in a 38-year-old male with no other causative factors. The episodes of haemoptysis stopped following stoppage of sildenafil.

Tuberculosis of oral cavity.

Tuberculous involvement of oral cavity is very rare. A 34-year-old male presented with non-healing ulcer at upper lip mucosa. Biopsy from ulcer revealed tuberculous lesion. He also had asymptomatic pulmonary tuberculosis diagnosed during work up for primary site of the disease.

Obstructive jaundice: a manifestation of pancreatic tuberculosis.

Tuberculosis of the pancreas is extremely rare and is most often associated with miliary tuberculosis or occurs in the immunocompromised patients. A case of isolated pancreatic tuberculosis in an immunocompetent patient is presented with constitutional symptoms and obstructive jaundice. Ultrasonography and computerised tomography showed a mass lesion in the head of pancreas. Histological examination of the peripancreatic lymph node and fine needle aspiration cytology from the head of pancreas confirmed the diagnosis following laparotomy. Patient recovered following the administration of antituberculosis chemotherapy.

Tuberculous abscess of rectus abdominis muscle.

Tuberculosis of skeletal muscle is very rare. A case of tuberculous abscess in rectus abdominis muscle is described in a seven year old male child. The patient presented with an abscess in the anterior abdominal wall, which subsequently ruptured. The diagnosis was made by histological examination of the excised tissue following local debridement.

Isolated tuberculous epididymo-orchitis.

Isolated epididymo-orchitis is an unusual presentation of tuberculosis. We report a case of bilateral epididymitis with right sided orchitis and scrotal involvement due to tuberculosis in a young male patient who had infertility. The diagnosis was suspected on ultrasonography of scrotum and confirmed by histological examination of scrotal and testicular tissue biopsy.

Intrapleural streptokinase in multiloculated malignant pleural effusion.

Intrapleural administration of fibrinolytic agents has been shown to be effective and safe in the treatment of loculated parapneumonic effusions. Its use in multiloculated malignant pleural effusions has been rarely reported. We report a case of malignant multiloculated pleural effusion who failed to respond to standard chest tube drainage but showed dramatic and complete resolution with intrapleural streptokinase.

Pneumomediastinum, pneumothorax and subcutaneous emphysema during radiotherapy in primary cavitating bronchogenic carcinoma.

An extremely rare case of cavitating large cell carcinoma lung is reported in a middle aged man who developed pneumomediastinum, pneumothorax and subcutaneous emphysema on thirteenth day of his tele cobalt radiotherapy to chest. Possible mechanisms of such complications during radiotherapy are also discussed.