RESUMO
Empyema necessitans (EN) is a rare long-term sequela of poorly or untreated empyema thoracis, characterized by the dissection of pus through the soft tissues and skin of the chest wall, ultimately forming a fistula between skin and pleural cavity. We herein present a male patient in his late 30s, a known case of tuberculosis (TB) on anti-tubercular therapy (ATT) under directly observed treatment short-course (DOTS), who recently came with complaints of backache for 3 days. Chest X-ray showed a massive pleural effusion, in view of which an intercostal drainage tube (ICD) was inserted and 1.5 L of pleural fluid was drained. An ultrasound (USG) back done revealed subcutaneous collection with communication to pleural space, which resolved after pleural fluid drainage. As there was a persistent communication between pleural space and right-sided subcutaneous plane with a massive effusion i.e., EN, he was advised to undergo thoracotomy with decortication and resection of communication which he underwent successfully. This case is presented for its rarity with atypical presentation.
RESUMO
Empty Sella syndrome is an uncommon condition characterized by the shrinking or flattening of the pituitary gland, resulting in the filling of the Sella turcica with cerebrospinal fluid rather than the normal pituitary gland. In this report, we present a case of undiagnosed partial empty Sella syndrome, which was found to be caused by pituitary hypophysitis with an idiopathic etiology. The patient, a middle-aged individual, presented atypically with acute adrenal insufficiency induced by a lower respiratory tract infection. The diagnosis was made following an investigative work-up that took into consideration the presence of hypotension, electrolyte imbalances, and a history of two post-partum lactational failures. Hormonal supplements were used to manage the patient conservatively, and no significant complications were observed.
RESUMO
Empty Sella syndrome is an uncommon condition characterized by the shrinking or flattening of the pituitary gland, resulting in the filling of the Sella turcica with cerebrospinal fluid rather than the normal pituitary gland. In this report, we present a case of undiagnosed partial empty Sella syndrome, which was found to be caused by pituitary hypophysitis with an idiopathic etiology. The patient, a middle-aged individual, presented atypically with acute adrenal insufficiency induced by a lower respiratory tract infection. The diagnosis was made following an investigative work-up that took into consideration the presence of hypotension, electrolyte imbalances, and a history of two post-partum lactational failures. Hormonal supplements were used to manage the patient conservatively, and no significant complications were observed.