A case for diagnosis - (a)

    This patient was 32 year old. He is a businessman and has two dogs in his farm. He came with cough and right-sided chest pain. Generally he was looking ill with low grade evening fever. He had mild degree of dyspnea. ECG was normal.

    Right hemithorax is retracted and the chest movement is restricted on the same side. There was generalized dullness over the right lung and no air entry is detected.

Urgent chest x-ray was done (see  pict.)

what do u think the possible diagnosis ?

The x-ray findings (click here)

What investigations done in Rashid Hospital :


Rigid bronchoscopy was performed:
1- Normal left bronchus tree
    2- Stretched right main bronchus
    3- No blue light reflection from bronchoscope.

CT scan chest was done ( see the picture and findings )

What was done in Rashid Hospital:
    1- Trial of USS guided aspiration with canula  gauge No.18-----> Failed
        cause: very thick fibrous tissues

Surgical intervention:

    No body expect future expansion of this lung and per-operative consent was taken for right pneumopnectomy.
    Because of extensive fibrous adhesions, the hilum of the lung was difficult to expose. A decision was taken to cancel the procedure.

Operative specimen investigations:
        Parietal pleura was sent for:
1- AFB
            2- Microbiology
            3- histopathology

        Fluid sample was sent for:
            1- AFB
            2- Microbiology
            3- cytology

Results of operative specimen investigations:

        1- AFB +++ ve in tissue
        2- AFB +ve in fluid
        3- Histopathology: Auramin stain ----- TB pleurisy
4- No evidence of malignancy

Post operative treatment:

One of patient's relatives was a football trainer. He made him make full physiotherapy for 6 months

Chest x-ray after 6 months (see pic.)  showed: