The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

Case Report Ind. J. Tub., 1992, 39, 49
ACUTE MASSIVE ATELECTASIS IN PULMONARY TUBERCULOSIS
R.P. Singh 1 , and S.K. Katiyar 2
(Received on 8.2.1991; Accepted on 4.5.1991)
Introduction
Atelectasis of the Jung in pulmonary
tuberculosis is fairly common. However, it is
usually not an acute and massive occurrence. Two
episodes of acute and massive atelectasis, of left
lung, occurring in cases of pulmonary
tuberculosis and both resolving with conservative
management are reported.
Clinical Reports
Case No. 1. N.D., a 42 year old female was
admitted for cough with mucoid sputum, pyrexia
and weight loss, of three months' duration. She
had developed heaviness in left chest and
breathlessness three days earlier. She was from
low socio-economic group and had not taken
anti-tuberculosis drugs before.
On examination, she was in unsatisfactory
health condition with gross weight loss, body
temperature 100° to 104°F, dyspnoeic, anaemic
and dehydrated. There was no cyanosis clubbing.
J.V.P. was not raised. Chest examination revealed
flattening and reduced movement with
mediastinal shift to left side. Percussion note was
dull on left side, breath sounds were absent on
the left side, except upper part and bilateral
rhonchi were audible. Cardio-vascular system was
normal.
Skiagram chest (Fig. 1) showed a dense
homogenous opacity occupying practically the
whole left hemithorax. Mediastinum was shifted
to the left side with contraction of the left
hemithorax. Blood test was within normal limits,
except ESR 56 mm/ first hour and Hb. 10gm%.
Sputum smear was positive for AFB. Culture of
sputum showed mixed organisms with
streptococci pneumoniae, strept. Viridans and
Neisseria Cattarhalis. She was put on
Streptomycin, Isoniazid, Rifampicin along with
Dexamethasone and Serratiopeptidase (Bidanzen
forte). Supportive treatment e.g. antibiotics,
bronchodilators, oxygen inhalation, cough
expectorant and I.V. fluid, was also given.
Bronchoscopy could not be done as patient
refused permission. The patient showed
significant clinical improvement after 72 hours.
The X-ray chest after 7 days showed partial lung
expansion and after three weeks complete
expansion (Fig. 2). The patient- is progressing
well,
Case No. 2. N.V., a 45 year old female school
teacher was admitted in a serious condition with
complaints of severe dyspnoea, cough with mucopurulent
sputum, high grade fever and heaviness
in left chest for two days. She had cough with
expectoration, frequent mild pyrexia, weight loss
and weakness for the last two months, for which
she took symptomatic treatment.
On examination, she was found to be acutely
ill with marked dyspnoea, cyanosis, body
temperature 103° to 104°F, pulse 120/minute,
B.P. 106/88 mm Hg. and dehydration. J.V.P. was
not raised and clubbing was absent. Chest
examination showed flattening and decreased
movement of left hemithorax with marked
mediastinal shift to left side. Dull note on
percussion and absent breath sounds with fine
crepitations were met with on left side. Bilateral
rhonchi were also heard. Other systems were
normal.
1, Reader; 2. Professor, Department of Tuberculosis and Chest Diseases, G.S.V.M. Medical College,
Kanpur-208 002.
Correspondence : Dr. R.P. Singh, D-25, Medical College, Kanpur-208 002.