A tuberculous pyothorax case which was very difficult to discriminate from chronic expanding hematoma

The case was a 62-year-old male, whose chief complaint was pain in his back behind his chest which gradually worsened from August 1996. Introduction to this hospital was on October 1st, of the following year. A large tumor shadow was recognized in the left middle to lower area of the lung by a chest X-ray. Also by a CT scan of the chest, in the same location as with the X-ray, a sharp shadow of a large tumor was recognized. Although it was suspected as being a worsening case of pyothorax or a tumor within the thorax, diagnosis was not confirmed, but on October 20, 1997, the extra-pleural pneumonectomy was made to diagnose as well as treat the case. According to the postoperative pathologic diagnosis, it was a case of psoriasis pyothorax caused by tuberculous pleurisy. This case had taken 42 years, an extremely long time to manifest with symptoms, as well as having had tuberculous pleurisy in his medical history. It is also similar with results obtained for CEH tests. When CEH becomes chronical, symptoms become noticeable. Pathologically, bleeding lesions were not recognized in this case, but clinical indications were that it was a special type of CEH.