Bilateral secondary spontaneous

pneumothorax
secondary to Miliary kochs
• 21 young male
• weight loss ,occasional fever x 1 month
• Radiologically – miliary nodules +
• Planned for TBCB for histopathological
diagnosis
• Tbcb done
• Uneventful TBCB
Gene expert TB
HPE

Started on ATT
After 1 week,

Presented to ER with complains of sudden

onset Breathing difficulty, dry cough,chest pain
on the right side

Tachypnoeic, respiratory distress +

Decreased air entry on the right side

Cxr
• ICD placed . Post procedure CXR revealed
expanded Lungs.
• CXR

• Patient got discharged.

On follow up, patient was reviewed in ER.

Air leak was not seen, coloumn movement +

So planned for removal

ICD was Clamped, serial cxr were monitored for

airleak
• No air leak was confirmed
• ICD was removed.

• Post removal, discharged

• After 1 hr patient of discharge
• Patient Presented to ER with shortness of breath,
dry cough, chest pain since 30 minutes after
climbing stairs 1 floor.
• TACHYPNOEA +, RESP DISTRESS +
• AIRENTRY REDUCED RT SIDE.
• HEMODYNAMICALLY UNSTABLE
• Chest X ray taken on an urgent basis – which
revealed – right sided pneumothorax
CXR
• In view of hemodynamical instability and
severe respiratory distress needle
decompression done under SAP
• ICD placed under strict aseptic precautions
• cxr
• . Post procedure chest X ray revealed – partly
unexpended lungs
• connected to ATRIUM with minimal negative
suction
• chest X ray repeated which revealed expended
lungs
• Patient wanted to go on DAMA
• Again developed resp distress despite on ICD
rt side.
• tachycardia with desaturation
• revealed reduced airentry on the left side
• CXR repeated- revealed Left sided
Pneumothorax
• ICD placed under strict aseptic precautions

• POST ICD CXR

• connected to atrium and negative suction

cxr
• patient showed persistant fevers
• chest x ray revealed worsening opacities
• ANTICIPATED ? PCP ? RESISTANT TB
• BRONCHOSCOPY DONE – normal study
Genexpert rif sensitive +
PCP negative
Rest of the reports were inconclusive
Genexpert tb & pcp report
• Bilateral thoracoscopic pleurodesis was
planned
• the same was explained to attenders and
family members
• He was shifted to OT
• he was desaturating to 60 % on isolation of rt
lung ad 77% on the isolation of left lung
• procedure was abandoned as the patient
could not tolerate
• adviced for further stay in hospital
• DAMA to medical college
• Patient already finished completed 4 weeks
ATT
• AS PER ID team opinion
COLLISTIN, MEROPENEM continued

Despite on medications, fevers were persistant

Blood cultures were sent which revealed

Burkholderia sensitive to meropenem and
Bactrim
• BACTRIM DS AND MEROPENEM were
continued along with ATT
• Collistin was stopped
• Patient was continued on negative suction as
there was partly unexpanded lungs on both
sides
• In view of ……….on CXR
• HRCT chest revealed……….
•