Abstract
IntroductionPleural effusion is common in patient with coronary artery bypass grafting (CABG) usually due to heart failure in preoperative and trauma of surgery in postoperative patient. Tuberculous Pleural effusion is most common form of extra pulmonary Tuberculosis. Preoperatively Tuberculous pleural effusion in CABG patients has rarely been described in literature.Presentation of caseA 62 years old gentleman with ischemic heart disease was admitted for coronary artery bypass grafting surgery. Preoperative workup showed left sided pleural. Intraoperatively left sided turbid yellowish colour effusion with loculation was noted while harvesting left internal mammary artery. Loculation were broken down, effusion was drained and tissues were sent for microbiology and histopathology. CABG was performed smoothly. Microbiology of pleural tissue revealed Mycobacterium tuberculosis while histopathology showed chronic granulomatous inflammation. Patient was started on antituberculous therapy and remained well six months postoperatively.ConclusionIn developing countries even without any constitutional symptoms of Tuberculosis high index of suspicion for Tuberculosis should be made for patient with pleural effusion especially in cases of cardiac surgery as to prevent morbidity and mortality.
Highlights
Pleural effusion is common in patient with coronary artery bypass grafting (CABG) usually due to heart failure in preoperative and trauma of surgery in postoperative patient
The following case report has been reported from Our University Hospital which is an internationally recognized teaching hospital and a tertiary care center based in Pakistan, in accordance with the SCARE guidelines for case reports [1]
Tuberculous pleural effusion (TPE) results from Mycobacterium tuberculosis infection of the pleura and is characterized by an intense chronic accumulation of fluid and inflammatory cells in pleural space2; resulting in significant morbidity and mortality
Summary
The following case report has been reported from Our University Hospital which is an internationally recognized teaching hospital and a tertiary care center based in Pakistan, in accordance with the SCARE guidelines for case reports [1]. Tuberculous pleural effusion (TPE) is the most common form of extra pulmonary tuberculosis [3]. TPE results from Mycobacterium tuberculosis infection of the pleura and is characterized by an intense chronic accumulation of fluid and inflammatory cells in pleural space; resulting in significant morbidity and mortality. Pleural effusion is common in patient with coronary artery bypass grafting (CABG) usually due to heart failure in preoperative [4] and trauma of surgery in postoperative patient [5]. In majority of CABG patients preoperative pleural effusion is not analyzed as its mostly consider to be due to heart failure but timely recognition of such patient with infection especially chronic infection can prevent significant morbidity and mortality. We report a case of 62 years old gentleman who came to us for CABG with left sided pleural effusion that turned out to be Tuberculosis
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