Right pulmonary arterial thrombus in a patient with tuberculous destroyed lung syndrome: computed tomography angiographic findings and a case report.

Abstract

Tuberculous destroyed lung syndrome (TDLS) is termed as total lung destruction from recurrent and chronic infections especially tuberculosis (TB). TDLS is almost an entity seen in adults and very rare in children. Pulmonary TB been a chronic infectious disease induces a systemic hypercoagulable state that causes pulmonary thromboembolism. This is a forty-year-old man been managed for pulmonary TB, presented from a peripheral health facility and came for a chest computed tomography angiography (CTA) on account of suspected thromboembolism. The CTA demonstrated a non-enhancing tubular structure/filling defect within the right pulmonary artery consistent with a thrombus. This measured about 51mm x 18mm in craniocaudal and mediolateral dimension. The thrombus is demonstrated to have caused dilatation and blockage of the right pulmonary artery. There is associated extensive destructive interstitial lung fibrosis bilaterally with air containing spaces consistent with the destroyed lung disease. Bilateral pleural thickening with turbid pleural effusion were also demonstrated bilaterally. A drainage tube was also noted within the right pleural space. A diagnosis of right pulmonary artery thrombus in a patient with tuberculous destroyed lung syndrome was made. The patient is currently on combined multi-drug therapy for pulmonary tuberculosis (rifampicin, isoniazid, ethambutol and pyrazinamide) and anticoagulant therapy with heparin to achieve anticoagulation. We present this case of pulmonary arterial thrombus coexisting with tuberculous destroyed lung syndrome due to its rare occurrence.