[A case of solitary tuberculosis in lower lung field showing marked pleural indentation complicated with chronic renal failure with special reference to mechanism of of formation of pleural retraction].
A case of 62-year-old male patient with tuberculosis in the lower lung field of right side was reported. The case showed a solitary lesion in S8b of 2.5 x 2.0 cm in size and was detected by the mass survey. The case was complicated with chronic renal failure and was treated by lobectomy because of suspicion of lung cancer, as there was a marked pleural indentation on CT. By examining the resected specimen, the following findings were revealed. The solitary exudative tuberculous lesion located in the margin of the basal segment extended both to the costal and diaphragmatic pleura, and a small triangular shaped normal lung parenchyma located at the periphery of the lesion was isolated, and the air flow from the lower lobar bronchus was cut. As a result, hyperinflation of the isolated normal lung took place through collateral air leak and check-valve mechanism (The Culiner Theory), finally the pleural constriction was formed at the boundary between the lesion where the elasticity was lost and the hyperinflated parenchyma.
Hirata
S
S
Third Department of Surgery, University of Tokyo, Japan.
Yamamoto
K
K
D006801:Humans; D016867:Immunocompromised Host; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011013:Pneumonectomy; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000473:pathology / Q000601:surgery