CTICasesTuberculous Empyema with Trapped Lung
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Imaging findings
Chest radiograph shows a large right pleural effusion, appearing volume-neutral or slightly expansive. CT reveals smooth, very thick pleural thickening throughout the right hemithorax with a "split pleura" sign, indicative of empyema. After drain placement, some fluid was removed, but the patient developed trapped lung. AFB stain was initially negative, and culture took 22 days to grow, eventually confirming Mycobacterium tuberculosis.
Key takeaways
Tuberculous empyema can present with very thick, smooth pleural thickening and a split pleura sign, potentially more prominent than in other bacterial empyemas. Diagnosis can be delayed, as AFB stains may be negative and cultures can take weeks to grow. Trapped lung is a common sequela of chronic empyema. Clinical suspicion, especially in chronically ill patients with remote exposures, is important.
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