Sudden death due to tension pneumothorax associated with pulmonary tuberculosis
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Sudden death due to tension pneumothorax associated with pulmonary tuberculosis Go Inokuchi 1,2 & Fumiko Chiba 1,2 & Yohsuke Makino 1,2 & Shigeki Tsuneya 1,2 & Hirotaro Iwase 1,2 Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract A man in his seventies who lived alone was found dead in his home. Postmortem computed tomography (CT) performed prior to autopsy showed right-sided tension pneumothorax. Autopsy revealed an active pulmonary tuberculosis (TB) lesion. Macroscopic and histopathological findings showed pleural infiltration by TB lesions, suggesting that tension pneumothorax developed in association with TB infection. Routine postmortem CT performed prior to autopsy is useful in screening for TB because the presence of TB lesions can be confirmed from characteristic pulmonary findings. However, it may be difficult to identify tuberculous pulmonary lesions on CT if pneumothorax occurs and the lung collapses completely as in this case. Thus, forensic pathologists and radiologists should be cognizant of this rare complication of TB. Keywords Pulmonary tuberculosis . Tension pneumothorax . Postmortem computed tomography . Infection control
Introduction
Case report
According to a World Health Organization report, tuberculosis (TB) remains among the leading causes of death from a single infectious agent, with 10 million affected individuals and 1.5 million deaths worldwide in 2018 [1]. That same year, the number of newly registered TB patients in Japan decreased to 15,590 [2]. However, the prevalence of TB in Japan is still relatively high at 12.3 per 100,000 population [2] compared with low-endemic areas such as Europe and the United States, which have a TB prevalence of 10 or less per 100,000 population [1]. In recent years, the annual number of deaths due to TB in Japan has been about 2000 [2]. Thus, TB is a disease sometimes encountered in forensic autopsy and infection prevention measures are always required. In this report, we describe a rare case of sudden death due to tension pneumothorax associated with pulmonary TB infection.
A man in his seventies who lived alone was found lying on his back in his living room by a neighbor. An ambulance was requested, but on arrival, the emergency medical team noted that rigor mortis had already set in. No resuscitation measures such as chest compressions and artificial ventilation were performed, and death was confirmed. About a month before death, the decedent had become bedridden and the neighbor who found him had been taking care of him. He complained of poor physical condition immediately before his death, but it was unclear whether he had any respiratory symptoms such as a cough. He had been diagnosed with depression and prostatic hyperplasia a few years earlier but had no apparent medical history because he had not visited a hospital recently. He smoked, but the number of cigarettes he smoked per day was not known. Postmortem computed tomography (CT) was performed 1 day after the body
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