Right-sided pneumothorax in a patient with chronic obstructive pulmonary disease and tuberculosis-affected left lung: a case report

Introduction: A spontaneous pneumothorax occurring in a patient with underlying lung pathology is classified as a secondary spontaneous pneumothorax (SSP). Its main cause is the chronic obstructive pulmonary disease (COPD), more rarely - a tuberculosis infection (TB). Untreated TB could lead to carnification of a part or the whole lung.Case report: A 35-year-old female patient was admitted with complaints of sudden right chest pain and severe dyspnea. The physical examination showed retracted and deformed left chest part, missing breathing sounds in the left and weakened breathing in the right. Chest CT revealed partial right-sided pneumothorax, bullous changes of the right lung and carnification of the whole left lung. Right thoracocentesis was performed. The postoperative period was uneventful. The chest drain was removed on the fifth day. After more detailed examinations the patient was diagnosed with COPD and TB and was transferred to the Department of Pulmonology and Phthisiatry for further treatment.Conclusion: In a patient who has two advanced and complicated lung diseases at the same time (COPD and TB), a spontaneous pneumothorax, even partial, is a life-threatening condition and requires special consideration and urgent therapeutic measures

A primary echinococcosis of the extrahepatic bile ducts: case report

Introducere. Echinococoza continuă sa fie endemică în Bulgaria. Cea mai frecventă formă este cea hepatică. Prezentare de caz. Noi raportăm un caz rar de echinococoză primară a căilor biliare extrahepatice la o pacientă de 70 de ani, cu anamnestic de febră înaltă, icter, greaţă, vomă și durere în etajul superior al abdomenului, pe parcursul a 10 zile. A fost descoperit un chist hidatic complicat, de dimensiuni mari, în lobul stâng al ficatului, fără comunicare cu arborele biliar. S-a efectuat explorarea căilor biliare, capitonarea chistului hepatic, colecistectomie și coledoco-duodenostomie. Nu a fost înregistrată nicio complicaţie. Discuţii. Echinococoza primară a căilor extrahepatice este foarte rară. Cazul nostru este al doilea, descris în Bulgaria. Tratamentul patologiei depinde de stadiu, localizare, dimensiune și de complicaţiile chistului. Concluzii. Tratamentul chirurgical și terapia postoperatorie cu albendazol rămân a fi cele mai bune opţiuni terapeutice.Introduction. Echinococcosis is still endemic in Bulgaria. The most common site of the hydatid cysts is the liver. Case presentation. We report on a rare case of a primary echinococcosis of the extrahepatic bile ducts in a 70 years old female patient with history of high fever, jaundice, nausea, vomiting and pain in the upper abdomen lasting for 10 days. We found a big complicated hydatid cyst in the left liver lobe without communication with the bile tree. Exploration of the bile ducts, capitonnage of the liver cyst, cholecystectomy and choledocho-duodenostomy were performed. We didn’t have any complications. Discussion. A primary echinococcosis of the extrahepatic bile ducts is very rare. Our case was the second of the kind described in Bulgaria. The treatment of the disease depends on the stage, the localization, the size and the complications of the cysts. Conclusions. Surgical treatment and postoperative therapy with albendazole remain the best treatment options

Spontaneous perforation of the bladder in a patient operated for a lung abscess: a case report

We present a rare case of a spontaneous perforation of the bladder in a female patient who underwent thoracic operation. A 45 year-old female patient with no other comorbidities was admitted to the department of thoracic and abdominal surgery of University hospital “Sveti Georgi” with clinical, laboratory and image findings of right lung abscess. A right thoracotomy was performed, a large lung abscess was found and upper right bilobectomy was performed. On the day of her discharge she complained of a sudden abdominal pain, ballooning of the abdomen, nausea and vomiting. The ultrasonography showed a free fluid in the peritoneal cavity. An urgent laparotomy was performed, a perforation of the bladder was found, resection of the necrotic part of the wall and two layer suture of the bladder were performed by urologist. Postoperatively, we had multiple complications. Tuberculosis was considered as one of the most likely diagnosis but was subsequently rejected. The patient was discharged after 70 days of hospital stay in a good health condition