Internal Medicine Images

Remembering the tragedy

Óscar Mateo Pardo-Rodríguez, Humberto Carlo Parra-Bonilla • Bogotá, D.C. (Colombia)

Dr. Oscar Mateo Pardo-Rodríguez: Médico Cirujano Universidad Nacional de Colombia, Médico Hospitalario Servicio de Cirugía General E.S.E. Hospital Universitario La Samaritana; Dr. Humberto Carlo Parra-Bonilla. Médico Internista Pontificia Universidad Javeriana. Médico Internista E.S.E. Hospital Universitaio La Samaritana Bogotá. Especialista en Epidemiología Colegio Mayor de Nuestra Señora del Rosario. Bogotá D.C. (Colombia).

Correspondence: Dr. Oscar Mateo Pardo-Rodríguez. Bogotá, D.C. (Colombia). E-mail:

Received: 15/VII/2019 Accepted: 11/II/2020


A 69-year-old male with high blood pressure, 50% LVEF heart failure, oxygen-dependent chronic obstructive pulmonary disease, a heavy smoking history and treated pulmonary tuberculosis was admitted to the emergency room due to mMRC 4/4 dyspnea, productive cough with yellow sputum, non-quantified fever, and diminished breath sounds. A chest x-ray showed left-sided diffuse heterogenous radiopacity and a high-resolution CT revealed left fibrothorax.

Fibrothorax is defined as the sequela of intense pleural inflammation, causing thickening and fibrosis (1, 2). Transforming growth factor-beta (TGF-|3) plays the most important role (3). It occurs most often as a complication of empyema and hemothorax, but also in pulmonary tuberculosis, connective tissue diseases, uremia, paragonimiasis, radiation therapy, asbestosis and with medications such as ergot alkaloids (2-4). It is diagnosed by imaging. Treatment may be pharmacological, using systemic corticosteroids, or surgical with decortication (2, 5). It has been associated with lung cancer (6).


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2. Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Broaddus CV, Mason RJ, Ernst JD, King TE Jr, Lazarus SC, Murray JF, Nadel JA, Slutsky A, Gotway M, editors. Murray & Nadel's textbook of respiratory medicine, 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:1439-1460

3. Michael A. Jantz, Veena B. Antony, Pleural Fibrosis. Clinics in Chest Medicine, Volume 27, Issue 2, 181-19

4. Nachiappan, A . Et Al. Pulmonary Tuberculosis: Role of Radiology in Diagnosis and Management. RadioGraphics 2017; 37:52-72. Jan-Feb, 2017

5. Hanane, Asri H & Zegmout, A. Historic sequelae of lung tuberculosis. Pan African Medical Journal. 2018;30:210. June, 2018.

6. Xu H, Koo HJ, Lee HN, Lim S, Lee JW, Choi CM, Kim MY. Lung Cancer in Patients With Tuberculous Fibrothorax and Empyema: Computed Tomography and 18F-Fluorodeoxyglucose Positron Emission Tomography Findings. Journal Comput Assist Tomogr. 2017 Sep/Oct;41(5):772-778.