A 26-year-old female was referred to us for evaluation of severe left sided chest pain of 1-month duration. A review of her records revealed that she had received directly observed therapy (WHO Category 1) for sputum positive pulmonary TB and had been declared cured 6 months prior to presentation. On examination, general physical examination was normal. Respiratory system examination revealed volume loss and absent breath sounds over left hemithorax suggestive of left lung collapse/fibrothorax. Sputum for AFB was negative.
Chest radiogram showed complete collapse of left lung with ipsilateral mediastinal shift (Figure 2(a)). CT of the thorax confirmed the chest radiographic findings (Figures 2(b) and 2(c)). A review of the patient's pretreatment chest X ray showed presence of left sided miliary shadows but no evidence of lung collapse (Figure 2(d)).
In view of lung collapse occurring after successful treatment of TB, bronchoscopy was undertaken to rule out endobronchial obstruction. Bronchoscopy showed complete occlusion of left main bronchus with only a pinhole sized opening (Figures 2(e) and 2(f)). Bronchoalveolar lavage was negative for AFB on staining and on culture. Endobronchial biopsy showed chronic inflammation with no granulomas. As the left main bronchus was completely cicatrized, the patient was unsuitable for stenting. A diagnosis of left main bronchostenosis secondary to tuberculosis was made and the patient was referred to the cardiothoracic surgeon for bronchial reconstruction/bronchoplasty. However, the patient declined to undergo any surgical procedure.