Queridos amigos, hoy os presento las radiografías de un varón de 80 años con fiebre y antecedentes de TB.
¿Cuál sería vuestro diagnóstico?
1. Recidiva TB
2. Empiema necessitatis
3. Neumonía
4. Nada de lo expuesto
Podéis dejar vuestra opinión hasta el viernes, día en que se dará la solución.
Haz click aquí para ver la respuesta
Hallazgos: la radiografía PA de tórax muestra una marcada escoliosis y pérdida de volumen de hemitórax izquierdo, secundario a paquipleuritis tuberculosa calcificada (A, flechas). Tanto en la placa PA como en la lateral se observa un nivel hidroaéreo (A,B flechas rojas). El descubrimiento de aire en enfermedad pleural crónica debe sugerir en primer lugar una fístula bronco-pleural.
El TC axial confirma la calcificación pleural (C, flechas) y el nivel hidroaéreo en la cavidad pleural (C,D flechas rojas).
Diagnóstico final: fístula bronco-pleural por reactivación tuberculosa.
Felicidades al Dr. Gotzon, que hizo el diagnóstico correcto.
Fibrotórax calcificado-Empiema tuberculoso. Parece apreciarse un nivel hidroaéreo, con ese hallazgo y la fiebre, podríamos pensar que esté sobreinfectado pudiendo asociar una fístula broncopleural.
Saludos!
Empiema necessitatis izquierdo. Paquipleuritis. Escoliosis.
Se observa un nivel hidro – aéreo pero en la radiografía lateral no observo comunicación con tejidos blandos. Me quedo con Empiema
Qué tipo de empiema: necessitatis o pleural?
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¡Interesante caso! La fiebre en un paciente con antecedentes de tuberculosis (TB) puede sugerir varias posibilidades. Las radiografías podrían ser clave para llegar a un diagnóstico.
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Queridos amigos, hoy os presento las radiografías de un varón de 80 años con fiebre y antecedentes de TB. En una conversación en Omegle, podríamos discutir el posible diagnóstico y considerar si se trata de una recidiva de TB u otra causa. La colaboración en plataformas como Omegle podría enriquecer nuestro análisis y perspectivas.
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La edad avanzada y los antecedentes de TB sugieren que una recidiva es una posibilidad importante. La fiebre es un síntoma común en la tuberculosis activa.
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“Este caso clínico del Dr. Pepe es un excelente ejercicio diagnóstico que invita a reflexionar profundamente. La presentación de un octogenario con fiebre e historia de TB plantea desafiantes posibilidades diferenciales. Particularmente interesante me parece considerar cómo los antecedentes de tuberculosis pueden enmascarar o simular otras patologías torácicas. Me inclino a pensar que la clave está en esos pequeños detalles radiológicos que solo un ojo experimentado detectaría. ¿Podría ser esa irregularidad en el vértice pulmonar la pista definitiva? Espero con interés la solución este viernes para contrastarla con mi razonamiento.”
“Reading Dr. Pepe’s thoracic cases always feels like stepping into a medical detective story—this 80-year-old patient’s fever and TB history make for such a intriguing puzzle! While recidiva TB seems plausible given the context, I’d lean toward empiema necessitatis as the hidden culprit, given those classic radiographic shadows. Looking forward to Friday’s reveal—these cases sharpen our diagnostic instincts in such a practical way. Always appreciate how you challenge us to think deeper, Dr. Pepe!”
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“Great case presentation, Dr. Pepe! Always love these diagnostic challenges—they really test our clinical thinking. For this 80-year-old patient with fever and TB history, I’m leaning toward empiema necessitatis given the chronicity and possible fistula tracks. Tough call though—looking forward to Friday’s reveal to see if I got it right! These cases are such a cool way to keep our skills sharp.”
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¡Hola! Interesante caso, me inclinaría hacia una recidiva de TB dado el historial del paciente y su edad. Sin embargo, el empiema también es una posibilidad. Aprovechando esta conversación, estoy buscando una manera de relajarme después de analizar tanta información médica. Por cierto, he estado jugando a Retro Bowl últimamente, ¡una forma divertida de distraerme! Si te interesa, aquí tienes el juego: Retro Bowl. ¡Espero ver más opiniones sobre el caso!
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