Inheritance from the past: Chronic calcific empyema

Abstract

Introduction: Fibrothorax, characterized by the widespread thickening of the pleura, can develop as a result of several disorders and can be seen as a consequence of empyema. After a very long latent period, reactivation or infection may occur. Hemothorax, empyema, asbestos exposure, and tuberculosis are frequent etiologies. This can occur frequently with bronchopleural fistula or pleurocutaneous fistula. In our article, we will present a case with a stable lesion containing fluid between calcified pleural sheets for many years, but a fistula has not yet developed, and recurrent hospital admissions with vague clinical findings. Case presentation: A 96-year-old man patient was admitted due to experiencing difficulty in breathing. He has been diagnosed with hypertension and heart failure and does not have a history of regular drug usage. According to his medical records, he had pulmonary tuberculosis around 65 years ago. He has been experiencing a chronic cough, expectoration of mucus, and dyspnea for approximately two decades. He received oral antibiotic treatments, but as his symptoms began to improve, he did not attend follow-up appointments. Upon reviewing the patient's past examinations, it was observed that thoracic CT scans conducted in 2010, 2022, and 2024 revealed the presence of pleural thickening, areas with fluid density, and calcifications in the right hemithorax. Additionally, areas with fluid density were consistently observed within the stable calcific mass lesion throughout this period. A close clinical monitoring protocol was instituted due to the patient's refusal to undergo thoracentesis, stable lung imaging for 14, and normal acute phase reactants and sputum cultures. Conclusion: In chronic calcified pleurisy, which is evaluated in favor of sequelae in patients with appropriate history and clinical findings, the etiology should be clarified by informing the patients, and treatment options should be evaluated without further degrading the patient's clinical.