Squamous Cell Lung Cancer Complicating a Tuberculous Fibrothorax

An 82-year-old man had worsening breathlessness, chronic cough, low-grade fever, and weight loss. Chest computed tomography (CT) revealed a round mass in the right lower lobe containing nonhomogeneous fluid, contiguous with extensive calcified fibrothorax. When the patient was 25 years old, he had had pulmonary tuberculosis and undergone artificial right pneumothorax. Chronic tuberculous empyema and lung cancer were considered in the differential diagnosis. Although made difficult by the thickened and calcified pleura, ultrasound-guided puncture allowed for extraction of a small amount of liquid. No evidence of mycobacteria or their genetic material was found. Positron emission tomography (PET) showed intense glucose uptake in the peripheral part of the lesion in the right lower lobe. Subsequent CT-guided percutaneous biopsy and histological examination revealed squamous cell carcinoma. No abnormal 18-fluorodeoxyglucose (FDG) accumulation was found in other parts of the body. After evaluation of the performance status and performance of pulmonary function tests, the thoracic surgeon explained the risks of surgery to the patient, who chose stereotactic body radiation therapy (SBRT). This chapter deals with the possible late sequelae and complications of tuberculosis occurring even after successful treatment. These include abnormalities of the lung parenchyma, pleura, airways, mediastinum, and chest wall. The chapter provides details of malignancies associated with chronic empyema and fibrothorax and radiological findings that help distinguish pleural lesions from peripheral pulmonary lesions.