Nontuberculous XXXX presenting as empyema and life threatening pneumothorax: A challenging situation in the emergency department.

@entity1 @entity662 @entity5229 @entity859 @entity1353 @entity26 @entity281 @entity2004 @entity378
Nontuberculous @entity281 in an immunocompetent young @entity1 complicated with @entity5229 is rarely reported. A 36-year-old @entity1 presented to the emergency department with a history of worsening @entity1353 and @entity662 . The @entity1 had unstable vital signs on presentation, and was referred to the resuscitation area on a monitored bed. The @entity1 had a chest x-ray (CXR) performed on a prior occasion at a primary health clinic, revealing pneumothorax and some fluid at the left costophrenic angle. On arrival at the hospital, bedside ultrasound was performed which confirmed the diagnosis of pneumothorax. His vital signs were pulse 153, BP 88/62, RR 50  breaths per minute and his @entity26 saturation on air was 92%. Tension pneumothorax was diagnosed based on clinical presentation and given vital signs. It was managed immediately with needle decompression followed by chest tube insertion. The @entity1 improved dramatically after needle decompression with stabilization of vital signs. A CXR was repeated post-needle decompression which showed an @entity5229 with an increase in the size of the effusion. Iatrogenic haemothorax was a possible explanation for this increase in effusion size. Chest tube was successfully inserted in the fourth intercostal space just anterior to the midaxillary line under full aseptic precautions. The chest tube drained 1.4  liters of blood, which on analysis showed a low pH and elevated @entity859 deaminase level. Two out of three sputum samples sent from the medical ward were positive for mycobacteria other than @entity378 as confirmed on culture. The @entity1 's symptoms improved with percutaneous tube @entity2004 and antituberculous medications.
