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July 4, 1977

Severe Dyspnea in a Woman With Known Tuberculosis

JAMA. 1977;238(1):61-62. doi:10.1001/jama.1977.03280010061028

History  A 35-year-old woman presented with severe dyspnea, left shoulder pain, and a dry cough. There were dullness and decreased breath sounds over the left side of the chest posteriorly. Her illness had started one year ago with productive cough, a left lower lobe infiltrate, and positive sputum cultures for Mycobacterium tuberculosis. She had been receiving antituberculosis treatment. Figures 1 and 2 are recent posteroanterior and lateral teleroentgenograms.

Diagnosis  Atelectasis of the left lung due to complete occlusion of the left main bronchus, resulting from bronchial tuberculosis.

Comment  The chest roentgenograms (Fig 1 and 2) show a striking shift of the mediastinum to the left, narrowing of the left intercostal spaces, and elevation of the left hemidiaphragm. The right lung has herniated to the left, passing in front of the mediastinum. The bronchogram (Fig 3) demonstrates a totally occluded left main bronchus (arrows). The occluded bronchus is also visible on