On the face of it, symptoms such as fever and shortness of breath may not be perceived as life threatening by the common public. After all, sometimes, something as innocuous as bronchitis (inflammation of airways) can present with these symptoms. However, for Mr. Joseph (name changed for confidentiality), an Indian expat in his 40s, a timely visit to the doctor proved to be a life saver. He presented with these complaints to a local clinic, where he was diagnosed with bronchitis and symptomatic medications were prescribed. As symptoms worsened over the following days, he was referred to International Modern Hospital (IMH) where he was diagnosed with left pleural effusion (a clinical condition in which there is abnormal accumulation of fluid between the lungs and the chest wall).
Dr.Saheer Sainalabdeen, Pulmonologist at the IMH hospital explained that on detailed evaluation, apart from fluid between the lung and the chest wall, there was a tear in the patient’s oesophagus (food pipe). To ensure the best possible outcome, a multidisciplinary treatment plan was formulated by a team of specialists i.e. Pulmonologist, Internist, Gastroenterologist and Intensivist. Gastroscopy (a study in which internal side of the food pipe and stomach is visualized) confirmed the perforation in the oesophagus. As part of the treatment,Joseph was advised against oral food intake along with other supportive measures were instituted as well. To find out the cause of the pleural effusion, Dr.Rohit Kumar conducted an advanced endoscopic procedure called Medical Thoracoscopy to visualize the lungs and pleura (covering of the lungs). Thoracoscopy showed features of infection in the lung–pleural cavity and biopsies were obtained from the pleura. Pulmonary tuberculosis was diagnosed in the tissue sample obtained from pleura, patient was started on anti-tuberculosis treatment and a good clinical recovery was observed during the follow up period.
Dr.Saheerand Dr. Anil Grover (Specialist Internal Medicine) explained that the patient had tuberculosis of the lung-mediastinal glands which eroded into the oesophagus causing the perforation. If not diagnosed timely, the rate of sepsis, multi-organ failure and death secondary to oesophageal perforation is more than 50%, as per the available scientific literature. Dr. Rohit Kumar, Medical Director, Head of surgery & emergency at IMH, states that the Thoracoscopy procedure, which very few surgeons perform in this part of the world, helped in early diagnosis and treatment forthe disease in this case.Hence, a major surgery was avoided through early intervention via keyhole.“The course of this particular case demonstrates how critical a multi-disciplinary approach can be from the patient’s perspective. It ensures that all possibilities are looked into and that the best possible care is being delivered by specialized practitioners based on facts of this case” stated Dr. Kishan Pakkal, CEO of International Modern Hospital.