RT Journal Article SR Electronic T1 Late-breaking abstract: A case of miliary TB presenting with large pneumothorax JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP p2712 VO 38 IS Suppl 55 A1 Ashfaq Hussain YR 2011 UL http://erj.ersjournals.com/content/38/Suppl_55/p2712.abstract AB A 30y old male presented to A&E with sudden onset of right sided pleuritic chest pain and acutely SOB.Background: Previously fit and well, Asian, born in UK, no medical problems.Smoker 10-15 cigarettes, occasional use of alcohol, lives alone and work in a printing factory. No recent contact with ill person and no family history of lung diseases.He has been complaining of dry cough for last two months since he returned from holidays in Spain, but did not seek any medical advice. Denies any h/o weight loss, hemoptysis, fever or rigors.This time presented with sudden onset of sharp right sided pleuritic pain and could not breath, so brought to A&E.Examination/Investigations: On arrivals sats were 90%on 15l O2, tachypnic, RR30/m, clearly in respiratory distress and absent air entry on right lung, and enlarged right supraclavicular lymph node.Emergency chest X-ray was arranged which showed large (75%) R sided pneumothorex.An emergency chest drain was inserted after failed aspiration and repeat CXR showed good expansions of the right lung and patient was referred to the medical team.When seen by medical team his CXR showed reticulonodular changes on both lung fields, on top of the Pneumothorax, which was latter reported as pattern of miliary TB.A sputum sample was sent for AFB, had a CT head and lumber puncture done and there was no meningeal involvement. His HIV test came back as negative and was started on anti TB treatment and so far has been doing well and making good recovery.Learning point: Learning point was that military TB can present with pneumothorax and one should not focus on the main abnormality on CXR which was pneumothorax in this case, but also look for other abnormalities which may be relevant to the presentation.