Neither the diagnistics nor treatment for nontuberculous mycobacterial (NTMB) pulmonary disease (NTNPD) are well investigated, with NTNPD and pulmonary tuberculosis (pTB) in combination especially requiring careful future evaluation. Bearing this in mind, joint X-Ray and CT examination permits the diagnosis of both conditions by determining pulmonary pathology and can therefore play a key role in the analysis of the patient's condition.

Material and methods. A 39-year-old man with a 5-year pulmonary tuberculosis history was admitted to our hospital. The final diagnosis was NTMPD in combination with tuberculosis of the right lung, which is complicated by tuberculosis empyema on the right side. MBT(+) NTMB(+).The patient additionally had drug resistance to streptomycin. On admission, he complained of a cough with muco-purulent sputum of up to 150ml per day, shortness of breath on a background of little physical activity. A destroyed right lung and pleural empyema are visualized from a CT scan. Multifocal nodes and pneumofibrosis are similarly observed in the left lung.

Results. The patient’s condition and diagnosis necessitated a  pleuropneumonectomy.  Surgerical complications developed on the 12th day after surgery. These were a bronchopleural fistula and pleural empyema in the right hemythorax. Accordingly, thoracocentesis and pleural draining  were performed. Three months after the first operation, thoracomyoplasty on the right side was performed to eliminate the empyema cavity. A month after this thoracomyoplasty, a significant improvement was observed on X-Ray image: the right hemithorax was homogenously darkened, there were no signs of a broncho-pleural fistula. Additionally, on the left there was a partial resorption of the foci.

Discussion. This clinical case illustrates the importance of radiological examinations when evaluating the patient's condition and establishing the necessity for surgery intervention in patients with nontuberculous mycobacterial disease and tuberculosis in combination. Furthermore, these diagnostic tools permit the detection of surgical complications and allow for improved assessment of treatment and recovery. 

Conclusion. Multispiral computed tomography of the lungs is the standard diagnostic method for lung lesions, including the rare combination of nontuberculous mycobacterial pulmonary disease and tuberculosis. Despite X-ray examination methods not allowing a differentiation for their respective pathologies within the lungs, they are indispensable in assessing the prevalence of any existing pathology and determining subsequent  treatment options.