Spontaneous Pneumothorax in Tuberculosis

Abstract

PURPOSE: This study analyses spontaneous pneumothorax occuring in the natural evolution of lung tuberculosis, focusing on the main differences compared with other types of spontaneous pneumothorax.METHODS:We retrospectively analysed patients with spontaneous pneumothorax treated in our unit between 1985 and 2004 and selected patients with lung tuberculosis as the cause of intrapleural presence of air. Diagnosis of tuberculosis was based on history and radiological and CT aspect after lung reexpansion and confirmed by bacteriological studies and evolution after tuberculostatic treatment. Out of a total number of 272 patients with spontaneous tuberculosis, 67 had lung tuberculosis. The treatment protocol was based on immediate chest drainage, full tuberculostatic treatment and thoracotomy in case of prolonged air leaks and lack of reexpansion.RESULTS:There was a dramatically raise of incidence of spontaneous pneumotorax caused by lung tuberculosis. In the first years of our study, this entity was very rare (less than 3% of total number of pneumothoraces) but its incidence continuously growed to an almost 30% of total number of pneumotoraces in the last years. Al the parameters taken into consideration show a much more difficult evolution of these patients: prolonged air leaks and drainage, higher rate of complications, longer hospitalisation and later recovery.CONCLUSION:Spontaneous pneumothorax due to tuberculosis has a growing incidence, which paralells with the incidence of tuberculosis. These patients are very fragile and require a different approach compared with other types of pneumothorax.CLINICAL IMPLICATIONS:Considering the actual growing incidence of tuberculosis we expect also a raise of number of patients with spontaneous pneumothorax caused by this disease. Full recovery requires a specific complex medical and surgical treatment.DISCLOSURE:P.V. Botianu, None.