THORACOSCOPIC FINDINGS IN SPONTANEOUS PNEUMOTHORAX IN AIDS

Six patients with the acquired immunodeficiency syndrome (AIDS) who su ffered eight spontaneous pneumothoraces between January 1990 and Janua ry 1993 underwent videothoracoscopy. The predominant macroscopic findi ngs, found in four patients on five occasions, were white-yellow nodul es dispersed throughout the lung surface. In addition, in one patient, these lesions were associated with multiple small apical bullae and, in another, a large reddish nodule with several smaller white satellit e nodules was noted on the parietal pleura. Methenamine silver stain o f biopsy samples of both the visceral and parietal nodules in these pa tients showed the presence of Pneumocystis carinii. May-Grunwald-Giems a stain of brushing samples of visceral lesions revealed P-carinii in two patients. In one of these patients, previously performed bronchoal veolar lavage (BAL) had not yielded P-carinii. On two occasions, the t horacoscopic findings were unremarkable, although in one of these pati ents, computed tomography (CT) had shown a large thick-walled cyst nea r the left hilum and BAL revealed P-carinii. Talc poudrage through the thoracoscopic cannula followed by chest tube drainage was performed i n all patients and was successful in treating three of five with prove d P-carinii pneumonia-related pneumothorax. The etiology of pneumothor ax in AIDS and the diagnostic and therapeutic utility of videothoracos copy in these patients are discussed.