PNEUMOTHORAX IN ACTIVE PULMONARY TUBERCULOSIS - RESURGENCE OF AN OLD COMPLICATION

With the recent resurgence of tuberculosis (TB) in western countries, the incidence of complicating secondary pneumothorax has also increase d. The work-up and management of this complication differs from that i n other types of secondary spontaneous pneumothorax (SSP). Our objecti ve was to assess clinical features and therapeutic modalities of SSP i n patients with and without active pulmonary tuberculosis (APTB). All patients diagnosed with SSP seen at the Hospital Xeral of Vigo from Ja nuary 1990 to June 1995 were candidates for this study. Full clinical, radiological and microbiological examinations were performed in all p atients. Invasive procedures (thoracic catheter aspiration, thoracosco py and thoracotomy) and mean hospital stay were compared in patients w ith and without APTB. Forty-eight patients with SSP were enrolled. Ele ven patients (10 males and one female, mean age 30 +/- 11 years) had A PTB; and 37 patients (31 males and six females, mean age 49 +/- 20 yea rs) had conditions other than APTB. Chest pain, cough and fever were m ore frequent in patients with APTB (90% vs 59%; 45% vs 13.5%; 36% vs 5 %, respectively). Catheter aspiration was successful in three of 10 (3 0%) of patients with APTB and in 15/23 (60.86%) of those without APTB. Catheter aspiration time was longer in the former group (25 +/- 22 da ys vs 13 +/- 11 days, P = 0.17). As initial treatment, thoracoscopy wa s performed in seven of 37 (18.91%) of those without APTB and in one o f 10 (10%,) patients with APTB. For patients with unsuccessful cathete r aspiration, thoracoscopy was performed in eight of nine (89%) patien ts without APTB and in none of the patients with APTB. Thoracotomy was performed in only one of nine (11%) without APTB and in four of seven (57%) patients with APTB. Patients with APTB had a longer hospitaliza tion (41 vs 18 days, P < 0.001). We concluded that SSP and APTB was a frequent association in our study. Patients with APTB showed a lesser and slower response to catheter aspiration. Despite severe clinical pr esentation and demand for more invasive procedures, patients with APTB showed a favourable response.