Late complications of collapse therapy for pulmonary tuberculosis

Study objectives: Collapse therapy for pulmonary tuberculosis involved plac ement of various materials to occupy space and keep the lung collapsed. Com plications are encountered decades later. Patients and methods: Between 1980 and 1997, we treated 31 patients with a history of pulmonary tuberculosis in whom collapse therapy had been used an d who later developed complications related to their treatment. Pyogenic em pyema was present in 24 patients, pleural calcifications with bronchopleura l fistula was present in 3 patients, pleural calcification with nonresolvab le pneumothorax was present in I patient, and migration of a foreign body w ith formation of subcutaneous mass occurred in 3 patients. All patients wit h empyema were treated with antibiotics and tube drainage of pus. In additi on, Lucite balls were extracted in 4 patients, lung decortication was perfo rmed in 6 patients, thoracoplasty was performed in 2 patients, and fenestra tion was performed in 16 patients. Bronchopleural fistulas were closed with sutures and reinforced with intercostal muscle flap in three patients; in one patient with pleural calcification and nonresolvable pneumothorax, tube drainage was attempted. In three patients with subcutaneous mass due to pa raffin migration, paraffin was extracted. Results: Pulmonary decortication (six patients) and thoracoplasty (two pati ents) resulted in elimination of empyema. Extraction of Lucite balls result ed in lung expansion and elimination of empyema in three of four patients; draining sinus remains in one patient. Fenestration resulted in elimination of empyema in 12 of 16 patients, with 3 patients with residual draining si nuses and I patient with remaining empyema. All bronchopleural fistulas clo sed with intercostal muscle flap remained closed. Following extraction of p araffin blocks, infection developed in one patient. During the follow-up pe riod, three patients died, all of unrelated causes. Conclusions: Delayed complications of collapse therapy for tuberculosis sho uld be treated without delay. Pressure on adjacent structures or their eros ion presents danger and mandates immediate extraction; however, there is no need for routine removal of every residual plombe. Further increase in the number of multiple-drug resistant strains may force the return of collapse therapy.