A Comparison of Clinical and Radiographic Signs of Nontuberculous Mycobacterial Pulmonary Disease, Destructive Drug-Resistant Pulmonary Tuberculosis and a Combination of Nontuberculous Mycobacterium Pulmonary Disease and Pulmonary Tuberculosis.

A misdiagnosis of isolated pulmonary tuberculosis (pTB) is highly likely when a patient has nontuberculous mycobacterial pulmonary disease (NTMPD) or a combination of nontuberculous mycobacterium pulmonary disease and pulmonary tuberculosis. Frequently, bacterial excretion is absent or only Mycobacteria tuberculosis (MBT) is found. This often results in an incorrect diagnosis and subsequent misinformed treatment regimes. In order to determine possible clinical and radiographic differences between patients with NTMPD (Group 1), destructive drug-resistant pulmonary tuberculosis (Group 3) and a combination of NTMPD and pTB (Group 2) we compare clinical and radiographic signs for these three patient groups. When comparing with Group 3 (2.5%), Groups 1 (25%) and 2 (17.4%) have a substantially higher incidence of pulmonary haemorrhages. Thus, upon clinically observing the combination of pTB and NTMPD, there are no pathognomonic clinical and radiographic detected symptoms. However, the presence of an indolent course, hemoptysis and bronchiectasis in the presence of acid-fast bacteria (or identified MBT) in the sputum makes it possible to suspect not simple pTB, but a combination of pTB and NTMPD. To clarify this necessitated in-depth bacteriological examination.

Surgical treatment of bilateral vanishing lung syndrome: a case report.

BACKGROUND: Volume reduction surgery is a routine treatment method for lung emphysema in chronic obstructive pulmonary disease (COPD) patients. The formation of giant bullous emphysema is an indication for surgical bullectomy. Bilateral giant bullae severely compromise lung function and complicate surgical treatment. CASE PRESENTATION: We present the algorithm for surgical treatment and correction of complications in a 38-year-old male with bilateral giant bullae (vanishing lung syndrome), severe COPD. Primarily the patient was admitted with a mild cough, mucopurulent sputum and dyspnea. A CT scan revealed bilateral giant bullae, displacing up to 50% of lung volume. A two-stage surgical bullectomy was planned, yet postoperative complications due to secondary bullae rupture prompted urgent revision with contralateral bullae resection. After complete bullectomy, severely reduced lung volume was successfully managed throughout a long postoperative rehabilitation period. At 5 year follow-up, spirometry indicators and radiological examination show significantly improved and stable lung function. CONCLUSION: This clinical case demonstrates the technical difficulties and possible complications of extended bilateral lung resections in patients with severe vanishing lung syndrome. Single-stage treatment of bilateral giant bullous emphysema is recommended to minimize postoperative complications and reduce risk of bullae rupture. Positive long-term outcome outweighs possible complications of surgical treatment.

Extensive tracheal resection in lung cancer and tuberculosis: a case report.

BACKGROUND: Tracheal bifurcation resection remains the greatest challenge in airway reconstruction, especially with extensive lesions. Additionally, lung cancer and pulmonary tuberculosis comorbidity complicate the chemoradiotherapy treatment due to the TB reactivation. This case describes tracheal resection in a patient with both tuberculosis (TB) and lung cancer. CASE PRESENTATION: The patient was diagnosed with right lung tuberculosis and upper lobe cancer with trachea invasion complicated by hemoptysis. A right pneumonectomy with circular trachea bifurcation resection was performed. Radiotherapy and chemotherapy were not administered to avoid TB reactivation. At 5.5 years post-surgery, there was cancer recurrence that was treated with radiation therapy. At 10 years post-surgery, an invasive squamous-cell carcinoma of a three-segment bronchus on the left was revealed. Radiation therapy and a course of chemotherapy were carried out with almost complete tumor regression. CONCLUSIONS: TB presence should not serve as a basis for the refusal of cancer treatment. Combined treatment may be recommended when the main infection focus in the pulmonary parenchyma is removed during surgery.

Video-assisted thoracoplasty in pulmonary tuberculosis: a retrospective study.

BACKGROUND: The long history of the struggle against tuberculosis (TB) inspired us to develop a new minimally invasive technique of thoracoplasty with videothoracoscope control (VATP). The aim of this study was to determine its efficacy. METHODS: We conducted a retrospective single-center study of a cohort of patients operated on between 1999 and 2017. Two hundred eight patients who were indicated for thoracoplasty with verified TB with cavities in the upper lobe/S6 were enrolled in this study. Treatment outcomes were assessed based on Laserson criteria and active TB absence verified with CT. RESULTS: Intraoperative and postoperative complications were observed in 15 (7.2%) and 4 (2.0%) cases, respectively. There were no 30-day mortalities. VATP with curative intent succeeded in 88% of cases according to Laserson criteria and active TB absence verified with computed tomography (CT). Clinical improvement (sputum negativity, closure of caverna, and lack of reactivation for 3 years) was achieved in 81% of cases. CONCLUSIONS: Comparing the successful results of this technique in the cohort of multidrug-resistant (MDR) TB patients with the outcomes of treatment of MDR TB worldwide (77% vs. 55%, respectively), the VATP technique is shown to be efficacious and thus recommended. CLINICAL TRIAL REGISTRY NUMBER: ISRCTN67743278.

Single lung resection: The limits of the possible. Clinical report.

INTRODUCTION: Single lung resection remains a challenge due to the preservation of the respiratory reserve. This report presents that case of a female patient with bilateral fibrotic-cavitary pulmonary tuberculosis complicated with empyema on the right lung. Only 3.5 lung segments were left after a multistage surgery. PRESENTATION OF CASE: The first stage included draining of empyema and transsternal transmediastinal right main bronchus occlusion. Then, upper lobectomy with partial S6 resection of the left lung, followed by pleuropneumonectomy was performed. At a follow-up of two years and 10 months, patient's condition was good. DISCUSSION: Although single lung surgery has been possible over half a century ago, it remains a high-risk intervention. CONCLUSION: With the removal of the non-functioning parenchyma and elimination of the air/vascular shunt, single lung resection volume exceeding lobectomy is possible, which may improve cardiorespiratory function.

Case of Video-Assisted Thoracoplasty Application in Pulmonary Tuberculosis Treatment.

A patient with extensive fibrocavitary pulmonary tuberculosis and extensively drug-resistant Mycobacterium tuberculosis underwent bilateral video-assisted thoracic surgery thoracoplasty. An examination 4 years post-surgery revealed that the patient was in a satisfactory condition and able-bodied. We performed surgery according to our proposed video-assisted thoracic surgery thoracoplasty technique. In the postoperative period, we noted early patient symptoms, including significantly less-pronounced pain than with standard incisions, the absence of limitations in upper limb mobility, and the absence of gross chest deformation. Permanent surgical collapse sufficient for closing cavities and the elimination of bacilli were achieved and confirmed with a computed tomography scan.