Surgery for the sequelae of postprimary tuberculosis.

This review describes diagnosis and management of sequelae of post-primary tuberculosis. It addresses elementary lesions such as bronciectasis, fibrostenosis, cavitation and broncholithiasis, the more complex situation of destroyed lung, and complications such as aspergilloma, hemoptysis and broncho-esophageal fistula.

Late extrusion of pulmonary plombage outside the thoracic cavity.

Plombage, a variant of collapse therapy for patients with pulmonary tuberculosis that uses a variety of foreign materials, was undertaken until the 1950s before the invention of effective antimicrobial therapy. Complications related to previous plombage procedures are not uncommon. Management of these complications can be challenging. We report a patient presenting with extrusion of plombage 59 years later and managed successfully with removal of the plomb and pectoral muscle flap transposition.

Expanding hematoma after extraperiosteal paraffin plombage.

PURPOSE: The development of a chronic expanding hematoma after paraffin plombage has not yet been reported because the procedure was performed only at a limited number of institutes during the short period before the development of antituberculous drugs. We herein report eight patients with chronic expanding hematoma several decades after undergoing extraperiosteal paraffin plombage. METHODS: We reviewed eight surgically treated patients with chronic expanding hematoma after undergoing extraperiosteal paraffin plombage. RESULTS: Swelling of the plombage space was shown in a chest roentgenogarm and a contrast-enhanced computed tomographic scan as an expanding inhomogeneous mass with subcapsular enhancements. The patient symptoms included a chest or axillary tumor in three patients, and shoulder pain in two, while three were asymptomatic prior to radiological evidence of disease progression. No tuberculous bacillus was detected on microbacterial examination. Both the paraffin and hematomas were removed. The average operative bleeding was 161 ml. One patient underwent muscle transposition for postoperative infection of the residual space. Following the operation, seven patients remained free from the disease and one had hematoma recurrence 9 years later, which was again removed. CONCLUSION: A chronic expanding hematoma following extraperiosteal paraffin plombage is a rare complication. However, this disease should be considered when a patient who has undergone paraffin plombage presents with late complications.

Vocal fold palsy due to plombage for tuberculosis.

A 67-year-old patient, who had previously undergone Lucite ball plombage for pulmonary tuberculosis, presented with a hoarse voice, intermittent stridor and breathlessness. Direct laryngoscopy confirmed a left vocal fold palsy. A left supraclavicular mass became apparent and a computerized tomograph (CT) scan showed that a Lucite ball had migrated into her supraclavicular fossa. Subsequently she developed left arm pain and weakness. The balls were removed surgically, following which her arm symptoms improved but her voice remained unchanged. Migration of implanted material should be considered when new symptoms appear in patients who have undergone plombage treatment.

Late reactivation of tuberculosis in an oleothorax.

The injection of oil into the pleural cavity was a widely used treatment of pulmonary tuberculosis until the advent of effective anti-tuberculous therapy. Long-term complications of oleothorax can occur when the oil is not removed. The authors present an unusual complication of oleothorax, reactivation of tuberculosis, 54 years after oil instillation.

Late complications of collapse therapy for pulmonary tuberculosis.

STUDY OBJECTIVES: Collapse therapy for pulmonary tuberculosis involved placement of various materials to occupy space and keep the lung collapsed. Complications 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 and who later developed complications related to their treatment. Pyogenic empyema was present in 24 patients, pleural calcifications with bronchopleural fistula was present in 3 patients, pleural calcification with nonresolvable pneumothorax was present in 1 patient, and migration of a foreign body with formation of subcutaneous mass occurred in 3 patients. All patients with empyema were treated with antibiotics and tube drainage of pus. In addition, Lucite balls were extracted in 4 patients, lung decortication was performed in 6 patients, thoracoplasty was performed in 2 patients, and fenestration 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 paraffin migration, paraffin was extracted. RESULTS: Pulmonary decortication (six patients) and thoracoplasty (two patients) resulted in elimination of empyema. Extraction of Lucite balls resulted 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 sinuses and 1 patient with remaining empyema. All bronchopleural fistulas closed with intercostal muscle flap remained closed. Following extraction of paraffin blocks, infection developed in one patient. During the follow-up period, three patients died, all of unrelated causes. CONCLUSIONS: Delayed complications of collapse therapy for tuberculosis should be treated without delay. Pressure on adjacent structures or their erosion 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.

[Primary pleural lymphoma after collapse therapy: modern aspects of an historic disease]. / Lymphomes pleuraux primitifs après collapsothérapie: aspects modernes d'une maladie historique.

INTRODUCTION: Pleural lymphomas after long standing pyothorax due to pulmonary tuberculosis are now well identified. Most cases have been described by Japanese investigators and it seems rare or unrecognised in Western countries. We report the study of six cases observed in a single institution. PATIENTS AND METHODS: Six pyothorax-associated pleural lymphomas, among 1,038 lymphoma (0.6%) collected during a period from 1989 to 1998, are described. Diagnosis was established by two pathologists with the usual histologic and immunohistochemical methods, according to the working formulation. The in situ hybridization method for Epstein-Barr virus was performed. RESULTS: The average age of the patient was 73 years. Presenting symptoms combined chest pain and constitutional symptoms more than 45 years after artificial pneumothorax or tuberculous pleuritis. Computerized tomography revealed a pleural mass which involved the adjacent chest wall. Open biopsy by thoracotomy show a diffuse B-cell non-Hodgkin-lymphoma in all cases. Though the lymphoma was initially localized, many poor prognostic factors (age, performance status, LDH, histology) explain the pejorative evolution (average survival of five months). Patients died from an uncontrolled tumoral proliferation or by infectious complications. In situ hybridization confirms the presence of Epstein-Barr virus in tumoral cells. CONCLUSION: Pleural lymphoma is an established complication of artificial pneumothorax. Even if the Epstein-Barr virus plays a crucial role in the pathogenesis, and despite the number of artificial pneumothorax operations that have been widely performed, this lymphoma remains rare, suggesting additional oncogenic factors.

Fatty infiltration of osseous structures: a long-term complication of oleothorax--case report.

Thoracic imaging of a patient treated for pulmonary tuberculosis with oleothorax therapy before the antibiotic era demonstrated a rare complication. Gross invasion by lipid with subsequent pathologic fracture of the adjacent thoracic vertebra may give rise to symptomatic spinal cord compression. Magnetic resonance imaging is a useful modality for help in diagnosing treatment complications of oleothorax.