Pyo-pneumothorax in patients with active pulmonary tuberculosis: an analysis of 17 cases without intrapleural fibrinolytic treatment

To review the medical records of patients with active pulmonary tuberculosis [TB] and pyo-pneumothorax [PPT]. Medical records of 17 patients [14 male, 3 female, mean age 23.8 years, range 20-52] with PPT and active pulmonary tuberculosis at Gulhane Military Medical Academia Haydarpasa Training Hospital, Istanbul, Turkey, were reviewed from January 1998 to December 2002. The patients were treated with chest tube drainage and chemotherapy. Intrapleural fibrinolytic agents or irrigation was not performed. Pleural fluid samples were available in 14 patients and the mean levels of LDH, protein and glucose in the pleural fluid were 1,767 +/- 944 U/l, 5.2 +/- 1.4g/dl and 31.7 +/- 22.6 mg/dl, respectively. Mycobacterium tuberculosis was detected in the pleural effusion of 3 patients. The duration of chest tube drainage was longer in cases who underwent open drainage [p = 0.014]. At the end of the treatment period 10 patients developed pleural thickening, 4 of them underwent decortication and pneumonectomy was also done in 1 patient. The development of pleural thickening was related to the level of pleural fluid glucose [p = 0.04]. This study shows that while taking care of patients with pulmonary TB the physician must be aware of the complication of PPT and that adequate chemotherapy and drainage must be duly performed