[Surgical bronchial torsion as a method of collapse therapy].
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In a retrospective study of 15 patients who were treated with collapse therapy for pulmonary tuberculosis on an average 30 years previously, we found 16 instances of exudation in the residual pocket: four were sterile and without fistula, ten had bronchial fistulae, one had an esophageal fistula, and one was a tuberculous empyema without fistula. Among the 11 exudations with bronchial or esophageal fistulae, none contained tubercle bacilli, six were infected with pyogenic microorganisms, and five remained sterile. In 12 cases, the diagnosis was suggested by chest x-ray film. Four of nine exudates which remained sterile and three of the seven infected ones could be stabilized by conservative measures; the others required a decortication, sometimes with parenchymal resection. This study shows that in late exudative complications of old collapse therapy, an initial conservative treatment can be curative in about 45 percent of the cases.
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Bronchopleural fistula (BPF) is a late complication of collapse therapy for pulmonary tuberculosis which usually develops several decades after the procedure. A characteristic finding in the chest radiogram is a pleural hydroaerial level, which suggests the diagnosis when associated with gravitational chocolate-like sputum. As the treatment of these patients is difficult, we think it is appropriate that they should be controlled in a primary care setting by periodical radiological studies (posteroanterior chest radiograms) which may permit early detection of the condition so as to establish specific therapy.
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