DRAMATIC IMPROVEMENT OF ADULT PATIENTS WITH POST-TB PULMONARY PNEUMATOCELE AND BAD PULMONARY FUNCTION AFTER SURGICAL INTERVENTION

Abstract

TYPE: Late Breaking Case Report TOPIC: Cardiothoracic Surgery INTRODUCTION: Pulmonary pneumatoceles (PCs) are thin walled air-filled cysts that develop within pulmonary parenchyma. PCs are developed after infection,or trauma. PCs caused as a complication of Staphylococcus pneumonia, and are more frequently in infants and children. Adult tuberculous pulmonary pneumatoceles are seldom [1]. PCs are asymptomatic. Large PCs may compress adjacent lung with mediastinal shift causing cardiopulmonary symptoms [2]. Surgical intervention is indicated when PCs cause cardiopulmonary compromise or rupture into the pleural space or unresolved infection [3]. CASE PRESENTATION: 60-years female patient presented by dry cough and shortness of breath (SOB). She was on corticosteroid therapy as treatment of bronchial asthma. She had history of resolved pulmonary TB. Clinical examination revealed diminished air entry . CXR showed translucent zone. CT with contrast showed large PC occupying >2/3 of hemithorax with mediastinal shift. During operation, rupture of PC by diathermy to avoid its over-inflation during ventilation , and wedge resection with fistula site repair through uniportal VATS.Closure of thoracotomy was performed as a routine with two ICT. Postoperative CXR revealed full inflated lung . They discharged with smooth postoperative course. DISCUSSION: PC in adult can occur during or after anti-TB treatment [3]. there was a history of resolved TB. Urgent surgery indicated in complicated PC (infection, tension, rupture). [6]. VATS procedure performed to PC excision and repair. CONCLUSIONS: Surgical excision of symptomatic complicated pulmonary pneumatocele with mini approach after well preparation gives marvelous improvement of respiratory condition. DISCLOSURE: Nothing to declare. KEYWORD: Pulmonary Pneumatocele, Pulmonary Tuberculosis, Fungal Ball, Cardiopulmonary Compromise.