Diffuse diseases may be inflammatory or infectious in etiology as in fibrothorax, or neoplastic (Figure 11), either primary or metastatic.
A fibrothorax is classically unilateral and represents the sequela of remote infection or trauma.
The indication for thoracotomy was an excess tube thoracostomy output in 51% of cases; other indications included shock, cardiac tamponade, rupture of a main bronchus, diaphragmatic rupture and fibrothorax.
Complications included 3 cases of adult respiratory distress syndrome, 4 cases of consumption coagulopathy, 36 cases of secondary bleeding that required either thoracotomy (N=26) or repeated thoracocentesis (N=10), 2 cases of empyema thoracis, 1 case of fibrothorax, 2 cases of sub-cutaneous emphysema, and 1 case of wrong placement of the thoracic tube which was discovered to be sub-cutaneous (the tube was replaced).
A late complication of a moderate or large haemothorax is the fibrothorax
, which is characterised by gradual deposition of a thick layer of fibrous tissue on the visceral pleura (Heffner et al 1995).
Delay in treatment causes various complications like empyema necessitatis, septicemia, brain abscess, amyloidosis, bronchiectasis, fibrothorax
, respiratory failure and death.
CT scan may be required to establish the degree of under development and to differentiate hypoplasia from other conditions that may closely mimic it radiographically: atelectasis from other causes, severe bronchiectasis with collapse and advanced fibrothorax
In Indian scenario usually patients present late and this entity is chronic and in form of fibrothorax.
CONCLUSION: Open thoracotomy and decortication meant for those patients who have chronic empyema with fibrothorax were there is technical difficulty in VATS for fear of underlying lung parenchymal injury can be achieved with low morbidity and mortality.