Tuberculosis accounts for 9.6 million new cases and 1.5 million deaths annually.1 The burden of tuberculosis is high in developing countries where Intensive Care Unit (ICU) facilities are limited.2 Despite improvement in health care facilities and treatment of tuberculosis, a significant number of patients are left with residual sequelae, leading to significant morbidity and impaired quality of life.3,4 Post tuberculosis (TB) pulmonary sequelae is defined as the state with different secondary lung parenchymal complications after healing of TB and includes; fibrothorax
, pulmonary fibrosis, end stage destroyed lungs, bronchiectasis and obstructive airway disease.5,6 The true prevalence of these complications are not known.4
However, taking adequate samples from thickened pleura (e.g., in mesothelioma and fibrothorax
) remains the most important limitation of the semirigid pleuroscope.
Open thoracotomy and decortication for chronic empyema (fibrothorax
Pleurisy, pleural effusion, and pleural nodules are the most common manifestations, while pneumothorax is rare ; fibrothorax
has been reported as a complication of recurrent untreated and severe pleurisy.
Diffuse diseases may be inflammatory or infectious in etiology as in fibrothorax
, or neoplastic (Figure 11), either primary or metastatic.
Exclusion criteria were (1) significant comorbidities (e.g., cancer, left ventricular heart failure, and unstable angina) likely to affect survival during follow-up period; (2) psychiatric disorders that could affect the ability to undergo NIV; (3) any other chronic respiratory disease that could interfere with data analysis (e.g., fibrothorax
, scoliosis, bronchiectasis, cystic fibrosis, and pulmonary fibrosis); (4) history of obstructive sleep apnoea syndrome (OSAS); (5) body mass index > 40 kg/[m.sup.2]; and (5) systemic steroids therapy.
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
. An associated laparotomy was performed in 8 patients; 1 thoracotomy was non-therapeutic.
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).
ARD event IDC-8 IDC-9 IDC-10 Pleural mesothelioma -- -- C450 Peritoneal mesothelioma -- -- C451 Unspecified mesothelioma -- -- C459 Malign pleural Neoplasm 1630 163 C384 Asbestosis 5152 501 J61 Pleural plaques -- -- J920 Unspecified pleural disease 5110 5110 J948 Unspecified fibrothorax
5110 5110 J941 Hydrothorax 5112 5118 J90 Rounded atelectasis unspecified 5190 5180 J981 Pneumoconiosis 5159 505 J64 Chronic restricted aerial flow -- -- -- Note.
Delay in treatment causes various complications like empyema necessitatis, septicemia, brain abscess, amyloidosis, bronchiectasis, fibrothorax
, respiratory failure and death.
Table 1: Major ailments for which patients were hospitalized in CVTS ward Patient Admitted for Number of Percentage Patients Trauma Chest/Vascular 91 12.43 Carcinoma esophagus 77 10.51 Bronchogenic carcinoma 67 09.15 Open Heart surgery 55 07.51 Hydatid Lung 44 06.01 Pneumothorax 39 05.32 Fibrothorax
36 04.91 CHD-PDA 23 03.14 Empyema 19 02.59 Table 2: Showing Number of Admissions, Operations, Discharges and Deaths Apr 04 to Mar 05 Month No.
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
. Main differential diagnosis of hypoplastic lung is Swyer James syndrome.