[Tuberculous pyothorax. 28 cases]

Despite the efforts in the fight against tuberculosis (Tb) and the decrease in its incidence, severe forms persist. Tubercular pyothorax (TP), which was a frequent complication, is still difficult to treat. We studied the epidemiological, diagnostic, therapeutic and progressive aspects of this particular localization.

Retrospective study collecting all the TP reported between 1990 and 1999 in the department of pneumology in Ariana. The inclusion criterion was any patient presenting with pleural-parietal empyema of tubercular origin. We excluded patients presenting with negative bacilliferous pyothorax cultures.

Twenty-eight cases of TP were retained among 875 cases of tuberculosis, i.e., 3.2%. The mean age of patients was of 44 years (range: 15-75) and they were moderate smokers: 27 PA. Infectious fever concomitant to a pleural syndrome was the typical clinical manifestation. In some patients empyema (3 cases) or cutaneous fistula (2 cases) were the circumstances in which the disease was discovered. Thoracic imaging is a very useful tool: standard radiography, tomodensitometry and magnetic resonance imaging permit analysis of the pleural wall and cavity. In 9 cases, pneumothorax was concomitant. A co-infection with pyogenic germs was present in 4 patients. Treatment of TP is triple; it associates specific poly-chemotherapy, thoracic draining and respiratory physiotherapy. The progression was satisfactory in the recent forms concomitant to a bacilliferous pulmonary Tb. Complications such as pleural-pulmonary after effects are inherent to the severe forms. Surgery was necessary for 9 patients (5 drainages, 2 rib resections and 2 decortications).

TP is a menace for functional prognosis. Treatment is double: early, curative and effective, and preventive of Tb and its risk factors.