Management of tuberculous pneumothorax in Nigeria

Forty-eight patients with tuberculous pneumothorax treated at the University College Hospital in Ibadan, Nigeria, over a 40-month period were reviewed. This represents 90 percent of all patients admitted with nontraumatic "spontaneous" pneumothorax during the period of survey. This finding shows that pulmonary tuberculosis (still endemic in Nigeria) is the most common cause of spontaneous pneumothorax in Ibadan.Because of delay in presentation, over 70 percent of the patients presented with hydropneumothorax or pyopneumothorax, which tend to prolong the length of intubation days and the period of hospitalization. The most significant factors affecting prognosis are nutritional status of the patient, extent of parenchymal damage, severity of the bronchopleural fistula, and presence of empyema.The goal of therapy had been directed toward prompt intercostal tube drainage, complete evacuation of fluid and pus, improvement in the nutritional status of the patient, and effective chemotherapy. With this approach, open thoracotomy was rarely indicated and decortication was only necessary in five patients. Our results with intercostal tube drainage and chemotherapy alone have been very encouraging.