Regional and global lung function in unilateral fibrothorax after conservative therapy and decortication

Twenty-six patients suffering from unilateral fibrothorax were investigated before surgery or conservative therapy (decortication, n = 15; conservative treatment, n = 11) and followed up after 24.5 and 18.6 months respectively. Global lung function analysis was done by body plethysmography, ventilation and gas exchange analysis and blood-gas analysis under resting and exercise conditions. Regional lung function analysis included the semiquantitative description of fibrothorax by X-ray photos, and ventilation-perfusion scintigraphy. The functional result of unilateral fibrotic pleurisy is restriction which is also persistent after therapy, but to a lesser degree. This restriction is shown in an increased dead space ventilation as well as in ventilatory inhomogeneities, which causes a distortion of respiratory gas exchange. A decrease of compliance of the lung and chest wall is not measurable after therapy. Conservative treatment leads to a functional improvement to the same degree as decortication in cases of severe preoperative functional disturbances of the operated patients. After a course of 1.5 and 2 years respectively, the reference value has not been reached in either group. The regional pattern after therapy is characterized by a restriction and under-perfusion of the formerly affected site. The regional improvement of lung function is independent of the type of therapy, however, it shows a close correlation to the amount of pleurisy prior to therapy. Conservative treatment is the therapy of choice as long as no complications of insufficient recovery impede the course of the illness.