Tuberculous and posttuberculous bronchopleural fistula. Ten year clinical experience

Between 1972 and 1982, 15 episodes of tuberculosis-related bronchopleural fistula (BPF) were observed in 13 patients at a municipal hospital in New York City. All 13 had a history of inadequate treatment for pulmonary tuberculosis, and seven had one or more associated chronic debilitating conditions. Past pleural inflammation with resultant fibrothorax appeared to be the source of the late BPF formation in at least seven patients, while rupture of a cavity during active disease was likely in four. Clinical presentation ranged from life-threatening tension-pneumothorax to incidental discovery, a long-term wasting illness being the most common form. Diagnosis was not difficult. Antituberculosis chemotherapy and tube suction were generally employed in treatment, with further surgical drainage procedures done when necessary and possible; open window thoracostomy was usually successful (four of seven BPFs closed, one stable for years), as were one case each of pleuropneumonectomy and decortication. When surgery was not feasible, long-term tube drainage was a useful alternative.