Pulmonary Resection in Complicated Pulmonary Tuberculosis

¹ Specialist in tuberculosis., The Department of Surgery, Hospital Español and Centro de Asistencia Medico Social de la Tuberculosis.
² The Department of Surgery, Hospital Español and Centro de Asistencia Medico Social de la Tuberculosis.

In our midst, as a rule, resection for active tuberculosis was not undertaken until one year ago. Consequently, our experience is limited. However, we feel that the three cases described merit this communication.

The first case is a young man with familial history of tuberculosis with hemoptysis of eighteen months' duration, sputum negative for acid-fast bacilli. A diagnosis of bronchiectasis in the lingulae and basal segments was made and left pneumonectomy was followed by recovery. The pathologic study revealed an active caseous tuberculosis in the apex, chronic inflammatory changes throughout the left main bronchus, and bronchiectasis.

The second case is a girl of 19 years, with a history of severe hemoptysis for the last seven years. Repeated sputum examinations were negative for acid-fast bacilli. Bronchographic study revealed cylindrical dilatation of the two right basal posterior branches. Right lower bobectomy was performed and the specimen showed miliary tuberculosis and bronchiectasis. Immediately after the operation an extensive flare up in the remaining right lung occurred. Sputum was positive for tubercle bacilli for the first time in her history. Streptomycin therapy was instituted with total clearing of the x-ray shadows, and repeated negative sputum.

The third case is a middle-aged man with a history of repeated attacks of pneumonitis with fever, cough and mucopurulent expectoration, complicated by a purulent empyema which was treated medically. Negative sputum. There was evidence of bronchiectasis in the left lower lobe and complete stenosis of the bronchus of the upper lobe. Left pneumonectomy was performed followed by uneventful recovery. The specimen showed a primary calcified lymph node in intimate relation with the notch of the upper lobe and main bronchus. The upper lobe bronchus, almost totally occluded by hypertrophic changes of the mucous membrane; bronchiectasis and caseous nodules in the lower lobe.