Authors
Bagirov M.A.1, 3, Tarasov R.V.1, 2, 3, Cadovnikova S.S.1, Popova S.S.1, Chashchina M.V.1, Hozikov A.S.1
1 Central Scientific Research Institute of Tuberculosis, Moscow
2 Moscow Medical University “REAVIZ”, Moscow
3 Russian Medical Academy of Continuing Professional Education, Moscow
Abstract
This article describes a clinical case that occurred in the practice of surgeons. A patient suffering from cavernous tuberculosis underwent atypical resection of the lower lobe (S6) of the right lung in a non-specialized medical facility. After the operation, she developed postresection empyema of the pleura with bronchopleural fistula.
In February 2022, patient H., 26 years old, developed symptoms that she considered signs of illness: a paroxysmal cough, an increase in body temperature to 38 degrees and severe headaches. X-ray examination, in particular computed tomography of the chest organs (CT of the chest), showed the presence of a cavity formation in S6 of the lower lobe of the right lung and multiple focal lesions in the upper lobe of the same lung. Based on the data obtained, an abscess of the lower lobe of the right lung with polysegmental pneumonia was diagnosed. S6 resection of the right lung was performed as part of the general medical network. After a histological examination, tuberculosis of the right lung was diagnosed. However, microbiological studies of diagnostic materials (sputum and surgical material) have not been conducted in the general medical network. The patient was prescribed anti-tuberculosis therapy in accordance with the treatment regimen for drug-sensitive tuberculosis. In the course of treatment, undesirable reactions were observed, due to which therapy was canceled. A month after the operation, bronchopulmonary fistulas with a diameter of up to 2 mm were detected on a control computed tomography of the chest organs (CT of the chest), which indicated a deterioration in the condition. The patient applied to CTRI, where she underwent repeated resection of her right lung (anatomical resection S6) with partial pleurectomy. In the postoperative period, an artificial pneumoperitoneum (APP) was additionally installed in a volume of 1200 ml, which made it possible to compress the right lung by lifting the right dome of the diaphragm. The drains were removed on the 34th day.
After a follow-up CT scan, histological examination and detection of mycobacterium tuberculosis (MBT) DNA in the biomaterial after a previous operation, as well as taking into account individual intolerance, anti-tuberculosis therapy in the amount of RHAmE was prescribed against the background of maintenance therapy. There was a positive trend and good tolerability of the treatment. As a result of the treatment, the patient showed positive dynamics both clinically and radiographically. After 12 months, the entire complex of medical measures was completed, and the woman was able to return to normal life.
Keywords: empyema of the pleura, bronchopleural fistula, lung resection, fibrothorax.
References
1. Kanybekov A, Malenkova SA, Yermekbay AA, et al. Empyema pleura. Vestnik Kaznsu. 2016; 4: 235-236. (In Russ.)
2. Giller DB, Martel II, Enilenis II, et al. Surgical Treatment of Tuberculous Pleural Empyema in Children. Surgery. Pirogov Journal. 2019; 8: 22-28. (In Russ.)
3. Smolnikova UA, Gavrilov PV, Ushkov AD, et al. Difficulties in the differential diagnosis of tuberculous pleural empyema and pleural mesothelioma. Russian Electronic Journal of Radiology. 2019; 9(1): 256-260. (In Russ.) doi: 10.21569/2222-7415-2019-9-1-256-260.
4. Askhadulin EV, Abashin RV, Baranov SV, et al. The experience of using valvular bronchoblocation in the treatment of patients with tuberculous pleural empyema with bronchopleural fistulas. Bulletin of new Medical Technologies. 2010; XVII(1): 57. (In Russ.)
5. Bogush LK, Didenko VF. Treatment of Tuberculosis Patients with Post-Resection Bronchial Fistulas. Alma-Ata: Nauka, 1975. 295p. (In Russ.)
6. Giller DB, Kesaev OSh, Korolev VV, et al. Difficulties in Diagnosing and Choosing Treatment for Post-Surgical Tuberculous Pleural Empyema with Bronchopulmonary Fistula. Russian Electronic Journal of Radiology. 2019; 3: 209-214. (In Russ.)
7. Guska NI, Faitelberg-Blank VR. Physiology and Pathology of the Pleura. M.V. Sergievsky, editor. Kishinev, 1978. 196 p. (In Russ.)
8. N.R. Paleev, editor. Respiratory diseases. Vol. 2. Moscow: Medicine; 1989. P.393-394 (In Russ.)
9. Chelnokova OG, Golovanova MN, Senin IG. Features of the Perception of the Problem of Tuberculosis by Primary Health Care Physicians. Tuberculosis and Lung Diseases. 2020; 98(1): 41-45. (In Russ.) doi: 10.21292/ 2075-1230-2020-98-1-41-45.
10. Clinical Guidelines. Tuberculosis in Adults. 2024-2025-2026 (15.05.2024). (In Russ.)
11. Krasnova NM, Kravchenko AF, Val NS. Principles of Rational Therapy for Tuberculosis. Effective Pharmacotherapy. 2019; 15(27): 20-26.
(In Russ.) doi: 10.33978/2307-3586-2019-15-27-20-26.
12. Shurygin AA, Makarova EA. The effect of early termination of tuberculosis treatment on its effectiveness. Pulse. 2021; 23(9): 136-141. (In Russ.)
13. Bogorodskaya EM, Alekseeva VM, Agapova VA. The impact of additional social assistance for newly diagnosed patients with pulmonary tuberculosis on the economic efficiency of anti-tuberculosis chemotherapy. Healthcare of the Russian Federation. 2012; 2: 18-23. (In Russ.)
14. Shapovalov AS, Polezhaev AA, Belov SA. Collapsotherapy for Pulmonary Tuberculosis: Return to the Origins. Pacific Medical Journal. 2017; 1 :94-87. (In Russ.)
15. Kildyusheva EI, Skornyakov SN, Medvinsky ID, et al. Pneumoperitoneum in the Complex Treatment of Common Forms of Destructive Pulmonary Tuberculosis. Ural Medical Journal. 2013; 2: 69-75. (In Russ.)
