Study of Factors Influencing the Nonclosure of Bronchopleural Fistula in Patients With Spontaneous Pneumothorax

Abstract

A pneumothorax is an abnormal collection of air or gas in the pleural space. Pneumothoraces are essentially of two types, spontaneous and tramautic pneumothoraces, based on whether the lung is diseased or not. Spontaneous pneumothoraces are further of two types-primary and secondary spontaneous pneumothoraces. A subcategory of traumatic pneumothorax is iatrogenic pneumothorax. Hydro-pneumothorax, pyo-pneumothorax and hemo-pneumothorax result from collection of clear fluid, pus and blood respectively in the pleural cavity. A bronchopleural fistula is a communication between the pleural space and the lung. MATERIAL AND METHODSA prospective study of 54 cases of spontaneous pneumothorax with bronchopleural fistula, which were admitted in Department of Pulmonary Medicine, SVRRGGH, Tirupathi, over a period of 1 year from July 2014 to July 2015 was undertaken. Patients with pneumothorax were identified by clinical and radiological examination, where it was necessary for CT chest to be performed. Depending on the chest x ray and CT chest findings, the patients were subjected to tube thoracotomy. Patients who had persistent bronchopleural fistula after 15 days had to be referred to the CT surgeon for decortication or pleurectomy. For all those whose bronchopleural fistula closed by itself, the intercostal tube was removed at the earliest. After completion of the study, the findings and results were analysed and compared with those of the previous studies. RESULTSIn the study period, out of 120 pneumothorax patients 54 patients with bronchopleural fistula were diagnosed. In 34 of the 54 patients, that is in 63% the bronchopleural fistula healed spontaneously in 2 weeks' time. In 16 of the patients even after 15 days of intercostal tube drainage, the bronchopleural fistula did not heal and they had to be referred to the cardiothoracic surgeon for decortication/pleurectomy; 46 of the 54(85.2%) were males and 8(14.8%) were females; 45 patients (83%) had TB pneumothorax; out of this 2 were MDR TB patients; 9 patients out of 54(17%) had non-TB pneumothorax, in which 2 were carcinoma lung; 7(13%) out of 54 patients, all men had diabetes, 2 of the 54 were HIV positive. There were 4 deaths, all of them due to aspiration pneumonia. CONCLUSIONSMen with TB pneumothorax, hydro-and pyo-pneumothorax seem to have delayed and non-closure of the bronchopleural fistula. Carcinoma lung seems to be associated with non-closure of the bronchopleural fistula more frequently. Diabetes and HIV do not influence the closure of the bronchopleural fistula according to our study.