PT - JOURNAL ARTICLE AU - Olga Danaila AU - Cristian Paleru AU - Ciprian Bolca AU - Adrian Istrate AU - Cristina Popa AU - Genoveva Cadar AU - Ioan Cordos TI - Artificial therapeutic pneumothorax induced by video assisted thoracoscopic surgery – Surgical treatment option in the modern management of pulmonary tuberculosis – Case presentation DP - 2011 Sep 01 TA - European Respiratory Journal PG - p2687 VI - 38 IP - Suppl 55 4099 - http://erj.ersjournals.com/content/38/Suppl_55/p2687.short 4100 - http://erj.ersjournals.com/content/38/Suppl_55/p2687.full SO - Eur Respir J2011 Sep 01; 38 AB - Introduction: Pulmonary tuberculosis (PTB) multidrug resistant (MDR) is still a major global health problem. After the discovery of antimycobacterial therapy the use of therapeutic pneumothorax (TP) decreased. Increased prevalence of PTB MDR, multiple adverse effects and high cost of TB drugs have returned the attention to this old method of treatment.Objective: The aim of this paper is to highlight the usefulness of TP induced by video assisted thoracoscopic surgery (VATS) as adjuvant therapy in cavitary PTB MDR.Method: A 27-year-old, male patient was diagnosed with cavitary MDR PTB. Because the individualized treatment has proved ineffective and the patient denied resection surgery, we performed repeated intrapleural air insufflations. In the absence of satisfactory lung collapse due to pleural adhesions, it was decided to associate a minimally invasive surgical procedures – VATS. Multiple adhesions localized to the right upper lobe and 6 right segment were distroyed (monopolar cautery, LigaSure) with full release of the lung. Pleural cavity was controlled with a single tube which was maintained clamped until his removal in the first postoperative day.Results: The surgical procedure was well tolerated without major complications and with sufficient parenchymal collapse, subsequently maintained by periodic air insufflations. After 4 months the patient was smear and culture negative and the cavity was reduced in size.Conclusions: In carefully selected cases, TP is an effective adjuvant procedure in the treatment of MDR PTB. VATS is useful for lysis of adhesions when lung collapse is insufficient.