Cavitation in pulmonary tuberculosis: its prognosis and treatment

Abstract

(1). Excavation occurring in the course of pulmonary tuberculosis is a serious complication as shown by the high mortality recorded. (51 per cent.).

(2). The question of prognosis in cases of cavity is closely related to the type of lesion, and the outlook in First stage cases is very much better than in the more chronic Third stage cavities ... 46.6 per cent arrested as opposed to 18.3 per cent. The Second. stage group occupy an intermediate position with 28 per cent arrested.

(3). Left -sided cavities appear to have a rather better prognosis than those located in the right lung ... 30.7 per cent arrested as against 21.3 per cent.

(4). Bilateral excavation is of grave prognostic import.

(5). Cavities situated in the lower lobe offer very little hope of a successful result, none of those in the present series having secured arrest or even improvement.

(6) . Artificial pneumothorax as a method of treatment has been disappointing in its results, due mainly to adherent pleura preventing an adequate collapse. The results of this treatment might be improved by its application as soon as breaking down is detected, even in the absence of any gross systemic disturbance.

(7). In carefully selected Second and Third stage cases, particularly where there is evidence of fibrous reaction thoracoplasty is more likely to produce benefit than any of the other methods of collapse.

(8). Phrenicectomy is of limited value in cases of excavation as in none of these under review were the results of this operation alone sufficient to secure obliteration of the cavity.

(9). Under general treatment alone First stage lesions gave the best prognosis (37.6 per cent arrested), while the outlook in the Third stage group with a figure of only 8.3 per cent arrested is disappointing. (10) . An uncollapsed chronic cavity remains a potential source of severe haemoptysis and of the 51 deaths recorded in this series ten (19.6 per cent) were the result of a fatal haemorrhage.