Tuberculous Pleuro-Cutaneous Fistula
Author(s)
Jamal Ghalimi1,
Sani Rabiou1*,
Marwane Lakranbi1,
Nadia Anoun1,
Yassine Ouadnouni1,2,
Mohamed Smahi1,2
Affiliation(s)
1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco. 2 Faculty of Medicine and Pharmacy, Sidi Mohamed Benabdellah University, Fez, Morocco.
1 Department of Thoracic Surgery, Hassan II University Hospital, Fez, Morocco. 2 Faculty of Medicine and Pharmacy, Sidi Mohamed Benabdellah University, Fez, Morocco.
ABSTRACT
Introduction: The pleural fistulas are defined by a fistula communicating the pleural cavity to the chest wall. They often occur in the immunocompromised individuals with pyogenic infections, much more rarely in immunocompetent patients with tuberculosis. Materials and Methods: Between February 2010 and August 2012, five patients were followed up and operated for tuberculous pleuro-cutaneous fistula in the thoracic surgery department of University Hospital Hassan II of Fez. Results: These were 2 female and 3 male patients, with the average age of 39 years, and the age ranging from 18 years to 60 years. One patient was operated on for tuberculous empyema; there are 20 years and another 15 years ago drained for tuberculous empyema. All patients had a fistula necessitated operating on an average of three years, with extremes ranging from 15 days to 6 years. The radiological assessment had objectified chronic pleural pocket in one case, a costal osteitis in 2 cases, multiple cystic lesions in one case and apseudotumor appearance and endo exothoracique in another. Patients had benefited from draining the abscess with fistula resection associated with a rib resection in 2 cases and thoracostomy with lung prosthesis in one case. Conclusion: Tuberculous pleuro-cutaneous fistula is a rare pathological entity, occurring most often in an array of multifocal tuberculosis, or as a complication of surgery for tuberculous empyema.
Introduction: The pleural fistulas are defined by a fistula communicating the pleural cavity to the chest wall. They often occur in the immunocompromised individuals with pyogenic infections, much more rarely in immunocompetent patients with tuberculosis. Materials and Methods: Between February 2010 and August 2012, five patients were followed up and operated for tuberculous pleuro-cutaneous fistula in the thoracic surgery department of University Hospital Hassan II of Fez. Results: These were 2 female and 3 male patients, with the average age of 39 years, and the age ranging from 18 years to 60 years. One patient was operated on for tuberculous empyema; there are 20 years and another 15 years ago drained for tuberculous empyema. All patients had a fistula necessitated operating on an average of three years, with extremes ranging from 15 days to 6 years. The radiological assessment had objectified chronic pleural pocket in one case, a costal osteitis in 2 cases, multiple cystic lesions in one case and apseudotumor appearance and endo exothoracique in another. Patients had benefited from draining the abscess with fistula resection associated with a rib resection in 2 cases and thoracostomy with lung prosthesis in one case. Conclusion: Tuberculous pleuro-cutaneous fistula is a rare pathological entity, occurring most often in an array of multifocal tuberculosis, or as a complication of surgery for tuberculous empyema.
Cite this paper
Ghalimi, J. , Rabiou, S. , Lakranbi, M. , Anoun, N. , Ouadnouni, Y. and Smahi, M. (2015) Tuberculous Pleuro-Cutaneous Fistula. International Journal of Clinical Medicine, 6, 506-511. doi: 10.4236/ijcm.2015.67068.
Ghalimi, J. , Rabiou, S. , Lakranbi, M. , Anoun, N. , Ouadnouni, Y. and Smahi, M. (2015) Tuberculous Pleuro-Cutaneous Fistula. International Journal of Clinical Medicine, 6, 506-511. doi: 10.4236/ijcm.2015.67068.
References
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http://dx.doi.org/10.1016/j.emcrho.2004.08.003 [2] Ka, A.S., Brousse, V., Diakhaté, I., et al. (2006) Abcès froid tuberculeux de la paroi thoracique chez l’enfant: A propos de 3 cas. Archives de Pédiatrie, 13, 1265-1266.
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http://dx.doi.org/10.1016/S0399-077X(98)80042-5 [4] Prasoon, D. (2003) Tuberculosis of the Intercostal Lymph Nodes. Acta Cytologica, 47, 51-55.
http://dx.doi.org/10.1159/000326475 [5] Navani, N., Punwani, S., Humphries, P.D., et al. (2010) Pleuro-Cutaneous Fistula Complicating Chest Drain Insertion for Tuberculous Effusion. QJM, 103, 799-800.
http://dx.doi.org/10.1093/qjmed/hcp175 [6] Chermiti Ben-Abdallah, F., Boudaya, M.S., Chtourou, A., et al. (2013) Tuberculose sternale avec fracture spontanee du sternum. Revue de Pneumologie Clinique, 69, 89-92.
http://dx.doi.org/10.1016/j.pneumo.2013.01.003 [7] Morris, B.S., Maheshwari, M. and Chalwa, A. (2004) Chest Wall Tuberculosis: A Review of CT Appearances. British Journal of Radiology, 77, 449-457.
http://dx.doi.org/10.1259/bjr/82634045 [8] Shah, J., Patkar, D., Parikh, B., et al. (2000) Tuberculosis of the Sternum and Clavicle: Imaging Findings in 15 Patients. Skeletal Radiology, 29, 447-453.
http://dx.doi.org/10.1007/s002560000207 [9] Chang, J.H., Kim, S.K. and Lee, W.Y. (1999) Diagnostic Issues in Tuberculosis of the Ribs with a Review of 12 Surgically Proven Cases. Respirology, 4, 249-253.
http://dx.doi.org/10.1046/j.1440-1843.1999.00183.x [10] Paik, H.C., Chung, K.Y. and Kang, J.H. (2002) Surgical Treatment of Tuberculous Cold Abscess of the Chest Wall. Yonsei Medical Journal, 43, 309-314.
http://dx.doi.org/10.3349/ymj.2002.43.3.309 [11] Lim, S.Y., Pyon, J.K., Mun G.H., et al. (2010) Reconstructive Surgical Treatment of Tuberculosis Abscess in the Chest Wall. Annals of Plastic Surgery, 64, 302-306.
http://dx.doi.org/10.1097/SAP.0b013e3181b0bb03
[1] Pertuiset, E. (2004) Tuberculose osseuse et articulaire des membres. EMC-Rhumatologie Orthopédie, 1, 463-486.
http://dx.doi.org/10.1016/j.emcrho.2004.08.003 [2] Ka, A.S., Brousse, V., Diakhaté, I., et al. (2006) Abcès froid tuberculeux de la paroi thoracique chez l’enfant: A propos de 3 cas. Archives de Pédiatrie, 13, 1265-1266.
http://dx.doi.org/10.1016/j.arcped.2006.06.009 [3] Bouslama, K., Bakir, L., Ben M’Rad, S., et al. (1998) Tuberculose de la paroi thoracique: A propos d’un cas et revue de la littérature. Médecine et Maladies Infectieuses, 28, 666-667.
http://dx.doi.org/10.1016/S0399-077X(98)80042-5 [4] Prasoon, D. (2003) Tuberculosis of the Intercostal Lymph Nodes. Acta Cytologica, 47, 51-55.
http://dx.doi.org/10.1159/000326475 [5] Navani, N., Punwani, S., Humphries, P.D., et al. (2010) Pleuro-Cutaneous Fistula Complicating Chest Drain Insertion for Tuberculous Effusion. QJM, 103, 799-800.
http://dx.doi.org/10.1093/qjmed/hcp175 [6] Chermiti Ben-Abdallah, F., Boudaya, M.S., Chtourou, A., et al. (2013) Tuberculose sternale avec fracture spontanee du sternum. Revue de Pneumologie Clinique, 69, 89-92.
http://dx.doi.org/10.1016/j.pneumo.2013.01.003 [7] Morris, B.S., Maheshwari, M. and Chalwa, A. (2004) Chest Wall Tuberculosis: A Review of CT Appearances. British Journal of Radiology, 77, 449-457.
http://dx.doi.org/10.1259/bjr/82634045 [8] Shah, J., Patkar, D., Parikh, B., et al. (2000) Tuberculosis of the Sternum and Clavicle: Imaging Findings in 15 Patients. Skeletal Radiology, 29, 447-453.
http://dx.doi.org/10.1007/s002560000207 [9] Chang, J.H., Kim, S.K. and Lee, W.Y. (1999) Diagnostic Issues in Tuberculosis of the Ribs with a Review of 12 Surgically Proven Cases. Respirology, 4, 249-253.
http://dx.doi.org/10.1046/j.1440-1843.1999.00183.x [10] Paik, H.C., Chung, K.Y. and Kang, J.H. (2002) Surgical Treatment of Tuberculous Cold Abscess of the Chest Wall. Yonsei Medical Journal, 43, 309-314.
http://dx.doi.org/10.3349/ymj.2002.43.3.309 [11] Lim, S.Y., Pyon, J.K., Mun G.H., et al. (2010) Reconstructive Surgical Treatment of Tuberculosis Abscess in the Chest Wall. Annals of Plastic Surgery, 64, 302-306.
http://dx.doi.org/10.1097/SAP.0b013e3181b0bb03