Clinicoepidemological study of hydropneumothorax in tertiary care hospital in western India

 

 

Abstract              Background: Hydropneumothorax (HPT) is defined as a collection of fluid and air in the pleural cavity. Present study was aimed to study Clinicoepidemological features of Hydropneumothorax. Methodology: Clinically diagnosed and confirmed 100 cases of Hydropneumothorax were included in the present study. Detailed clinical history and laboratory investigation information regarding clinical symptoms and signs were obtained. Result: In this study majority of study participants were from 23 to 42 year of age i.e. 57%. Most common complaints were cough 94%, expectoration 90%, dyspnoea 80% and chest pain in 70%. Tuberculosis was the most common etiological factor 92 out of 100 patients. HPT was more common on right side (61%) compare to in left side 39%. Conclusion: Most patients were from young adult age group presented most commonly symptoms like cough, expectoration, and dyspnoea and chest pain. TB remains the most common aetiology for Hydropneumothorax.

Key Word: Hydropneumothorax; Tuberculosis.

 

INTRODUCTION

Hydropneumothorax (HPT) is defined as a collection of fluid and air in the pleural cavity. It may be localized (encapsulated) or it may involve the entire pleural cavity. HPT is classified as "Acute" or "Chronic" depending upon duration and pathological reaction but there is no sharp dividing line in either time or pathological response between the two. Common causes of HPT are infection, iatrogenic during procedure or aspiration of pleural effusion and thoracic trauma. Chronic pyogenic infection at thoracic cavity was common in pre-war era, became less frequent in post-war years and now uncommon in developed countries. But acute or chronic infection of pleura is very common in developing countries probably due to poor nutrition and improper management.^1–3 Tuberculosis is an important community health problem. Although not very often, pneumothorax, empyema and HPT are complications of pulmonary TB and cause significant morbidity and mortality. Usually these complications are due to the rupture of a sub-pleural tuberculosis focus, parenchyma nidus or small cavity into the pleural space. In most patients with TB bronchopleural and/or pleurocutaneous fistulas are common manifestations. These complications make the management even more difficult.¹ Post-surgical (thoracic) pleural space infections and complications still occur in developing countries as a result of poor post-surgical ICU setup, infrastructure and unavailability of thoracic surgeon. In India, HPT is treated with antimicrobial/ antituberculous drugs and intercostals drainage tube or surgical procedures like decortications, partial or complete pneumonectomy etc.^4,5 This results in long hospital stay. Many with poor general condition status cannot be subjected to surgery, so Intercostals drainage tube with antimicrobial agents/antituberculous drugs is alternatively practiced. ⁶ So, present study was aimed to study Clinicoepidemological features of Hydropneumothorax.

 

METHODOLOGY

The present study was conducted in Government Medical College Surat. Total 100 patients diagnosed as Hydropneumothorax were included in the study period from Feb. 2012 to January 2018. Total 100 patients of Hydropneumothorax more than 12 years of age and ready to participate in the study were included. Patients having previous history of ICD insertion were excluded from the study. Ethical permission was obtained from institutional ethics committee. Informed consent was obtained from study participants. Clinically diagnosed and confirmed cases of Hydropneumothorax were included in the present study. Detailed clinical history information regarding clinical symptoms and signs were obtained. The patients were subjected to the routine laboratory tests like blood CBC, ESR, LFT, RFT, RBS, FBS, Serum HbsAg, Sr. HCV, Sr.HIV, sputum for AFB, gram stain with culture sensitively, cytology, pleural fluid or PUS for routine, microscopy , protein, sugar, LDH, cell for total and deff. Count, ADA, TB PCR, pl. fluid culture, Pl. fluid/pus AFB culture and drug sensitivity, chest X-ray, USG chest and abdomen, CT thorax as per requirement. Pleural biopsy/ medical thoracoscopy as required. Descriptive statistics were applied to describe the data.

DISCUSSION

In present study majority of patients were from 23 to 42 years of age. In India, incidence of HPT is common in young age group due to tuberculosis. According to Kamat et al, out of 100 patients, 29 cases had an age below 24 years and 58 were between 25-44 years. Study of R K Tandon et al showed that incidence of HPT was more common in 10-40 years age group which is consistent with the present study findings i.e. 57% of patients in 23 to 42 years of age group. Other studies also showed result i.e. A S Geha et al and M M Sherman et al showed incidence of HPT were higher after 40 years of age group. These studies were conducted in developed countries where incidence of tuberculosis was low. In the present study proportion of HPT exceedingly dominating in males. Similar results were also seen in different studies is as follows: R.K. Tandon et al – 75%, A.S. Geha et al – 75.6%, Kamat et al – 88% and Emerson et al – 83.4%. It is obvious that Males are more prone to mechanical stress due to strenuous work, smoking and tall stature, tuberculosis, chronic bronchitis with emphysema, all these being more common in males^7–10 Cough, expectoration, chest pain and dyspnoea are the most common symptoms in the present series and by Kamat et al. This may be explained on the basis that tuberculosis being the most common etiological in the present series. In our series, we reported positive gram stain or culture report of pleural fluid in 54% of cases. Bryant et al reported 67.8% positive cultured fluid while Sherman et al reported 66% positive report and Emerson et al reported 69.6% positive report. In present series, fluid culture sensitivity report was negative in 46% of the patients. This negative culture report in present series was related with good number of tuberculous HPT. Tuberculosis organisms do not grow on ordinary media. Special media like Twin 90 and Dorset egg media will take six weeks to grow. In Kamat et al, 57% cases were positive for sputum acid-fast bacilli. In my study 41% cases were positive for sputum acid-fast bacilli. Results can be explained by higher rates of underlying tuberculosis.^7,10 It is evident from the present study that the disease was more common on right side (61%) as compared to left side 39%. Bilateral HPT was not seen in any patients. Other study like R.K. Tandon et al, it was right sided 57.14% and Asif et al in which right and left lung involved 54 and 46 % respectively. This is probably due to the greater bulk of the right lung. Bilateral HPT is quite an infrequent occurrence in all the series. In my study 40% of patients have opposite lung disease or pathology found in which 5 emphysematous lung, 20 infiltrative lesions ,15 infiltrative lesions with cavitations lesion were found. In these group more complications, mortality and morbidity were found. These patients were less suitable for surgical management due to less reserve lung mass or volume.^8,10,11

 

CONCLUSION

Most patients were from young adult age group presented most commonly symptoms like cough, expectoration, and dyspnoea and chest pain. Pleural fluid investigations including microbiological and biochemical work-up was useful to establishing etiological diagnosis in Hydropneumothorax. TB remains the most common aetiology for Hydropneumothorax.

 

REFERENCES

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