A case report of stage Ⅲ silicosis complicated by pulmonary tuberculosis and secondary pneumothorax treated with minimally invasive thoracoscopic surgery / 中国职业医学

ABSTRACT

Objective To analyze the feasibility of using minimally invasive thoracoscopic surgery to treat stage Ⅲ silicosis complicated by pulmonary tuberculosis and secondary pneumothorax. Methods This study retrospectively analyzed the clinical data of a patient with stage Ⅲ silicosis complicated by pulmonary tuberculosis and secondary pneumothorax. Results The patient had stage Ⅲ silicosis complicated with active pulmonary tuberculosis for 1.5 years. In March 2021, a left-sided pneumothorax occurred and was conservatively treated with closed chest drainage. In April 2022, the patient was admitted with sudden frequent coughing and left-sided chest discomfort. Based on occupational history, dust exposure history, high-kilovolt anterior-posterior chest radiography, chest computed tomography, and sputum smear results, the diagnosis was "stage Ⅲ silicosis; active tuberculosis (positive for acid-fast bacilli in sputum smear); left-sided pleural effusion, pulmonary bulla rupture; secondary pneumothorax (recurrent tension type in left, encapsulated in right); left pleural adhesion". On the second day of admission, left-sided closed chest drainage was performed with poor outcome. On the fifth day of admission, minimally invasive thoracoscopic treatment was performed, including left lung volume reduction, pleural adhesion cauterization, and pleural fixation. Postoperative anti-inflammation, anti-tuberculosis, and symptomatic supportive treatments were administered. Due to the patient's severe underlying disease, wound healing was slow postoperatively, but no serious complications occurred. The pneumothorax completely absorbed and recovered in 17.0 days. Conclusion Minimally invasive thoracoscopic surgery is an effective treatment for silicosis complicated with pulmonary tuberculosis and secondary pneumothorax, and it is worth promoting.