Long-term follow-up after thoracoscopic resection of solitary pulmonary tuberculoma.

Background: Pulmonary tuberculosis continues to be a significant health problem, especially due to increasing incidence of multi-resistant mycobacteria and patients with immunodeficiency. Pulmonary tuberculoma, like other solitary lung nodules, can often be a diagnostic challenge; moreover no consensus exists on the management strategy.

Aim: To analyze the results of tuberculoma treatment with thoracoscopic lung resection, followed by anti-tuberculosis treatment (ATT).

Methods: All patients who underwent thoracoscopic resection of tuberculoma between 1996 and 2008 were retrospectively analyzed. The diagnosis was confirmed morphologically and/or microbiologically. Data were collected from case reports, outpatient medical records, Estonian Tuberculosis Registry and National Population Registry.

Results: Forty-three patients (25 men, 18 women) with mean age of 43.3 (range 15-68) years were included. Thoracoscopic approach was converted to thoracotomy in three cases. Median postoperative stay in surgical department was four days. No intra-hospital mortality occurred. Eleven patients received pre-operative ATT for 8 to 288 (median 115) days and 42 patients were treated post-operatively for 40 to 672 (median 185) days. One patient defaulted in ATT. First-line drugs were prescribed in 37 and second-line in five patients. During the median follow-up of 9.0 (range 3.2 to 16.1) years, none of the patients developed relapse.

Conclusions: Thoracoscopic pulmonary resection provides a minimally invasive opportunity for morphological and microbiological diagnosis of tuberculoma; and results in an excellent cure rate in combination with ATT.