Tuberculosis diagnosed by thoracic surgeons.

Introduction: Tuberculosis is frequently omitted in the diagnostic workup and may be identified accidentally following thoracic surgeries, mostly those targeting lung cancer.

Objectives: This study aimed to assess the clinical characteristics of patients who underwent thoracic surgery that resulted in the diagnosis of tuberculosis and to review lesions initially found on chest imaging in the context of the potential presence of tuberculosis.

Patients And Methods: We analyzed medical records of all patients hospitalized at the Department of Thoracic Surgery of the National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland, between the years 2014 and 2018 (n = 57) in whom tuberculosis was diagnosed. Two radiologists who knew the diagnosis retrospectively analyzed preprocedural chest computed tomography scans of the study patients.

Results: Tuberculosis was diagnosed by culture of specimens obtained during video‑ assisted thoracoscopy (21 patients), thoracotomy (24 patients), mediastinoscopy (6 patients), transthoracic fine‑ needle biopsy (3 patients), and transbronchial biopsy (1 patient). In the remaining 2 individuals, the diagnosis was established based on the microbiological examination of drained pleural fluid. In 42 patients (73.7%), the diagnosis of tuberculosis was unexpected to thoracic surgeons. Radiological findings suggestive of tuberculosis were present in 38 patients (66.7%). The radiologists who retrospectively analyzed the imaging records suggested tuberculosis in 31 persons (54.3%), whereas those who carried out the initial preprocedural evaluation, in 11 (19.3%).

Conclusions: The majority of the study patients presented with radiological findings encountered in tuberculosis, which should have led to a less invasive diagnostic workup. This highlights the role of radiologists in the identification of the disease.