Thoracoplasty and contralateral pneumothorax.

In certain instances of bilateral pulmonary tuberculosis it is a frequent practice to recommend induction of an artificial pneumothorax (A.P.) to control disease on one side when indications for thoracoplasty on the other side are clear cut. A number of writers over the last 16 years have pointed out the extra risk and added danger of operating with a contralateral A.P. present, but have not specified the nature of this increased hazard except to reaffirm the frequency of spontaneous pneumothorax on the contralateral side. The purpose of this paper is to report a series of patients in whom spontaneous pneumothorax did not occur, to make alternative suggestions to account for the changes which undoubtedly do occur on the side of the A.P., and to state reasons for believing that the A.P. is best dispensed with. The paper is based on observations made during and after operations. This study in patients with contralateral A.P. undergoing thoracoplasty was provided by the alleged occurrence of spontaneous pneumothorax on the contralateral (A.P.) side in three consecutive patients during the first 24 hours after the first stage of the operation. It is my contention that there is no increased likelihood of spontaneous pneumothorax following thoracoplasty compared with its occurrence during the course of A.P. therapy alone, or at any rate of spontaneous pneumothorax as at present defined and recognized. However, before considering the somewhat complex nature of the changes that the contralateral lung may undergo, the compositiQn of the clinical material must be described.