Kyungmin Roh, Presenter: Nothing to Disclose

Sung Shine Shim, Abstract Co-Author: Nothing to Disclose

Sook Yun Song, Abstract Co-Author: Nothing to Disclose

Sangmin Lee, Abstract Co-Author: Nothing to Disclose

Jee Eun Lee MD, Abstract Co-Author: Nothing to Disclose

Yon Ju Ryu, Abstract Co-Author: Nothing to Disclose

Ji Young Hwang MD, Abstract Co-Author: Nothing to Disclose

To characterize the prognosis and identify radiologic and clinical factors contributing to mortality in patients with tuberculous destroyed lung (TDL).

Between May 1994 and April 2009, 200 patients were diagnosed with tuberculous destroyed lung (TDL) by radiological findings at our institute. Among these, a total of 169 patients with simple chest roentgenography and clinical data were enrolled. The extent of TDL was assigned a score based on the visually estimated lesion area. A field score of 1 denoted about 25% of the lung area; 2, an area of opacification constituting 26–50% of the lung area; 3, an area of the lesion constituting 51–75% of the lung area; and 4, an area of the lesion constituting more than 75% of the lung area. Cumulative survival probabilities were estimated using the Kaplan–Meier method, and the log-rank test was utilized to compare survival curves between patient characteristics. Those radiologic and clinical factors found to be significantly associated with survival were analyzed further with a Cox proportional hazard model to adjust for potential confounding effects of each factor. Hazard ratios (HR) with 95% confidence intervals (CI) were used to report the results.

The mean age of the patients was 64 years (range, 33–90), and 103 patients (61%) were men. TDL-related mortality was 19% (32/169), and a field score ≥3 was the only independent predictor for a shorter survival (hazard ratio, 3.477; 95% confidence interval, 1.462–8.273, p = 0.005).The median frequency was one hospitalization (range, 0–11) during the follow-up, which had a mean duration of 31 months (range, 0–172). Pneumonia developed in 96 patients (57%), and 50 (30%) developed acute respiratory failure requiring mechanical ventilation, 37 (22%) developed hemoptysis, 24 (14%) developed spontaneous pneumothorax, and 22 (13%) had a reactivation of tuberculosis. Overall mortality was 28% (47/169) with a 39-month median survival (range, 0–176) after diagnosis.

TDL patients frequently experienced several respiratory events (77%) requiring hospitalization and had a poor prognosis, particularly those with more extensively destroyed lung which is involved more than 50% of the lung area.

This is the largest series to date evaluating the clinical courses and prognostic factors in TDL patients and emphasize the importance of screening TDL patients to provide adequate care.

Roh, K, Shim, S, Song, S, Lee, S, Lee, J, Ryu, Y, Hwang, J, Prognostic Factors in Patients with Tuberculous Destroyed Lung: Radiologic and Clinical Findings.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9009283.html