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Perinatal tuberculosis: implications of failure to isolate the lungs in an infant undergoing thoracotomy.

Subramaniam R, Gupta S, Prasad CN

Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India. rajeshwarisubramaniam@hotmail.com

A 3-month-old male infant presented with intermittent low-grade fever from the age of 1 month. On investigation, a non-homogenous opacity was found in the upper lobe of the right lung. A computerized tomographic scan revealed loss of aeration of the right upper lobe and partial collapse of the middle lobe. A provisional diagnosis of congenital cystic adenomatoid malformation of the lung (with episodes of infection) was made. We describe the use of a single lumen tracheal tube (TT) for thoracotomy and lobectomy in this infant. The surgical procedure was complicated by a flood of thick, semisolid caseous material from the TT tube causing hypoxia and inability to ventilate the infant. The problem was managed appropriately in the circumstances. The infant died on the 10th postoperative day after two episodes of pneumothorax and, finally, sepsis, and multiorgan failure. Histopathological examination of the tissues and smears revealed acid-fast bacilli in all fields and confirmed the diagnosis of perinatal tuberculosis. This appears to be the first report of its kind of an anesthetic complication of perinatal tuberculosis. A brief update on this condition and the importance of lung separation in infants undergoing thoracotomy is discussed.

Published 20 July 2005 in Paediatr Anaesth, 15(8): 689-93.
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