title: The frequency and treatment of pneumothorax associated with pulmonary nontuberculous mycobacterial infection.
abstract: OBJECTIVE
  Characteristics of pneumothorax associated with nontuberculous mycobacterium (NTM) infection are rarely reported, especially in terms of surgical treatments. Our objectives were to show the tendency and clinical courses of pneumothorax due to NTM and discuss the way of therapy in our hospital.
  
  
  METHODS
  We retrospectively analyzed 557 patients with NTM infection over a period of 5 years at the Nagara Medical Center.
  
  
  RESULTS
  A total of 12 out of the 557 patients (2.2%) suffered from pneumothorax caused by NTM infection without other pulmonary diseases. The diagnosis of all NTM cases was mycobacterium avium complex. Of these 12 patients, three required observation only (25%), five required drainage only (42%), and four required surgery after drainage (33%). The four surgically treated patients suffered from empyema as well as pneumothorax. They were in worse nutritional condition than non-surgically treated patients. For the patients requiring surgery, we selected reasonable surgical methods; we sutured the fistula of lung in all cases and covered it with muscle or omentum or polyglycolic acid sheets without a case in which endobronchial embolization was performed in advance before surgery. Finally, all pneumothorax healed. Thereafter, three of these four patients took unfavorable courses: progressing malnutrition, complications worsening or contralateral pneumothorax.
  
  
  CONCLUSIONS
  We should select an appropriate treatment including surgery against NTM-associated pneumothorax without losing an opportunity because of its intractability and exhausting effect.
authors.affiliation: Department of Thoracic Surgery, Nagara Medical Center, Nagara 1300-7, Gifu, 502-8558, Japan. imsk581107@gmail.com.
authors.forename: Masaki
authors.identifier: http://orcid.org/0000-0003-0076-4169
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Thoracic Surgery, Kyoto University Graduate School, Kyoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Thoracic Surgery, Kyoto University Graduate School, Kyoto, Japan.
authors.forename: Teruya
authors.initials: T
authors.lastname: Komatsu
authors.affiliation: Department of Thoracic Surgery, Kansai Electric Power Hospital, Osaka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Respiratory Medicine, Nagara Medical Center, Gifu, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Thoracic Surgery, Nagara Medical Center, Nagara 1300-7, Gifu, 502-8558, Japan.
authors.forename: Takuji
authors.initials: T
authors.lastname: Fujinaga
mesh_terms: D000368:Aged; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000382:microbiology; D009170:Nontuberculous Mycobacteria / Q000302:isolation & purification; D011030:Pneumothorax / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Mycobacterium avium complex; Nontuberculous mycobacterial infection; Pneumothorax; Surgery; Treatment