Outcomes of hydropneumothorax among pulmonary tuberculosis patients: a prospective observational study from a tertiary care center in north India

Hydropneumothorax is an uncommon but serious complication of pulmonary tuberculosis (PTB), often resulting from the rupture of a tuberculous cavity into the pleural space with bronchopleural fistula formation. Early diagnosis and optimal management are crucial to improving outcomes. A descriptive study was conducted over 18 months in 50 microbiologically confirmed PTB patients presenting with pneumothorax or hydropneumothorax at a tertiary care hospital in Punjab, India. Demographic, clinical, radiological, and microbiological data were recorded. Lung expansion was quantified using Light's Index at serial intervals up to 8 weeks. Statistical analysis was performed using Chi-square/Fisher exact tests; p<0.05 was considered significant. The mean age was 34.48±11.69 years, and 82% were male. All patients presented with breathlessness, 96% with chest pain, 68% with fever, and 62% with cough. New TB cases comprised 82%, recurrent 8%, and loss-to-follow-up 10%. The mean lung expansion time was 2.92±2.16 weeks. Significant associations were found between drainage status and lung expansion (p=0.01) and between type of TB and lung expansion (p=0.04). Complete radiological expansion was achieved in 76% of patients within 8 weeks. Surgical referral to the Cardiothoracic and Vascular Surgery Department was required in 24%. Hydropneumothorax in PTB predominantly affects young adult males and often requires prolonged drainage. Early intercostal tube drainage significantly improves lung expansion outcomes, particularly in new TB cases.