THE ROLE OF THORACOSCOPY IN THE AIDS IMMUNOCOMPROMISED PATIENT

A review of the thoracic complications associated with the immunosuppression seen in the setting of the acquired immunodeficiency syndrome (AIDS), transplantation, and cancer chemotherapy was undertaken to define the role of thoracoscopy and video-assisted thoracic surgery in this context. Pulmonary parenchymal disease, pleural effusions, pneumothorax, and pericardial effusions are the primary conditions in which thoracoscopy can be helpful. Thoracoscopic wedge biopsy can be used in patients with parenchymal disease when bronchoalveolar lavage, transbronchial biopsy, or an empiric trial of antibiotics fail to yield a diagnosis. If pleural effusions are loculated and highly fibrinous, effective drainage can be achieved thoracoscopically. Early bleb stapling and apical pleurectomy are often necessary in the management of AIDS-related pneumothorax and can be readily done using video-assisted thoracic surgical techniques. Successful thoracoscopy in the immunocompromised patient requires the ability to tolerate one-lung anesthesia, a manageable lung parenchyma, and a satisfactory coagulation profile.