Which of the following are appropriate indications for pulmonary resection for mycobacterial disease?

A. Localized pulmonary disease caused by M. avium-intracellulare.

C. Localized pulmonary disease due to multiple drug–resistant M. tuberculosis. 

E. Massive hemoptysis from a right upper lobe cavity occurring during an appropriate course of chemotherapy for pulmonary tuberculosis in a sputum-negative patient.

DISCUSSION: Modern antimycobacterial chemotherapy is very effective. Surgical treatment of pulmonary mycobacterial disease is rarely necessary; however, pulmonary disease caused by M. avium-intracellulare or multiple drug–resistant M. tuberculosis is not likely to respond to chemotherapy and should be resected if the disease is localized. Chemotherapy for tuberculosis is almost invariably curative in children, regardless of the extent of disease. The size of a tuberculous cavity is not an indication for resection. Massive hemoptysis from a cavitary lesion is life threatening and is an indication for pulmonary resection.