chest wall tuberculosis
Introduction
Introduction to chest wall tuberculosis Chest wall tuberculosis is a common chest wall disease, most of which are secondary infections, often manifested as cold abscess or chronic sinus, often secondary to tuberculosis in the lung, pleura or mediastinum, only local to tuberculosis which performed. Young people who are more common under the age of 30, more men, most patients with no obvious symptoms, or mild pain. The abscess can rupture on its own, forming a chronic long-term non-healing sinus. The lesion is more common in the chest wall, followed by the chest wall and less in the spine. basic knowledge The proportion of illness: 0.0035% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: tuberculosis, hemoptysis, amenorrhea, pneumothorax
Cause
Chest wall tuberculosis
Infection (85%)
Chest wall tuberculosis is a common chest wall disease, refers to chest wall soft tissue, ribs, costal cartilage or sternal tuberculous lesions, the majority of chest tube tuberculosis is secondary infection, the most common primary lesion is tuberculosis, pleural tuberculosis or mediastinal lymphadenopathy However, the degree of chest wall lesions is not proportional to the severity of lung and pleural lesions. Clinically, when the chest wall abscess is present, the primary lesion may be still or heal, directly from the primary rib or sternal tuberculous osteomyelitis. The formation is extremely rare, mostly manifested as tuberculous cold abscess or chronic chest wall sinus, mostly in young or middle-aged.
Pathogenesis
In the case of pulmonary or pleural tuberculosis, the chest wall can be invaded by:
1. Lymphatic pathway is the most common infection of chest tuberculosis. Mycobacterium tuberculosis is immersed in the lymphatic vessels of the pleural adhesion through the lymphatic vessels of the pleural adhesion to the sternum of the chest wall, the thoracic paravertebral and intercostal lymph nodes, and then the lymph nodes are worn. Invade other tissues on the chest wall to form tuberculous abscesses.
2. Directly spread superficial lung or pleural tuberculosis lesions can directly destroy the parietal pleura, spread to various layers of the chest wall tissue, spread through the intercostal muscles to the soft tissue of the chest wall to form abscesses, often in the intercostal muscle layer 1 abscess, with a hole in the middle, forming a gourd-like shape. After the abscess penetrates the intercostal muscle, it gradually extends outward and downward due to the gravity fall, and settles to the side of the chest wall or the upper abdominal wall. If there is secondary infection in the abscess, It can be broken by itself; it can also form a chronic sinus due to puncture or incision and drainage, and it will not heal for a long time.
3. Hematogenous dissemination is rare in clinical practice. Only when the patient's immunity is extremely low, Mycobacterium tuberculosis enters the systemic circulation and invades the ribs and sternum, causing tuberculous osteomyelitis. With the destruction of the cortical bone, the tubercle bacillus invades the chest wall. Soft tissue and disease, no matter which way to invade the chest wall, the chest wall tissue will be destroyed in the late stage due to the enlargement of the lesion.
Prevention
Chest wall tuberculosis prevention
1. Strengthen health education so that young people can understand the harms and ways of infection of tuberculosis, develop good health habits that do not spit, and sterilize or disinfect drugs for tuberculosis patients.
2. Regular physical examination of adolescents should be done early, early isolation and early treatment. In addition, BCG should be given to infants and young children on time to make the body immune and reduce the occurrence of tuberculosis.
3. Found that there are symptoms such as low fever, night sweats, dry cough, blood stasis in the sputum, etc., should go to the hospital for examination in time, after the diagnosis of tuberculosis, immediately use streptomycin, remi seal, ethambutol drugs for treatment, at the same time, Pay attention to increase nutrition to enhance physical fitness. As long as it is found to be timely and completely treated, structural nuclear disease can be completely cured.
Complication
Chest wall tuberculosis complications Complications, pulmonary tuberculosis, hemoptysis, pneumothorax
Tuberculosis is easy to occur. Tuberculosis, commonly known as "pulmonary sputum", is a highly contagious chronic wasting disease caused by tubercle bacilli invading the human body.
1, systemic symptoms systemic symptoms are low fever in the afternoon, fatigue, loss of appetite, weight loss, night sweats, etc., when the lung lesions spread rapidly, there may be high fever, women may have menstrual disorders or amenorrhea.
2, respiratory symptoms are generally dry cough or only a small amount of mucus sputum, with secondary infection, sputum is mucinous or purulent, about 1/3 of patients have varying degrees of hemoptysis.
3, when the inflammation spreads to the parietal pleura, the corresponding chest wall has tingling, generally not severe, with the increase of breathing and cough, chronic severe pulmonary tuberculosis, respiratory function impairment, progressive dyspnea, even purpura, and pneumothorax or When there is a large amount of pleural effusion, there is a sudden difficulty in breathing.
Symptom
Common symptoms of chest tuberculosis Symptoms of fatigue, weight loss, sputum, bloodshot, night sweats, tuberculosis, low fever, abscess, secondary infection, bone destruction
Systemic symptoms are not obvious, but there may be symptoms of general tuberculosis infection, such as weight loss, fatigue, night sweats and low fever. Local signs show different clinical manifestations and signs according to the lesions. The initial stage of the disease is painless cold abscess. Fluctuation, but there is no redness, fever and tenderness on the surface of the abscess. The abscess is not connected with the surface skin. The puncture can extract milky white pus or a small amount of cheese-like substance. The smear or ordinary culture can be seen without purulent bacteria. When the abscess is increasing, The surface of the abscess becomes thinner and the tension is increased. For example, the purulent bacteria invade the abscess and cause secondary suppurative infection. At this time, the skin of the abs surface appears redness, fever, swelling and tenderness, and may even be accompanied by acute inflammatory reaction of the whole body. Fever, the last abscess collapses to form a chronic sinus that has not healed for a long time, long-term pus, or pus discharge through drainage, pus is milky white bean dregs, after the formation of sinus can be long-lasting or time-lapse, abscess Adjacent ribs or sternum are compressed or eroded by abscess, causing irregular destruction of bone destruction.
Examine
Examination of chest wall tuberculosis
1. Thoracentesis: The most reliable diagnostic method is to find tubercle bacilli from puncture pus; or to determine the diagnosis of granulation tissue biopsy at the sinus, the puncture site should be selected above the abscess to avoid vertical puncture and cause pus along The needle path flows out to form a fistula.
2, X-ray examination: the diagnosis of chest wall tuberculosis is very helpful, may show lung or pleural tuberculosis lesions, rib or sternum destruction, chest wall soft tissue shadow, but it must be clear, X-ray examination negative can not rule out chest wall tuberculosis Diagnosis.
3, if there is a chronic fistula or ulcer, can be diagnosed by biopsy.
Diagnosis
Diagnosis and diagnosis of chest wall tuberculosis
diagnosis
In chest wall disease, the most common is chest wall tuberculosis. Therefore, for chest wall masses without acute inflammation or those with chronic sinus formation, the diagnosis of chest wall tuberculosis is considered, such as tuberculosis in patients' lungs or other organs. Diagnosis The possibility of tuberculosis for the chest wall is even greater. The most reliable diagnostic method is to find tuberculosis from the pus pus; or to determine the diagnosis of granulation tissue biopsy at the sinus.
Differential diagnosis
1. Suppurative chest wall abscess: local acute inflammation, and often have systemic infection symptoms, a shorter course of disease and more pus in the purulent sputum.
2. Spinal tuberculosis and paraspinal abscess: X-ray examination of the spine can confirm the diagnosis.
3. Externally wearing tuberculous empyema: After the puncture of the mass, it can be seen to be significantly reduced, but soon it can be quickly bulged, and the chest X-ray examination can confirm the diagnosis.
4. Breast tuberculosis: generally located in the shallow part of the female pectoralis major, breast in the front chest wall, clinically less common.
5. Chest wall tumors: common chest wall tumors are: chondroma, chondrosarcoma, fibrosarcoma, neurofibromatosis and cavernous hemangioma. However, this soft tissue tumor can be similar to the chest wall cold abscess, so it should be distinguished when diagnosed.
6. Costal cartilage disease: more common in young women, lesions often involve one or both of the 2nd to 4th costal cartilage, the affected costal cartilage is obviously elevated and tenderness is mild, it is feasible to locally inject 50mg of dexamethasone, if conservative treatment is invalid. Consider surgical resection.
