Thoracic vertebral tuberculosis paravertebral abscess penetrating the thoracic cavity
Introduction
Introduction of thoracic tuberculosis paraspinal abscess into the chest Spinal tuberculosis ranks first in tuberculosis, among which tuberculosis is the most common tuberculosis, accounting for more than 50% of spinal tuberculosis. The incidence of thoracic tuberculosis accounts for 30% to 40% of spinal tuberculosis, and almost all thoracic tuberculosis has different degrees of paraspinal abscess, of which about 1% break into the chest, forming secondary pleurisy or empyema. Paraspinal abscesses are worn out and cause respiratory symptoms after entering the chest. Often misdiagnosed as a chest disorder, delaying the diagnosis and treatment, thus affecting the prognosis. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: pleural effusion, atelectasis, tuberculosis
Cause
Thoracic vertebrae tuberculosis paraspinal abscess into the thoracic cavity
Spinal tuberculous abscess can be locally infiltrated or directly ruptured into adjacent organs, the most common is the lung, penetrating into the esophagus or colon is rare, can be encountered when the rupture penetrates into the chest, as for the cause of abscess ulceration, It is not clear yet, and it is still in the discussion stage.
Prevention
Thoracic vertebrae tuberculosis paraspinal abscess into the chest cavity prevention
In order to prevent the patient from recurring, the patient should be given some health education, and the patient should be treated with 3 or 4 drugs for 2 months. The total course of treatment is no less than 6 months and early, combined, moderate, regular, and full-course chemotherapy. Some understanding, monthly review of liver function, if necessary, add liver-protecting drugs, patients with better transition, should be engaged in light physical labor, to achieve work and rest, prevent colds and various infections, should properly smelt the body, enhance physical fitness .
Complication
Thoracic vertebrae tuberculosis paraspinal abscess into the thoracic complication Complications, pleural effusion, pulmonary atelectasis
The diseases caused by the paravertebral abscess of thoracic tuberculosis into the chest or lung have been divided into three types by scholars. They are now divided into three types:
Type I: simple ulceration, paraspinal abscess rupture, may be associated with pleural effusion, pleural effusion volume is different, pleural effusion patients with chest tightness, shortness of breath or high fever, X-ray atelectasis .
Type II: pulmonary adhesion type, after paraspinal abscess ulceration, the lung and visceral pleura will be wrapped in the rupture of the rupture, forming adhesions. At this time, the visceral pleura is thickened, the lung itself has no lesions, and there may be pus or cheese between the adhesions. Samples, but this period of patients is more difficult to diagnose from the image.
Type III: pulmonary lesion type, paraspinal abscess breaks through the visceral pleura, penetrates into the lung, forms a package in the lung, the lesion develops further, or forms a tuberculosis in the lung to form a tuberculosis; or wears a broken bronchus, the patient can cough clinically Cheese samples, pus and even dead bones.
Symptom
Thoracic vertebrae tuberculosis paraspinal abscess into the chest symptoms Common symptoms Chest pain abscess pleural effusion short paraplegia migratory abscess
The age of the patient can be seen in both children and the elderly, but most of them are young and middle-aged. The thoracic vertebrae lesions are mostly in the thoracic vertebrae 6 to 10, and the paravertebral abscess is more common in the right thoracic cavity. About 2/3 of the cases involve about half of the cases with paraplegia. Occasionally, the abscess is also penetrated into the lungs at the same time, so the condition is more serious.
Most patients have formed a effusion or empyema at the time of treatment. A few patients have sudden fever (38 ~ 40 °C) during hospitalization. Symptoms such as chest pain, cough and shortness of breath, such as thoracic tuberculosis, are like the findings of common exudative pleurisy in internal medicine. , often misdiagnosed.
Paravertebral abscesses and other broken parts, the size of the mouth is not the same, the small ones such as rice grains, or sieve holes, the larger diameter of about 0.5 ~ 1cm.
Pleural effusion (or pus) is generally hundreds of milliliters, and more than 100mL.
Examine
Thoracic tuberculosis paraspinal abscess into the chest examination
The main methods of examination for this disease are as follows:
(1) X-ray: In addition to pleurisy or effusion, the mediastinum is faintly visible with enlarged paravertebral shadows. There are no active tuberculosis lesions in both lung fields and mediastinum. X-rays of thoracic vertebrae, especially in the body. The slice shows that the borderline of the paravertebral shadow on the same side as pleurisy is unclear or even disappears from pleurisy.
(2) CT: There can be a mass shadow on the lateral side of the paravertebral abscess, and there is no obvious boundary with the paravertebral; the paraspinal abscess can be found, the edge is not smooth or the wrapped pleural effusion and pleural thickening.
(3) MR I: A mass is seen on the side of the paravertebral abscess, which communicates with the paravertebral. After strengthening, the display is clearer. At this time, the abscess wall has a high signal, and the pus itself has a low signal.
Diagnosis
Diagnosis and differentiation of thoracic tuberculosis paraspinal abscess into the thoracic cavity
For patients with this disease, the performance and treatment of each type are different. Therefore, clinically, the type of simple type, lung adhesion type and lung lesion type should be identified according to the diagnosis points. Clinically, the thoracic tuberculosis is broken into the chest or lung. The main points of diagnosis are as follows:
(1) Symptoms: cough, chest tightness, shortness of breath or fever.
(2) X-ray: paravertebral abscess blur or disappear, or a triangle pointing to the lung; sometimes pleural effusion X-ray findings.
(3) CT or MR I: The surface of the paraspinal abscess is not smooth, and the mass is visible in the paravertebral or lung. CT or MR I can directly show the relationship between the paraspinal abscess and the surrounding tissue, which is decisive for diagnosis.
