cavitary tuberculosis
Introduction
Introduction to hollow tuberculosis Cavity tuberculosis: the long-term unhealed cavity wall is thick and thick, due to the therapeutic effect and the body's immunity, the lesions have absorption and repair, and the deterioration progresses alternately, resulting in chronic fibrovascular tuberculosis, prolonged disease course, symptomatic fluctuation, and sputum positive Is the main source of transmission of tuberculosis. The x-ray shows single or bilateral, single or multiple thick-walled voids, often accompanied by bronchial disseminated lesions and pleural thickening. Due to fibrotic contraction of the lesion, the hilum is hanging, the texture is weeping willow, the mediastinum moves to the disease side, and the adjacent lung tissue or contralateral lung is compensatory emphysema, often accompanied by chronic bronchitis, bronchiectasis, secondary lung infection. , pulmonary heart disease, etc. More serious lung damage, fibrosis, leading to lung or unilateral lung contraction, resulting in "destroyed lungs." basic knowledge The proportion of illness: 0.09% Susceptible people: no specific population Mode of infection: droplet spread Complications: pneumothorax
Cause
Cavity tuberculosis
Cause
Mycobacterium tuberculosis belongs to the actinomycetes, mycobacteria of the mycobacteria family, and is a pathogenic acid-fast bacteria. Mainly divided into human, cattle, birds, mice and other types. People who are pathogenic to humans are mainly human bacteria, and bovine bacteria are rarely infected. The resistance of tuberculosis to drugs can be formed by the development of congenital drug-resistant bacteria in the flora, or it can be quickly developed due to the use of an anti-tuberculosis drug alone in the human body. bacteria. Drug-resistant bacteria can cause treatment difficulties and affect the efficacy.
Prevention
Cavity tuberculosis prevention
1. Vaccination with BCG
BCG should be vaccinated in uninfected persons such as neonates, recruits and new trainees with negative serotonin test, young workers in new TB medical units, and adolescents undergoing kidney transplantation.
2, chemoprevention
Selective chemoprevention of infected persons is as follows:
(1) Close contacts of patients with bacteriucin, such as children with positive serotonin test (no BCG), strong positive adolescents.
(2) The children and adolescents were tested positively, and the adult sputum test was strongly positive.
(3) Inactive tuberculosis is one of the following:
1 long-term large amount of glucocorticoids, immunosuppressants, cytotoxic drugs.
2 radiation therapy.
3 before and after gastrectomy.
4 recruits, new students, strong test positive.
5 tuberculosis and HIV double infection, AIDS patients with positive test.
6 Kidney transplant recipients have tuberculosis, or have inactive tuberculosis.
7 diabetes combined with inactive tuberculosis.
8 patients with silicosis (silicosis) who were positive for the test.
For chemoprevention, the isoniazid adult is 0.3g/d, the child is 6-8mg/(ks·d), and the treatment lasts for 6 months.
3. Eliminate the source of infection
Sputum smear positive (smear positive) tuberculosis is the main source of infection, eliminating the source of infection is the fundamental countermeasure to control tuberculosis. The initial treatment of smear-positive pulmonary tuberculosis and re-treatment of smear-positive pulmonary tuberculosis is the main target of chemotherapy.
Complication
Cavity tuberculosis complications Complications
1, pneumothorax
When the lung cavity and cheese-like lesions are close to the pleural area, it can cause tuberculous pus. Miliary tuberculosis can cause bilateral spontaneous pneumothorax.
2. Endobronchial stenosis
Caused by endobronchial lesions.
3, bronchiectasis
Repeated progression and fibrosis of tuberculosis lesions, resulting in the destruction of the normal structure of the bronchus in the lungs, can cause secondary bronchiectasis, often repeated hemoptysis. Often located in the upper lobe, called dry branch expansion. Can cause fatal hemoptysis.
4, empyema
The pleural effusion of exudative pleurisy, if not treated in time, can be gradually cheeseified or even purulent, becoming tuberculous empyema. It is the result of the progression of cardiovascular and cavitary lung tuberculosis infection, often occurring after pneumothorax, accompanied by failure and loss of resistance to infection.
5, pulmonary aspergillosis
Common in tuberculosis. Hemoptysis is the leading cause of death in this disease.
6, chronic pulmonary heart disease
Severe tuberculosis causes extensive destruction of lung tissue. Chronic fibrovascular tuberculosis or one-sided lung damage, complicated by emphysema, bullous bullae, can cause spontaneous pneumothorax, can also lead to chronic heart disease, and even cardiopulmonary failure.
Symptom
Cavity tuberculosis symptoms common symptoms thin cough hemoptysis rheumatoid snorkeling signs of low heat septicemia
1. The tuberculosis cavity occurs mostly in the posterior segment of the upper tip, the dorsal segment of the lower lobe, and the posterior basal segment. Inflammatory cavities occur mostly in the middle and lower lung fields and can occur in any of the lungs and lung segments. When occurring in the lungs of the front, the inflammation cavity should be considered first.
2. The tuberculous cavity is thick-walled with cheese walls as the main body, and the density of the wall is not high. Inflammatory cavities first appear dense cloud-like shadows, and there are translucent areas in the shadows, and the walls are irregular.
3, tuberculosis hollow walls have thick-walled voids, thin-walled voids, tension holes, etc., the walls of the cave may have calcification. The inflammatory wall is thicker, generally more than 3mm, a few can reach 10mm, but the acute cavity of staphylococcal pneumonia (especially the blood-borne so-called "bubble cavity") and chronic lung abscess can form thin-walled voids; In addition to the abscess caused by staphylococcal pneumonia, attention should also be paid to the identification of abscess-type pulmonary amebiasis.
4, tuberculous cavity in addition to infection, generally there will be no liquid level, and inflammatory cavity due to inflammatory tissue necrosis, liquefaction often have liquid level.
5, common multiple forms of tuberculosis around the cavity, such as cloud-like infiltrating shadows, fiber strips, nodules, calcification shadows, common pleural adhesions adjacent to the cavity, common ipsilateral, contralateral bronchial dissemination . The outer edge of the cavern wall of inflammation has a large number of blurred shadows, which can be a radiographic edge of the image of pneumonia infiltration, often spanning, and the surrounding pleura may have a more serious reaction. Chronic lung abscess When the inflammation subsides, the fiber in the cave wall proliferates, the density increases, and the irregularity sometimes occurs. In general, inflammation cavities often have no disseminated lesions.
6, tuberculosis hollow large and small changes are relatively slow, and inflammation of the cavity due to inflammation is acute, the size is easy to change.
7, tuberculosis cavity is generally less than 6cm rare.
8, tuberculous cavity often have bronchial disseminated foci; secondary infection can have liquid level.
9. Tuberculosis cavities often shrink with effective anti-tuberculosis treatment and expand with anti-tuberculosis treatment.
10, the cavity in the atelectasis is mostly tuberculous cavity; tuberculosis caused by atelectasis often due to pulmonary fibrosis contraction, accompanied by chronic inflammation of the bronchus or endobronchial tuberculosis, caused by stenosis, does not completely block the trachea Or bronchi.
Examine
Examination of hollow tuberculosis
1, laboratory inspection
Routine tests such as blood, urine, stool, erythrocyte sedimentation rate, liver and kidney function were routinely checked once during admission. Abnormalities were reviewed, and 1 time was reviewed at discharge; liver and kidney function were reviewed once a month. The TB tuberculosis was admitted to the hospital three times in a row, and the smear method was acid-stained and microscopically examined, and at least once a month. In the necessary unconventional examinations, the tuberculosis culture, strain identification and drug sensitivity test are performed. Those with negative tuberculosis can be tested for polymerase chain reaction (PCR) and anti-tuberculosis antibodies. Those suspected of having secondary infections should be tested for common bacteria, fungi, anaerobic bacteria and drug susceptibility.
2, chest X-ray examination
Patients admitted to the hospital should have a recent posterior position of the chest (within 1 week), and if necessary, a lateral position, a anterior arch position, and a tomographic photograph. The chest radiograph was taken every 2 months during treatment and at the time of discharge. Chest is performed once a month or as necessary. Thoracic CT examinations are performed as needed.
3. Other inspections
Tuberculin test according to the condition, fiberoptic bronchoscopy and bronchoalveolar lavage fluid examination, fiberoptic bronchoscopy or percutaneous lung biopsy, thoracoscopy, mediastinoscopy, lung function, blood gas analysis, electrocardiogram, ophthalmoscope, laryngoscope, etc. an examination.
Diagnosis
Diagnosis and diagnosis of cavitary pulmonary tuberculosis
diagnosis
Medical history
1. Ask about the history of exposure or previous history of pleurisy, anal fistula, cervical lymphadenopathy, diabetes, and BCG contact.
2, there are symptoms of tuberculosis, such as low fever, general malaise, fatigue, night sweats, loss of appetite, cheeks flushing. Miliary tuberculosis and caseous pneumonia are often associated with high fever, some may be associated with joint pain, and women may have menstrual disorders.
3, early dry cough, cavity formation, infection, purulent purulent or purulent, hemoptysis, chest pain, severe breathing difficulties.
Differential diagnosis
The clinical and X-ray findings of tuberculosis are often similar to many non-tuberculous lung diseases. It is easy to be misdiagnosed. It is necessary to emphasize the comprehensive analysis based on medical history, relevant laboratory data, X-ray films, etc. The necessary fashion needs to be observed dynamically and carefully identified.
