tuberculoma
Introduction
Introduction to tuberculoma Tuberculosis, also known as tuberculosis, is not a tumor, but a special form of tuberculosis. Tuberculoma is generally not cancerous. Most of the tuberculomas have evolved from secondary pulmonary tuberculosis. When the number of tuberculosis bacteria is small, the virulence is low, and the body's allergic reaction is weak and the immunity is strong, the tuberculous inflammation is soon wrapped by fibrous tissue to form a tuberculoma. The tuberculosis ball is a fibrous package of tuberculosis, which is generally non-infectious, but may recur and re-infect, and it is contagious at that time. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: respiratory transmission Complications: pneumothorax, bronchiectasis, empyema
Cause
Causes of tuberculosis
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
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, immunosuppressive agents, 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
Tuberculosis complications Complications, pneumothorax, bronchiectasis
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.
Symptom
Symptoms of tuberculoma common symptoms Wet rhythm hemoptysis with cough and phlegm, low heat, fatigue, difficulty breathing, cachexia
The disease is concealed, the symptoms are not typical, some patients have no symptoms, and occasionally when the body is found, more men than women, more than 40 years old, more history of tuberculosis infection and exposure history.
Examine
Tuberculosis examination
Imaging characteristics
1, the site: more common in the subclavian region, that is, the posterior segment of the upper tip of the lung is more common, followed by the lower back segment.
2, shape: round, oval more common, irregular shape second, the density is high and uneven, the spherical contour is clear and tidy, occasionally see shallower leaves, and some may also be accompanied by voids, hollow forms are different, often It is thick-walled, and some of the cavities are eccentric, mostly biased toward the hilum side, and burrs are less common. Calcification has practical implications for the diagnosis of tuberculoma. There are several types of calcification: localized arc calcification along the subcapsular, layered circular calcification or diffuse spotted calcification. Proliferative or fibrotic lesions in the lung fields near the tuberculosis sphere, the so-called satellite foci, also contribute to the diagnosis. A strip of shadow is sometimes seen between the hilum and the hilum.
3, the diameter of the lesions <4cm tuberculosis tumors are mostly round, smooth edges, uniform density, common calcification, surrounding spleen thickening of the satellite near the apex, rare shallow lobes, sparse long burrs, near the small end of the small cavity and slightly lower Density, etc., lesions >4cm in diameter are mostly shallow lobes or irregular in shape, uneven density, smooth edges, more common calcification, surrounding satellite foci, sparse burr near the heart cavity and slightly lower density in the middle, etc. Scanning is enhanced or not enhanced by the capsule, and rare uniform enhancement is achieved. The atypical CT findings ultimately depend on pathological examination.
Pathological anatomy
A tuberculoma or tuberculosis ball is pathologically a cheese lesion surrounded by a fibrous membrane with a diameter of about 2 cm. There are four reasons for its formation: (1) it is formed by fibrosis of cheese pneumonia. (2) The formation of caseous necrosis from tuberculous granulation tissue, often composed of several small lesions. (3) Formed by obstructive voids filled with cheese material. (4) The outward development of large bronchial tuberculosis close to the hilum. Among them, the first one is the most common. The lobulation is caused by the fusion of multiple tuberculosis spheres. The cavity is formed by the liquefaction of necrotic material in the lumps along the bronchus. Calcification is the formation of cheese necrosis calcium deposits in the mass, and most of the pleural changes are localized pleural hypertrophy and fibrosis caused by chronic inflammation. TB can generally find tuberculosis.
Diagnosis
Diagnosis and diagnosis of tuberculoma
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Differential diagnosis
1, should be differentiated from peripheral lung cancer, especially round lung cancer.
2, the size and shape of the lesion: tuberculosis ball is mostly less than 5cm, the shape is more regular, lung cancer should be considered when the shape is more than 5cm and the shape is irregular.
3, the nature of the lesion: the performance of round or elliptical, mostly irregular, may be associated with lobulation, cavity, calcification, satellite stove and pleural changes, burrs are rare. Lesions of calcification or satellite lesions are important means of differential diagnosis.
