Lecture topic:

«Cavernous, fibrous-cavernous and cirrhotic pulmonary tuberculosis. The clinic, diagnostics, differential diagnostics, outcomes.»

Lecturer: Dr Babaeva I.Yu.

Tuberculosis cavern is a cavity formed in the area of tuberculosis damage, limited from the adjacent tissue three- layer capsule.

An important feature of cavernous tuberculosis is the limited and reversible nature of morphological changes, which manifest themselves as a thin-walled cavity without pronounced infiltrative, focal and fibrous changes in the adjacent lung tissue.

The clinical picture of cavernous tuberculosis:

1.Patients who first fell ill with cavernous tuberculosis have no complaints.

2.Cough with little mucous sputum.

3.Increased fatigue, decreased appetite, Unstable moods.

4.Shortening of the percussion sound, after coughing and deep sigh over the affected , sometimes single wet and dry wheezing is heard.

5.Most of patients have "silent" caverns.

X-ray diagnosis of cavernous

tuberculosis:

The leading radiological syndrome, is the RING shadow syndrome:

●closed enlightenment of a rounded or irregular shape.

●the external and internal contours of the cavity are clearly defined and parallel to each other.

●The width of the wall is not more than 3-4 mm.

●In the surrounding lung tissue there is no infiltration, focal shadows and fibrosis.

●There may be an additional radiological sign of the cavity - the level of the liquid, which manifests itself as a horizontal strip in its lower part.

Differential diagnosis of cavernous tuberculosis:

1.Chronic abscesses

2.Residual cavities after an abscess

3.Decaying peripheral cancer

4.Emphysematous bullae (cavities)

5.Local pneumosclerosis of cellular structure

6.Air-filled bronchogenic cysts

7.Parasitic cysts

Fibrous-cavernous tuberculosis (FCT) is characterized by the presence of one or more caverns with a well-formed fibrous layer in the walls, pronounced fibrous and polymorphic focal changes in the lung tissue. FCT is characterized by a chronic, undulating, usually progressive course.

FCT and its complications are the main cause of death in patients with pulmonary tuberculosis (up to 80% of all deaths from tuberculosis).

Main types of fibrous-cavernous tuberculosis:

1.Limited and relatively stable (It has a relatively limited extent and does not show a clear tendency to progress);

2.Progressive;

3.Complicated (Pleural empyema, tuberculosis of the larynx or intestines are often found. it is complicated by caseous pneumonia, which is often fatal. It is accompanied by amyloidosis of the kidneys, liver, spleen).

Types of cavities depending on the specific formation mechanism:

1.Proteolytic cavities - melting of caseous masses begins in the center of the pneumonic focus and gradually spreads to the periphery

2.Sequestering cavities - melting of caseous masses in the marginal areas with advancement to the center of the caseous focus

3.Alterative - The main cause of disintegration is microcirculation and tissue nutrition disorders in the zone of tuberculous lesions, followed by necrosis of individual areas

4.Atheromatous - melting caseous masses in encapsulated foci.

The clinical picture of FCT

1.It is characterized by symptoms of intoxication, cough with sputum, sometimes with an admixture of blood, shortness of breath.

2.Chest deformity, displacement of the mediastinum towards the lesion, pronounced and varied stetoacoustic symptoms.

3.The severity of clinical manifestations fluctuates depending on the phase of the tuberculous process (phases of an aggravation and remission).

X-ray diagnostics of fibrous-cavernous

pulmonary tuberculosis

The radiological syndrome is a syndrome of a formed fibrous cavity:

1.Closed enlightenment of irregular shape (polygonal, slit- like, etc.)

2.External and internal cavities are defined.

3.The width of the cavity wall is not the same along the perimeter of increased intensity.

4.Distinct deformation of the pulmonary pattern around the cavity, pleural thickening above it.

5.Lungs with a cavity are reduced.

6.It shifts towards the cavity of the lung root, the mediastinum of the trachea, and the interlobar grooves.

7.Deformation of the bone skeleton (slanting of the ribs, narrowing of the intercostal spaces above the fibrous cavity, expansion of the intercostal spaces in the area of development of compensatory emphysema).