Tuberculosis of bronchial tubes – the specific inflammatory damage to a bronchial wall caused by M. tuberculosis and which is usually complicating the course of tuberculosis of intra chest lymph nodes (VGLU) and lungs. Not stopped pristupoobrazny cough with allocation of a poor phlegm, thorax pain, short wind, a blood spitting is typical for tuberculosis of bronchial tubes. The diagnosis is exposed taking into account data of a X-ray-tomographic research, a bronchography and bronkhoskopiya, the analysis of laboratory material on VK, tuberkulinodiagnostik. Treatment of tuberculosis of bronchial tubes is performed by antitubercular antibiotics which can be entered systemically and locally (it is inhalation, intratrakheobronkhialno).
Tuberculosis of bronchial tubes
Tuberculosis of bronchial tubes - a kliniko-morphological form of tuberculosis of respiratory organs which leading sign infiltrative, ulcer or svishchevy defeat of walls of bronchial tubes is. Can arise at primary tubercular process or again develop as a complication of active tuberculosis of lungs and VGLU. It is often combined with tuberculosis of a trachea and throat. Sexual and age distinctions in incidence of tuberculosis of bronchial tubes are not expressed, however it is known that at the vaccinated children bronchial tubes are surprised by 2,4 times less than at not imparted. Statistically, most often (in 13-20% of cases) is complicated by trakheobronkhialny tuberculosis fibrous tuberculosis of lungs, is slightly more rare (in 9-12%) kavernozny and disseminirovanny, is even more rare (in 4%-12%) – infiltrative and focal tuberculosis. All this dictates the increased vigilance concerning possible development of tuberculosis of bronchial tubes in persons with other forms of tuberculosis of respiratory organs.
Reasons of tuberculosis of bronchial tubes
As the independent shape, tuberculosis of bronchial tubes meets seldom. More often the current of destructive forms of tuberculosis of lungs, a tubercular bronkhoadenit and primary tubercular complex is complicated by it. Infection of a bronchial tree with mikobakteriya of tuberculosis can happen the next ways:
- contact - at germination of granulations from the affected lymph nodes in a bronchial tube wall;
- bronkhogenny - at allocation through bronchial tubes of the infected phlegm at patients with destructive forms of tuberculosis;
- limfogenny – at dispersion of mikobakteriya on peribronkhialny lymphatic ways at patients with VGLU tuberculosis;
- hematogenic - at distribution of mikobakteriya on peribronkhialny blood vessels at extra pulmonary or miliarny tuberculosis.
At perforation of a bronchial tube kazeozny masses at the initial stage notes infiltration of a mucous membrane of bronchial tubes against the background of which specific epitelioidny granulomas are formed. Perforation can be so microscopic that is not even visualized at a bronkhoskopiya. Nevertheless, together with kazeozny particles a significant amount of MW can get to a gleam of a bronchial tube, leading to aspiration of the infected material and development of aspiration kazeozny pneumonia. Treatment happens to formation of cicatricial fabric in the place of perforation that leads to deformation and a stenosis of a trachea and bronchial tubes, development of a pneumosclerosis and violations of pulmonary ventilation.
In case of bronkhogenny infection first of all in process it is involved the bronchial tubes draining a cavity. At the same time hyperaemia and hypostasis of a mucous wall of a bronchial tube, hypostasis of a submucous layer develops; function of a vibrating epithelium and bronchial glands therefore in a gleam of bronchial tubes a large number of a mucous secret collects is broken. Sometimes against the background of infiltration of bronchial tubes ulcer defects which begin to live with formation of a hem are formed. At tuberculosis of bronchial tubes segmentary and subsegmentary branchings or large bronchial tubes can be surprised (share, intermediate, main, the field of bifurcation).
Classification of tuberculosis of bronchial tubes
In a ftiziopulmonologiya distinguish infiltrative, ulcer and svishchevy (fistulose) patomorfologichesky forms of tuberculosis of bronchial tubes. At infiltrative option defeat of a wall of a bronchial tube is traced on a limited extent; the site of a thickening and hyperaemia has the roundish or extended form; in this place the cartilaginous drawing of a bronchial tube is not differentiated, however the gleam of a bronchial tube can not change. Batsillovydeleniye, as a rule, is not observed.
At an ulcer form of tuberculosis mouths of segmentary and share bronchial tubes are surprised more often. At productive inflammatory reactions ulcer defects limited, superficial, having the smooth or covered with granulations bottom. If inflammatory reaction has ekssudativno-necrotic character, ulcers deep, bleeding, with the bottom covered with a dirty-gray raid. Bakteriovydeleniye is marked out more often.
The Svishchevy form of tuberculosis of bronchial tubes is formed at break of a lymph node in a bronchial tube wall. Limfobronkhialny fistula has the funneled form; when pressing it whitish-yellow kazeozny masses is allocated. Through fistula from lymph nodes calcium crystals can get into bronchial tubes. Bronkholita can obturirovat small bronchial tubes, promoting development of an atelektaz of lungs and in the long term - bronkhogenny cirrhosis of a lung.
Symptoms of tuberculosis of bronchial tubes
In most cases (98%) tuberculosis of bronchial tubes proceeds chronically, the subsharp and sharp current is observed seldom (2%). The clinical picture of tuberculosis of bronchial tubes is defined by its form, localization, existence of complications, defeats of pulmonary fabric.
In the classical option trakheobronkhialny tuberculosis proceeds with persistent cough which is not stopped after reception of protivokashlevy medicines. Cough is pristupoobrazny, barking, disturbs the patient day and night, is followed by office of not plentiful viscous phlegm of mucous character, flavourless. At an ulcer form the blood spitting can be noted. In case of accession of a stenosis of bronchial tubes breath becomes whistling, short wind develops. The pain and burning which are localized behind a breast between shovels are other characteristic signs of tuberculosis of bronchial tubes.
The infiltrative form of tuberculosis of bronchial tubes can proceed asymptomatically or with poor clinical signs. The all-infectious symptoms accompanying pulmonary tuberculosis (fever, night perspiration, loss of weight) at tuberculosis of bronchial tubes are expressed moderately or are absent. From complications of trakheobronkhialny tuberculosis bronchial pneumonia, stenoses of a trachea and bronchial tubes, bronkhoektaza most often meet. At a bronchial tube gleam obturation bronkholity the clinic can remind bronchitis, a foreign matter, a bronchial tube tumor.
Diagnosis of tuberculosis of bronchial tubes
Patients with tuberculosis of bronchial tubes at the time of diagnosis, as a rule, already stay on the registry at the phthisiatrician. Much less often tuberculosis of bronchial tubes comes to light at planned fluorography, at is long in the fever persons, patients with persistent cough and an unmotivated blood spitting. Purposeful inspection is carried out in the conditions of an antitubercular clinic.
The X-ray analysis and KT of lungs finds destructive damage of lungs, deformation of bronchial tubes, sites of hypoventilation and an atelektaz. Secondary changes of bronchial tubes (stenoses, bronkhoektaza) come to light in the course of a bronchography. Fibrobronkhoskopiya allows to establish localization and a form of process: catarrhal endobronchitis, infiltrative, ulcer, cicatricial defeat mucous, bronchial tube fistula. However even lack of endoscopic signs of specific defeat does not exclude the diagnosis of tuberculosis of bronchial tubes. The research of a phlegm and lavazhny liquid on existence of MBT allows to confirm the bakteriovydeleniye fact.
Results of a tuberkulinodiagnostika are most often characterized by giperergichesky reaction, however it most often reflects activity of process in lungs. IFA-diagnostics - definition in blood of a caption of antitubercular antibodies is used. Differential diagnosis of tuberculosis of bronchial tubes is undergone with nonspecific bronchitis and trakheobronkhity, sarkoidozy Beck, foreign matters of bronchial tubes, silikotuberkulezy, an endobronchial tumor, syphilis of bronchial tubes. The bronkhoskopiya with a biopsy and a morphological research of pathological sites is made for verification of nature of changes of bronchial tubes.
Treatment and forecast of tuberculosis of bronchial tubes
Detection of trakheobronkhialny tuberculosis indicates the complicated course of pulmonary process therefore therapeutic impact on an organism has to be complex and strengthened. In medical courses various combinations of antitubercular means (not less than 3-4 names among which there is a streptomycin, rifampicin, , , PASK) are used. Terms of treatment of infiltrative or ulcer tuberculosis of bronchial tubes make 3-6 months; a svishchevy form – 8-10 months. As pathogenetic therapy, corticosteroids are applied to reduction of infiltration and hypostasis of mucous.
At tuberculosis of bronchial tubes, except system reception of himiopreparat, local therapy is used: at the localized process – endobronchial introduction of himiopreparat, at widespread defeat - aerosol therapy. Methods of local influence can also include sanatsionny bronkhoskopiya with removal of kazeozny masses and washing of bronchial tubes, a diatermokoagulyation or cauterization of granulations by trikhloruksusny acid, laser therapy mucous bronchial tubes. At development of a cicatricial bronkhostenoz of II and III degrees the question of surgical treatment is raised: stenting, plasticity of a bronchial tube or resection of a lung. During rehabilitation are shown sanatorium and climatic treatment.
The current and outcome depend on a form of tuberculosis of lungs and bronchial tubes. More than in 80% of cases at the correct treatment clinical treatment of tuberculosis of bronchial tubes is noted. For the prevention of a recurrence within the next 2 years in the spring and in the fall specific chemoprophylaxis is carried out.