Kavernozny tuberculosis of lungs – a destructive form of a disease which distinctive feature is existence in pulmonary tissue of the isolated cavity of disintegration (cavity). Clinic of this form of tuberculosis of a malosimptomn: fatigue, the lowered appetite, cough with a phlegm are expressed poorly; the sudden blood spitting or bleeding can indicate pathology. Radiodiagnosis, a tuberkulinodiagnostika, detection of MBT in a phlegm helps to reveal kavernozny tuberculosis of lungs. Treatment includes hospitalization, antitubercular chemotherapy, respiratory gymnastics, physical therapy; according to indications – surgical tactics.
Kavernozny tuberculosis of lungs
Kavernozny tuberculosis of lungs – the stage of progressing of tuberculosis of lungs proceeding with formation of a thin-walled cavity for which inflammatory and fibrous changes of walls and surrounding pulmonary fabric are not peculiar. Incidences are generally subject adult patients; with primary tubercular complex and tuberculosis of VGLU formation of cavities occurs at children less often.
More than in half of cases the kavernozny form serves as an outcome of infiltrative tuberculosis, in other cases – disseminirovanny and focal tuberculosis of lungs. At absence or inadequacy of specific treatment the kavernozny form passes into a fibrous kavernozny tuberculosis of which the fibrozirovaniye of walls of a cavity and a surrounding parenchyma of lungs, and also existence of the numerous centers of an obsemeneniye is characteristic. 5-6% of all cases of a tuberculosis infection are the share of a share for the first time revealed kavernozny and fibrous tuberculosis of lungs in pulmonology. The subsequent progressing of tubercular process can lead to approach of a final stage of a disease – tsirrotichesky tuberculosis – to wrinkling of a lung owing to extensive growth of rough connecting fabric.
Reasons of kavernozny tuberculosis of lungs
Destructive process can begin at any clinical form of tuberculosis of lungs - infiltrative, disseminirovanny, focal, a tuberkulema. The massive superinfection, increase in a sensitization and change of reactivity of an organism, associated diseases and addictions (smoking) can serve as the contributing conditions for development of kavernozny tuberculosis.
Formation of band education (cavity) in a lung is preceded by a disintegration phase - education in the inflammatory center of a cavity which is filled with a special type of necrotic fabric – kazeozny masses. Under the influence of proteolytic enzymes dry kazeozno-necrotic masses gets a liquid consistence and is gradually torn away through the draining bronchial tube, leaving a residual cavity on the place. Further this cavity is filled with air, and at violation of drainage function of a bronchial tube – liquid.
The wall of the created cavity is presented by three layers: from within it is covered by a layer of kazeozny masses (a piogenny cover), in the middle there is granulyatsionny a cover presented by huge and epitelioidny cages, outside the cavity is surrounded with the thin elastic soyedinitelnotkanny capsule. Existence of a single cavity, lack of the expressed inflammatory reaction and fibrous changes in bronchial tubes, lymphatic vessels and the fabric surrounding them are characteristic patomorfologichesky signs of kavernozny tuberculosis of lungs.
Classification of kavernozny tuberculosis of lungs
According to the pathogenetic characteristic of cavities in phthisiology distinguish their following types:
- fresh breaking up – formation of cavities in the centers of kazeozny disintegration which are not delimited from pulmonary fabric (a disintegration phase)
- fresh elastichesky – formation of the two-layer delimited cavities with existence of piogenny and granulyatsionny covers (a disintegration phase)
- encapsulated – actually kavernozny tuberculosis of lungs, the organization of cavities with three-layer structure (see above)
- fibrous – correspond fibrous to tuberculosis; outside of a cavity are surrounded with a fibrous cover
- sanified – cavities are cleared of granulations and a kazeoz; in fact represent residual cavities after treatment of tuberculosis.
Depending on the size of a cavity averages (with a diameter of 2-5 cm) and big share on small (with diameter less than 2 cm) (with a diameter over 5 cm).
Symptoms of kavernozny tuberculosis of lungs
Localization of kavernozny tuberculosis of lungs usually unilateral. The disease develops, as a rule, for the 3-4th month of inefficient treatment of other forms of tuberculosis. The clinical picture is most expressed in a disintegration phase. There is cough with a phlegm, a blood spitting. Over a cavity of disintegration damp rattles are listened.
After the end of formation of a cavity the symptomatology becomes poor, low-expressed and not specific. The adynamy, constant feeling of fatigue, the lowered appetite, weight loss can be noted, periodic subfebrilitt. Patients with kavernozny tuberculosis of lungs are the tank of an infection and a source of distribution of mikobakteriya. Therefore exactly the bakteriovydeleniye a basis for more detailed inspection of the patient becomes frequent.
Can point the pulmonary bleeding developing to the hidden tubercular process as though it is causeless, against the background of full health. So-called aneurisms of Rasmussen (when involving in a cavity of terminal pulmonary arteries), cavity aspergillomycosis, including the sanified cavities can become a source of profuzny bleeding. To the complicated option of a course of kavernozny tuberculosis the break of a cavity in a pleural cavity also treats with development of bronkhoplevralny fistula or an empiyema of a pleura.
Kavernozny tuberculosis of lungs proceeds not longer than 2 years. Healing of cavities is possible in several options: with formation of a hem, tuberkulema, single tubercular center, the sanified cavity. In other cases kavernozny tuberculosis passes tuberculosis of lungs into a fibrous kavernozny.
Diagnosis of kavernozny tuberculosis of lungs
As a rule, by the time of detection of kavernozny tuberculosis of lungs patients already stay on the registry at the phthisiatrician, and in the anamnesis there are data on the postponed tubinfektion. Less often tuberculosis in this stage comes to light for the first time, usually – when carrying out preventive fluorography. Auskultativny data are not informative therefore cavities often call "mute". Gemogramma is more often within norm, is sometimes observed insignificant , a limfotsitopeniye, increase in SOE.
Further radiological inspection (X-ray analysis of lungs) finds ring-shaped shadows with peripheral localization of oval or rounded shape. After obtaining radiological data differential diagnostics with lung abscess, peripheral cancer of a lung, bullous emphysema, limited pheumothorax, echinococcosis, osumkovanny pleurisy is required. Essential help in it is given by laboratory and endoscopic researches.
At for the first time the revealed kavernozny tuberculosis of lungs in the analysis of a phlegm of MBT are found in a large number. Carrying out a bronkhoskopiya is necessary not only for receiving material for a research in the absence of a phlegm, but also for detection of inflammatory changes in the bronchial tubes (endobronchitis) interfering closing of a cavity. Result of tuberkulinovy tests slabopolozhitelny.
Treatment and forecast of kavernozny tuberculosis of lungs
Because of an active bakteriovydeleniye patients with kavernozny tuberculosis of lungs need hospitalization in the conditions of an antitubercular clinic. Therapy for the first time of the revealed kavernozny process is carried out by means of simultaneous purpose of 3-4 antitubercular medicines (usually - an isoniazid, an etambutol, rifampicin and streptomycin). For ensuring high concentration of specific chemotherapeutic means they can be entered intravenously, vnutribronkhialno, and also directly into a cavity cavity. The tuberkulinoterapiya, remedial respiratory gymnastics, physical therapy (an induktotermiya, ultrasound, laser therapy) is in addition appointed. In case of high risk of development of medicinal resistance of mikobakteriya to the scheme of treatment add a ftorkhinolona and .
In opportunities carrying out a 4-6-month course of specific therapy brings positive results: there is a termination of a batsillovydeleniye, reduction and closing of a cavity. If during the called term it is not possible to reach healing of a cavity, the decision on expeditious treatment of kavernozny tuberculosis is made: resections of a lung, operational kollapsoterapiya (imposing of artificial pheumothorax). At any succession of events after a stationary stage sanatorium and out-patient treatment with the subsequent dispensary observation is carried out.
In most cases kavernozny tuberculosis of lungs gives in to treatment. Against the background of tuberkulostatichesky therapy of a cavity of the small sizes are closed and cicatrize. Cavities with rigidny walls over time again are filled with kazeozny masses that leads to formation of a psevdotuberkulema. Failures (suppuration, aspergillomycosis, progressing of tubercular process, etc.) meet seldom.