Tsirrotichesky tuberculosis of lungs – a final stage of tubercular process for which it is typical prevalence of pneumocirrhosis over specific defeat of pulmonary fabric. Tsirrotichesky transformation of a lung is followed by short wind, cough with a phlegm, a blood spitting, respiratory and heart failure. Tsirrotichesky tuberculosis of lungs is diagnosed taking into account X-ray semiotics, functional yielded, results of laboratory and bronkhologichesky inspection. Depending on a phase of a course of tsirrotichesky tuberculosis of lungs antibiotic treatment, specific chemotherapy, correction of pulmonary heart failure is appointed. At limited pneumocirrhosis surgical intervention is made.
Tsirrotichesky tuberculosis of lungs
Tsirrotichesky tuberculosis of lungs – morphological option of a course of a tuberculosis infection which is characterized by the rough cicatricial changes in a pulmonary parenchyma and a pleura which are combined with the minimum activity of a specific inflammation. Develops in the outcome of other forms of tuberculosis of respiratory organs; on observations of different authors, meets frequency of 0,1-8%. Formation of tsirrotichesky tuberculosis of lungs requires the long term estimated for years. At this form of tubercular process morphological reorganization of pulmonary fabric is irreversible, and in the started cases the lethal outcome is possible. Patients with tsirrotichesky tuberculosis of lungs are subject to joint observation from experts in the field of phthisiology and pulmonology.
Reasons of tsirrotichesky tuberculosis of lungs
Tsirrotichesky tuberculosis of lungs usually serves as an outcome of other secondary forms of tuberculosis and seldom arises at primary process. In the majority of observations rough tsirrotichesky changes of a parenchyma are formed against the background of infiltrative, fibrous , disseminirovanny tuberculosis of lungs or pleurisy of a tubercular etiology.
At infiltrative tuberculosis of lungs inflammatory infiltrate in which there is a fibrin loss, a kollagenization of alveolar membranes, a fibrozirovaniye of sites of an atelektaz becomes a patomorfologichesky basis for growth of connecting fabric. At a fibrous kavernoznom tuberculosis rough fibrous transformation affects walls of a cavity and a perikavitarny zone. At involution of disseminirovanny tuberculosis there is a soyedinitelnotkanny transformation of the pathological centers; tsirrotichesky process carries, as a rule, diffusion bilateral character. In all these cases so-called pneumogene cirrhosis of a lung is formed.
At the patients who had tubercular pleurisy, treatment by means of artificial pheumothorax or a surgical torakoplastika plevrogenny cirrhosis develops: at the same time connecting fabric sprouts in a pulmonary parenchyma from a reinforced pleura. VGLU tuberculosis, primary tubercular complex, tuberculosis of bronchial tubes can be complicated by Tsirrotichesky tuberculosis of lungs. At these forms pneumofibrosis develops as a result of a bronchial tube obturation in the atelektatichesky site (more often in reed segments of the left lung, the top or average share of the right lung). Such mechanism of pathogenesis carries the name of bronkhogenny cirrhosis.
Replacement of considerable sites of a parenchyma with connecting fabric, deformation of bronchial tubes, obliteration of vessels, restriction of mobility of lungs owing to pleural shvart and emphysema results in insufficiency of gas exchange and blood circulation, formation of pulmonary heart. Against the background of cicatricial fabric the osumkovanny centers of a kazeoz, and also sites of a productive inflammation are defined. At bronkhogenny option cirrhosis the specific inflammation is usually localized in lymph nodes and bronchial tubes.
Tsirrotichesky tuberculosis of lungs is more often diagnosed for elderly patients as reorganization of pulmonary fabric proceeds more actively with age. Children have a starting factor for development of pneumocirrhosis in due time not recognizable primary tuberculosis which became complicated atelektazy a lung. Taking into account the area of defeat distinguish limited (segmentary, share) and diffusion; one - and bilateral tsirrotichesky tuberculosis of lungs.
Symptoms of tsirrotichesky tuberculosis of lungs
Tsirrotichesky tuberculosis of lungs proceeds wavy, with the periods of an aggravation of a nonspecific and tubercular inflammation. Weight of manifestations depends on extensiveness and localization of tsirrotichesky changes in lungs. At segmentary or verkhnedolevy cirrhosis the symptomatology which is usually low-expressed. Out of an aggravation insignificant short wind and periodically arising dry cough takes place. Even in case of activization of nonspecific bacterial flora, in view of a good bronchial drainage, the expressed clinical picture usually does not develop.
Other current is peculiar to tsirrotichesky tuberculosis of lungs with nizhnedolevy localization or a significant area of defeat. At nizhnedolevy cirrhosis the clinic of purulent bronchitis develops – cough with a purulent phlegm, quite often short wind of astmoidny type disturbs, the blood spitting periodically repeats. Body temperature rises to 38 °C and above, there is an intoksikatsionny syndrome, the set of damp rattles appears. In a phase of an aggravation of tubercular process the batsillovydeniye and symptoms of tubercular intoxication join. At total unilateral or bilateral tsirrotichesky tuberculosis of lungs into the forefront short wind, tachycardia, cyanosis acts.
Hypertensia in a small circle of blood circulation causes developing of pulmonary bleedings. Aspiration of blood can be followed by development of aspiration pneumonia. Gradually the phenomena of heart failure amplify: there are peripheral hypostases, a gepatomegaliya, ascites. At long purulent intoxication HPN develops visceral . Massive bleedings, warm and pulmonary insufficiency and become causes of death of patients with tsirrotichesky tuberculosis of lungs.
Diagnosis of tsirrotichesky tuberculosis of lungs
The complex of diagnostic actions is carried out by the pulmonologist or the phthisiatrician. At survey of patients deformation of a thorax (its flattening, a skoshennost of edges, narrowing of mezhreberiya, emphysematous expansion of the lower departments) draws attention. At percussion over area of pneumocirrhosis shortening of a pulmonary sound is defined. Breath is rigid, sometimes bronchial, dry and damp rattles are constantly listened.
The main diagnostic information on specifics of a disease is given by a X-ray analysis of lungs. On roentgenograms blackout of the struck share or segments is found, pathologically changed site of a lung is reduced in sizes. Against the background of blackout lighter sites can be allocated (bronkhoektaza, cavities). The pleura is thickened, the shadow of a sredosteniye is displaced towards defeat. Especially accurately described changes are visible on tomograms. Earlier for identification of changes from bronchial tubes in a zone of cirrhosis the bronchography was widely used, however now it is successfully replaced by KT of lungs.
MBT in a phlegm come to light changeably, more often at aggravations of tubercular process. At a phlegm bakposeva, mainly, allocate the nonspecific microflora confirming activity of inflammatory process. Tuberkulinodiagnostika in diagnostics by tsirrotichesky tuberculosis of lungs does not play the leading role. Bronkhoskopiya at helps to find post-inflammatory cicatricial stenoses of bronchial tubes, purulent endobronchitis. When carrying out spirometry sharp decrease in respiratory volumes, mainly, of ZhYoL is defined. Tsirrotichesky tuberculosis of lungs is differentiated with HNZL, sarkoidozy lungs, a pneumoconiosis, a fibroziruyushchy alveolit.
Treatment of tsirrotichesky tuberculosis of lungs
Therapeutic tactics at tsirrotichesky tuberculosis of lungs at the same time pursues several aims: knocking over of a nonspecific inflammation, suppression of activity of specific process, correction of pulmonary heart failure.
At an exacerbation of a nonspecific microbic infection antibiotic treatment courses, sanatsionny bronkhoskopiya are conducted. For the purpose of improvement of bronchial passability bronchial spasmolytics, expectorant means, inhalations are appointed. The issue of the choice of the scheme of tuberkulostatichesky therapy is resolved in an individual order. For reduction of symptoms of chronic pulmonary heart oxygenotherapy is used, antioxidants, antiagregant, vozodilatator are appointed.
Existence of limited unilateral cirrhosis of a lung is the indication to carrying out a resection of a lung (a segmentektomiya, lobectomy). It allows to prevent progressing of cirrhosis and emergence of complications: pulmonary bleedings, warm and pulmonary insufficiency, an amiloidoz which become a cause of death of, at least, 3% of patients. Prevention of tsirrotichesky tuberculosis of lungs comes down to timely treatment of its earlier forms.