CAVERNOUS TUBERCULOSIS

2.  DEFINITION
 PATHOGENESIS
 ETIOLOGY AND TYPES
 SIGN AND SYMPTOMS
 DIFFRENTIAL DIAGNOSE AND FORMS
 TREATMENT
 REFERENCE

4.  Distinctive features of cavernous form of lung
tuberculosis are the presence of the thin-walled
cavity located on a background of slightly
changed lung tissue at absence of the expressed
infiltrative and fibrotic changes. Cavernous
tuberculosis develops among patients with,
disseminated, focus lung tuberculosis, at
disintegration of tuberculomas; at late revealing
of disease, when the phase of disintegration is
finished by formation of cavities, and the
attributes of the initial form disappear. At
radiographic examination rounded cavity is
defined, with a thin two-layer wall and usual
localization in subclavicular area.

5.  The physical signs are usually not present.
Only at coughing at height of a breath
separate damp rattles are listened. Catarrhal
appearance arise later at occurrence of
perifocal inflammation changes around a
cavity, thickening of its wall.
 The changes in blood of the cavernous
tuberculosis patients are poorly expressed:
normal quantities of leukocytes, ESR more
often are accelerated (20 – 40 mm / h).

6.  Fibrous-cavernous lung tuberculosis — the chronic disease
wavy proceeding for a long time, with intervals of
regression of specific inflammation. For this form of the
lung tuberculosis is characteristic the presence of one or
several cavities existed for a long time accompanied with
the sharply expressed sclerosis of surrounded tissues and
rather massive fibrotic degeneration lung tissue and
pleura.
 The anamnesis of the patients with fibrous-cavernous lung
tuberculosis is characteristic by the complaints to long
period of the disease, on wavy of its course. The intervals
between outburst and clinical favorable condition can be
very long or, on the contrary, the often recurrence of
outburst can be observed. In some cases the patients
subjectively do not feel symptoms of the disease. The
clinical displays of fibrotic-cavernous tuberculosis are
multiform, they are caused by tubercular process, and also
by developed complications. Distinguish two clinical
variants of fibrotic-cavernous lung tuberculosis:

11.  In sputum and in flush waters from bronchi MBT are found out
and elastic fibres. But for detection of MBT the application not
only bacterioscopy, but also luminescent microscopy and cultural
methods are necessary.
 The treatment of the patients with cavernous lung tuberculosis
should be complex, with inclusion of methods of collapse therapy
and surgical intervention.
 The surgical removal of a cavity is an important stage in
treatment of the patients with cavernous form of lung
tuberculosis, but for their complete healing it is important to
carry out long (1 -1,5 year) antibacterial therapy with control of
resistance and sensitivity of MBT.
 At presence of active tubercular process in bronchi inhalations of
aerosols and intratracheal introduction of antibiotics is necessary.
Use of complex therapy gives opportunity for clinical healing of
the cavernous forms of lung tuberculosis.

12.  Taking into account the clinical picture of the
disease development there are three main types
of fibrous-cavernous tuberculosis:
 Limited form - a fairly stable species,
characterized by stopping the development of
cavities.
 Progressive form of chronic illness with
alternating periods of remission and
exacerbation of the inflammatory response;
cavities tend to develop in size and quantity.
 Complicated form is characterized by
complications - bleeding, respiratory and heart
failure, "heart lung, empyema of pleura,
amyloidosis of other organs.

13.  limited and rather stable fibrotic-cavernous lung
tuberculosis, when after effective chemotherapy
there comes the certain stabilization of process and
the aggravation can be absent within several years;
 fibrotic-cavernous lung tuberculosis with repeated
irregular change of aggravations and remissions.
 In the periods of acute worsening of the condition
rises of temperature are explained by development
of outbursts of specific process around cavity,
bronchogenic disseminations. Temperature can be
high when the secondary infection combine with
specific. The bronchi inflammation is accompanied by
long “«hoarse” cough, with hardly discharged viscous
mucus-purulent sputum.
 Often complications of this condition are:
 hemoptysis;

14. the intensive lung hemorrhage
caused by erosion of large vessels
owing to caseous necrotic of
process in them;
general exhaustion of a body;
amiloidosis of internal organs;
lung-heart insufficiency;
spontaneous pneumothorax.

15. Percussion gives the clearly
expressed symptoms: shortage of
auscultation sounds in places of
pleura thickening and massive
fibrosis. During outbursts at
significant extent and depth of
pneumonic and infiltrative processes
it is possible to note shortening of
percussion sounds. There is no rules
in distribution of these processes;
therefore it is impossible to charge
about their preferred localization.

16.  Auscultation reveals diminished breath sounds in
places of fibrosis and pleura thickening. At presence
of infiltrative pneumonic aggravations it is possible to
find out bronchial respiration and fine damp rattles.
Above cavities of the large and huge sizes is listened
bronchial and amphoric breath sounds and large,
pronounced large coarse moist rales. Above small
cavities the fine moist rales less pronounced, not
plentiful are better listened at coughing. Above an
old cavity the “scratch of a cart”, “peep”, are
listened, caused by cirrhosis of a wall of a cavity and
surrounded tissue. Thus, at fibrotic-cavernous
process it is possible to find out rich of stethoacoustic
symptoms. However there are be “silent” and
“pseudo-silent” cavities, which do not give neither
percussion nor auscultation symptoms.

17. On radiograph the picture of fibrosis
and shrinkage of lungs, old fibrotic
cavity is revealed with thick fibrous
walls (one or several), pleural
stratification. Radiographic picture of
fibrosis and shrinkage of lungs most
often are found out in the upper parts
of lungs, with preferred defeat of one
of them. Mediastinum and trachea
are displaced to direction of the
greater defeat.

18.  The upper parts are reduced in volume, the
transparency of them is drastically lowered
because of hypoventilation. A picture of lung
fields is drastically deformed owing to
development gross fibrosis. Transparency of
the lower parts of lungs frequently is
increased because of their hyperinfiltration.
The lung roots, as a rule, are displaced up.
The large vessels are determined as direct,
regular shadows —so-called symptom «of the
tense string». The groups of focuses of
various size and intensity are usually visible
in both lungs brocnhogenic dissemination.

19.  At fibrotic – cavernous process, the cavity settles
down among rough fibrosis of lungs, their walls are
deformed, are dense, are thick more often. Quite
often at the bottom cavities the small level of a
liquid is defined. At an aggravation and progressing of
the process around a cavity the sites of fresh
infiltrations are visible. At treatment these changes
undergo slow dissolution and reduction and partial
shrinking of a cavity. Sometimes fibrotic cavity comes
to light only at tomography, as on general view
radiograph the shadow of a cavity can be covered by
strata of multiple shadows, fibrosis and pleural
depositions. Bacteriological examination of sputum
usually reveals MBT expectoration, sometimes
massive, and elastic fiber.

20.  CBC AND URINE ANALYSIS
The condition of blood at the patients with fibrous-
cavernous tuberculosis depends on a phase of disease.
In acute phase it carries such character, as at an active
tuberculosis, but with change of the formula to
lymphapenia, left shift and accelerated ESR up to 30 –
40 mm / hour. Anemia develops at heavy hemorrhages,
sometimes sharply expressed. At a secondary infection
high leucocytosis is observed up to 19 000 – 20 000 and
increase of neutrophils.
 In urine.
At amyloidosis of kidneys, high level of protein usually
is revealed, which quite often develops at the patients
with fibrous cavernous tuberculosis, the fiber accrues,
hyaline cylinders appear.

21. Colonies of Mycobacterium tuberculosis in
Löwenstein-Jensen medium

22.  BACTEC MJIT
 polymerase chain
reaction
 biological
microchips
Positive samples show up
as yellow in the well,
negative samples are
colourless
Biological microchips
The BACTEC TB-460 instrument MGIT tube

23. are important in the diagnosis and
management of TB, especially in smear-
negative cases.
Chest X-ray findings, associated with
pulmonary TB (PTB), are non-specific.
There aren’t chest X-ray findings
absolutely typical for PTB. Diseases
other than PTB can causer both the
«classical» and the «atypical» chest X-
ray findings.

24.  Roentgenoscopy
 Roentgenography
 Fluorography
 Electroroentgenography
 Tomography
 Roentgenokimography
 Brochography
 Computerized
tomography
etc.

25.  X-ray syndrome of «ring-
like shadow»:
 cavernous tuberculosis
 fibrous-cavernous
tuberculosis
 destruction of cancer
 ecchinococcal cyst after
rupture
 abscess after rupture
 bullous emphysema
 etc.
Fibrous-cavernous tuberculosis
of the right upper lobe

26.  Treatment is a long and complex process using
methods of chemotherapy, metabolic,
immunological and hormonal therapy. In some
cases, is assigned to surgical intervention.
 Drug treatment takes into account the duration
of the process and stages of its development.
The first detection of the disease treatment is
carried out in the first category in an intense
degree. First of all, is the active phase of
chemotherapy. Intense degree determines the
appointment of the four anti-TB drugs -
isoniazid, rifampicin, pyrazinamide and
streptomycin or ethambutol. Depending on the
resistivity of mycobacteria treatment lasts 3-5
months.

27.  PUBMED.COM
 SLIDESHARE
 WIKIPEDIA
 GOOGLE IMAGES OF MBT
 TEXTBOOK OF PULMONARY DISEASES

28. for amiable attention!