Tài liệu POST TUBERCULAR SEPUELAE pptx

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Extrapulmonary
Extrapulmonary
Pleural fibrosis
Pleural fibrosis
Pneumothorax
Pneumothorax
Amyloidosis
Amyloidosis
Cardiac
Cardiac
Abdominal
Abdominal
Skeletal
Skeletal
Neurological/TBM
Neurological/TBM
Genitourinary
Genitourinary
Hemoptysis
Hemoptysis
Common, potentially fatal
Common, potentially fatal
More common in young
More common in young
Incidence 30
Incidence 30
-
-
35%
35%
Causes :
Causes :
Rasmussens
Rasmussens
aneurysm, scar
aneurysm, scar
carcinoma,
carcinoma,
bronchiectasis
bronchiectasis
,
,
broncholith
broncholith
,
,
aspergilloma
aspergilloma
Hemoptysis
Hemoptysis
: Rx
: Rx
Bed rest
Bed rest
Diseased side be dependent
Diseased side be dependent
Sedation
Sedation
Rule out bleed from UR tract
Rule out bleed from UR tract
Restoration of fluid balance
Restoration of fluid balance
Antifibrinolytics
Antifibrinolytics
Bronchoscopy
Bronchoscopy
:
:
diagnostic and therapeutic : (i)localizes
diagnostic and therapeutic : (i)localizes
lesion, (ii)can place balloon catheter/CO2 laser, (iii)
lesion, (ii)can place balloon catheter/CO2 laser, (iii)
arterial
arterial
embolotherapy
embolotherapy
:
:
successful in 98%
successful in 98%
Surgery : last but definite Rx
Surgery : last but definite Rx
Bronchiectasis
Bronchiectasis
Increases with increase in severity of
Increases with increase in severity of
parenchymal
parenchymal
involvement
involvement
No relation to age,sex or presence of cavity
No relation to age,sex or presence of cavity
Causes : fibrosis,
Causes : fibrosis,
atelectasis
atelectasis
,
,
bronchostenosis
bronchostenosis
, rupture
, rupture
of calcified node into bronchus
of calcified node into bronchus
Bronchiectasis
Bronchiectasis
sicca
sicca
Diagnosis :
Diagnosis :
CxR
CxR
,
,
bronchography
bronchography
, CECT
, CECT
Management :
Management :
postural drainage, infection control,
postural drainage, infection control,
complications management
complications management
Bronchostenosis
Bronchostenosis
Most serious complication of
Most serious complication of
endobronchial
endobronchial
TB
TB
60
60
-
-
95 % of
95 % of
endobronchial
endobronchial
TB
TB
Occurs in spite of chemotherapy : as late as 3
Occurs in spite of chemotherapy : as late as 3
years after treatment
years after treatment
Tracheal involvement : respiratory failure,
Tracheal involvement : respiratory failure,
retention of secretions, failure of
retention of secretions, failure of
endotracheal
endotracheal
intubation
intubation
Treatment :
Treatment :
cortiocosteroids
cortiocosteroids
have no role :
have no role :
repeated dilatation, end to end
repeated dilatation, end to end
anastomosis
anastomosis
Destroyed lung
Destroyed lung
Massive destruction of one lung
Massive destruction of one lung
Left bronchus syndrome :
Left bronchus syndrome :
Ieft
Ieft
bronchus
bronchus
longer, 15% narrower, decreased
longer, 15% narrower, decreased
peribonchial
peribonchial
space : review of 172 cases
space : review of 172 cases
showed 109 (63%) cases on the left :
showed 109 (63%) cases on the left :
perfusion to the affected side absent
perfusion to the affected side absent
Management : of complications
Management : of complications
Aspergilloma
Aspergilloma
Majority of fungal balls in TB cavities are
Majority of fungal balls in TB cavities are
aspergilloma
aspergilloma
Mucormycosis
Mucormycosis
has also been implicated
has also been implicated
Cavities >2.5 cm +
Cavities >2.5 cm +
ve
ve
serology : precipitins in
serology : precipitins in
25%; radiological evidence in 11%
25%; radiological evidence in 11%
Asymptomatic presentation
Asymptomatic presentation
Hemoptysis(5
Hemoptysis(5
-
-
90%), cough, weight loss
90%), cough, weight loss
Air crescent (
Air crescent (
Monod
Monod
) sign, Halo sign, bell like
) sign, Halo sign, bell like
image with fungus ball as clapper inside bell.
image with fungus ball as clapper inside bell.
Aspergilloma
Aspergilloma
’
’
Diagnosis :
Diagnosis :
CxR
CxR
, sputum culture, serology,
, sputum culture, serology,
bronchoscpy
bronchoscpy
Contents : dead and live
Contents : dead and live
mycelial
mycelial
elements,
elements,
fibrin, mucus, inflammatory cells, degenerated
fibrin, mucus, inflammatory cells, degenerated
blood and epithelial elements
blood and epithelial elements
Management :
Management :
(
(
i)asymptomatic
i)asymptomatic
: spontaneous
: spontaneous
lysis(7
lysis(7
-
-
10%) followed
10%) followed
radiologically
radiologically
,
,
(ii)symptomatic :
(ii)symptomatic :
intracavitary
intracavitary
instillation of
instillation of
antifungals(amphotericin
antifungals(amphotericin
B,
B,
nystatin
nystatin
), resection
), resection
surgery, radiotherapy
surgery, radiotherapy
Calcification
Calcification
Healed tubercular lesions
Healed tubercular lesions
Pleural diseases :
Pleural diseases :
descrete
descrete
radioopaque
radioopaque
shadows or sheet
shadows or sheet
-
-
like calcification
like calcification
Can erode bronchial wall or arterial wall resulting
Can erode bronchial wall or arterial wall resulting
in
in
hemoptysis
hemoptysis
Coughed
Coughed
-
-
out calcified
out calcified
stones(broncholiths
stones(broncholiths
)
)
Extensive calcification can result in respiratory
Extensive calcification can result in respiratory
failure and
failure and
cor
cor
pulmonale
pulmonale
Open negative syndrome
Open negative syndrome
Thin walled cavities with
Thin walled cavities with
epithelialization(preventing
epithelialization(preventing
cavity collapse)
cavity collapse)
More frequent in chemotherapy era
More frequent in chemotherapy era
CxR
CxR
: thin walled ring shadows
: thin walled ring shadows
Histology : incomplete epithelial lining with
Histology : incomplete epithelial lining with
necrotic foci with
necrotic foci with
M tuberculosis
M tuberculosis
Complications : secondary infection,
Complications : secondary infection,
aspergilloma
aspergilloma
, scar carcinoma,
, scar carcinoma,
pneumothorax
pneumothorax
,
,
lung volume loss
lung volume loss