4.2.7. Cavernous lung tuberculosis


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.

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).

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.

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