4.2.8. Fibrous-cavernous lung tuberculosis


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:

  1. 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;
  2. 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:

  1. hemoptysis;
  2. the intensive lung hemorrhage caused by erosion of large vessels owing to caseous necrotic of process in them;
  3. general exhaustion of a body;
  4. amiloidosis of internal organs;
  5. lung-heart insufficiency;
  6. spontaneous pneumothorax.

The external appearance of the patient with long time proceeding of fibrous cavernous lung tuberculosis is rather specific and is named habitus phtisicus. The patient has weight loss, flabby dry skin, easily going in wrinkles, muscles atrophy, mainly of brachial, dorsum and intercostal zones. At large fibrotic changes and presence of cavities on the one side of chest cause the following signs: backlog at breath and flattened side of this part the chest, fallen back supra and infra clavicle and intercostal spaces. The patients suffer from constant intoxication. They suffer from hypotonic syndrome, heart hypertrophy, tachycardia, and especially at displacement of heart. At often outbreaks of tuberculosis process lung insufficiency of II and III grade develop. The cyanosis of extremities and of lips mucous are become evident. Subsequently, the liver is enlarged. Oedema can appear. At progressing of the tuberculosis process, the specific defeat of esophagus and intestine are observed. At cachexia, amyloidal nephritis and lung-heart insufficiency development, the forecast becomes uncertain.

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.

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.

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. 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.

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.

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.

Prior to the beginning application of chemotherapy average life time of such patients was limited 2 — to 3 years. Now there are all opportunities for the prevention of development of fibrous-cavernous process. For this purpose right at the beginning of this or that form of disease the effective chemotherapy is needed, with determinations of MBT sensitivity to anti-tuberculosis drugs. The treatment should be complex, continuous and long. If the patients have drug resistand MBT or intolerance to basic anti-tuberculosis drugs, it is necessary carefully select drugs among reserve anti-uberculosis preparations.

The healing of cavities with fibrotic wall always proceeds very slowly. If necessary common therapy supplement by surgical intervention. Lung resection could be made or its removal at unilateral process and good functional parameters. Now operations at bilateral process also give quite satisfactory results in most cases: the patient keeps work capacity, becoming MBT negative, his life span is considerably extended.

Share this Article: