4.2.9. The cirrhosis of the lungs


The clinical signs of cirrhotic tuberculosis are diverse. The progressing dyspnea and cough with sputum are most typical complaints of the patients. If at the beginning of the disease, dyspnea occurs only at physical loading, later it arises even in a condition of rest. Hemoptysis and lung hemorrhage arise at angioectasia rupture. The increase of temperature is connected to an aggravation of pneumonia bronchectasis. The hemogram changes correlate with pneumonia aggravations: moderate leucocytosis appear, ESR – is accelerated up to 20-30 mm / hr. The deformation of the chest is revealed at examination of the patient. The chest flattened, the ribs oblique, and intercostal spaces narrowed. The fall of supra- and subclavicle fossa are marked, the lower parts of the chest are extended caused by emphysema. At the patients with unilateral cirrhosis, the displacement of trachea occurred to the damaged part of the lungs.

Percussion reveals short pulmonary sound above cirrhotic area. The tympani tones occurred above emphysematous areas.

At auscultation, weakened rigid or bronchial breath, dry, dispersed, and whistling rales are listened. The sonorous moist rales are listened above brocnhectatic cavities with “dry” tone, which is characteristic for cirrhosis. At unilateral cirrhosis, the border of relative heart dullness displaced in direction of damaged lung.

Rentgenography for unilateral cirrhosis presence of massive shadow occupying the whole lung lobe is characteristic. The lung lobe wrinkled and diminished by cirrhotic process; the lower border of lung defined on 1 – 2 inter-costal spaces above. The root of the lung tightened up and displaced outward from defeated side. On the defeated side the lung fields narrowed and slanting rib disposition are marked. The mediastinum organs displaced in the direction of the defeated part. On x-ray examination at bilateral cirrhosis, diffuse decreased transparence of lung fields are defined. The opacity represented as clear-cut linear shadows. The lung roots tightened up and the heart, suspended on them, has “drop-like/pendent” form.

The pure cirrhotic forms of tubercular process are observed not often. More often could be observed the forms of cavernous-fibrosis, when alongside with massive cirrhosis in lungs it is possible to reveal cavities of disintegration of various size and forms. These cavities could be old cleared cavities or cavities keeping in the walls specific inflammation processes and brocnhectatic cavities. Similar sorts the processes result in switching off the lung from breath actions and in complete loss of its function. Such lung had received the name “the destructed lung”.

The morphological picture of «destructed lung” of tubercular etiology is characterized by reduction in 2-3 times of the lung sizes in comparison with norm, carnification of lung tissue, growing together and thickening of visceral and parietal pleura. “Destructed lung” often develops on one side of the lung, preferably in left.

The alveolar lung tissue completely replaced by fibrosis. On a background of fibrosis, there are small and medium size cavities, multiple bronchectasis. Sometimes on cirrhotic background, one – two large cavities are observed. Depending on expression lung parenchyma sclerosis and cavitary formations it is possible to allocate three types of “destructed lung ” of tubercular etiology:

  1. Cavernous-cirrhotic type – on background of cirrhosis one large, “leading” cavity is visible.
  2. Poly cavernous-cirrhotic type – presence of a number of small cavities on cirrhotic background of lung.
  3. Аpneumatic-cirrhotic type – complete replacement of lung parenchyma by fibrosis with prominent bronchectasis and small residual cavities.

The treatment should be carried out on the following directions:

  1. treatment of the basic lung process;
  2. improvement of bronchial passableness (bronchi dilatators, expectorants);
  3. treatment of lung-heart insufficiency.

The prevention of tubercular cirrhosis consists of in correct and duly treatment of lung tuberculosis.

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