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ComplicationsofPulmonary

Tuberculosis
1. Hemoptysis
2. Pleurisy
3. Pleuraleffusion
4. Empyema
5. Pneumothorax
6. Aspergilloma
7. Endobronchitis
8. Brochiectasis
9. Laryngitis
10. Cor pulmonale
11. Cabronchus
12. Enteritus
13. Miliary Tuberculosis
14. HIVrelatedopportunisticinfections
Hemoptysis
Usualinadvanceddisease
Maybefirstsymptom
Min,moderateormassive
MassivefloodingofT.B.treedeath
Min:inflammationcapillarybreakdown
diapedisis
Massive erosionofarteriesinnecroticareas/
wallofcavity
PostTBbronchiectasis
Pleurisy&PleuralEffusion
Underlyingtablesionoflung(postprimaryTB)
Pneumonialesion
Cavitary
Hypersensitivityreactiontotubproteinswitha
fewmonthofpriortuberculosisinyoungchildren
S/S
Dullache,pleuritic chestpain
Toxemia
Exertiondyspnoea
Clinicallydetectable>500CC
CXR:
Fluid:Exudative
Spgravity >1016
proteins >3gm%
LDH >2/3rd ofserumLDS
Glucose <60mg%
Lymphocytes
ADA
AFB <20%
Pl.biopsy 6070%
Treatment ATT
pleuralaspiration
steroid(Massive/B/L)
TuberculosisEmpyema
RuptureofTuberculosislesioninpleural
cavitypurulentfluidinpleuralcavity
(Empyema)
Pus:mainlypolymorphs
Encystment incommon
Treatment: ATT Decortication
I.C.D. Thoracoplasty
Pneumothorax
Spon.Pneumothorax:ruptureofsub.Pleuraltuberculosislesion
S/S
Acutechestpain
Tightnessinchest
Tensionpneumo thorax
Markedresp.distress
Tachy cardiac&Cyanosis
Chestsigns:ofpneumo thorax
Treatment
ATT
I.C.D.
Min:conservative
Contd..2
Pyopneumothorax
Pus&Airboth ICD&ATT
Aspergilloma
InwelltreatedcavityAspfumigationsball
inthecavitytypingfree
S/S
NoS/S
Hemoptysis
Contd..3.
CXR
Aircrescentsign
Changespositiononchangeofposture
Treatment
Surgicalresection/antifungal
TuberculosisEndobronchitis
Cause
DirectimplantationofbronchiwithTBbacilli(sputum)
Lymphatic
L.N.rupture
Hematogenous
S/S
degreeofobstruction
Cough,expectoration
Wheeze,haemoptysis
Collapse
CXR
Pulmonarydiseasewithcollapse,obstructionemphysema
FOB
Congestion,granulation,ulcer,stenosis
ATT,Costicosteroids
Bronchiectasis
Mechanism;
Pr.ComplexL.N.compression
Walldamageduetotub.Granulationtissue
Posttub:fibrosis
S/S
Nonretentionofsecretions
Asymptomatic(upperlobe)
S/SofP.T.(whenactivedisease)
TuberculosisLaryngitis
AdvancedP.T.
DirectimplantationofLarynx(+ve AFB)
S/S
Sorenessofthroat
Dryhackingcough
Hoarsenessofvoice
Changedvoicewhispering
Painfulphonation
Epiglottic painfulswallowing
Diagnosis
Laryngoscopy:ulcer,granuloma,paresisofVocalcords
Sputum:+AFB
Treatment
ATT&Corticosteroids
Corpulmoale
Mechanism:
Extensivelungdestructionscarring
57%casesofcor pulmonale inIndiaduetoP.T.
DestructionofPul.Vasculatare,tuberculousendarteritis &vaso
construction
HypoxiaPulmonaryHT
S/S
Dyspnoea,Cyanosis,RHF
P2loud&split
CXR
ProminentPulmonaryconus
Increasedtransversedia ofheart
Prominentpul arteries
ECG
PPulmonale
RVH&strain
RBBB
Treatment
EarlydiagnosisofactiveTB
CarcinomaBronchus
PTwithCain;
Middleaged/elderly
Tabacco smoking
Scarcarcinoma
Tuberculous Enteritis
SecondaryfromPulmonaryTuberculosis
Swallowingofsputum(AFB+ve)
Usuallyileocaecal area
UlceratedtransversediameterfibrosisSAIO
S/S
Abdominalpain
Alternatingdiarrhaea &constipationvisile peristalsis
Lossofappetite&weight
Treatment
ATT
Internalobstructionsurgery
Miliary Tuberculosis
MilletlikelesionsMiliary TB
Hematogenous spreadofLargenoofbacilli
Whenpatientdefensesarelower
S/S
Fever,malaria,anorexia
Menningial,irritation(TBH)
CXR
Diffuseevenlydistributedmicronodularshadows
SputumAFB:Negativeusually
Treatment
ATT+(steroidinsevercases)