Cirrhotic tuberculosis: What's it, causes, symptoms, diagnostics, treatment, prevention

Cirrhotic pulmonary tuberculosis is characterized by a large proliferation of scar tissue, among which active tuberculosis foci are stored, causing periodic exacerbations and, perhaps, scant bacterial excretion.

• Pathogenesis
• Pathomorphology
• Symptoms
• Differential diagnosis
• Cirrhosis after a nonspecific inflammatory process
• Pulmonary aplasia
• Sarcoidosis III st.

Cirrhotic tuberculosis includes processes, under which:

• Tuberculosis changes in the lungs with clinical manifestations of process activity;
• Tendency to periodic exacerbations;
• Possibility of periodic appearance of scanty bacterial excretion.

If cavities are found against the background of cirrhosis, then this indicates in favor of fibrous-cavernous tuberculosis, and the absence of signs of activity - post-tuberculosis cirrhosis.

Cirrhotic tuberculosis is segmental and lobar, limited and widespread, one-sided and two-sided.

Cirrhotic tuberculosis: pathogenesis

Cirrhosis is the proliferation of connective tissue in a parenchymal organ, which causes a restructuring of its structure, compaction and deformation. The formation of cirrhosis is caused by dysregulation of connective tissue growth, stimulation of collagen formation.

Bronchogenic cirrhosis - occurs after tuberculosis of the intrathoracic lymph nodes, complicated by atelectasis. After a month or more in the area that was laid, cirrhotic changes develop.

Pneumogenic cirrhosis—develops due to:

and) infiltrative tuberculosis (the lobby) — connective tissue grows in the area of ​​specific changes;

to) chronic disseminated tuberculosis - connective tissue grows in foci and vessels in both lungs;

in) fibrous-cavernous tuberculosis.

Pleurogenic cirrhosis - the cause of such cirrhosis is a pathological process in the pleura, eg, purulent pleurisy, when connective tissue grows from the pleura into the lung. The airiness of the lungs is preserved, but the pleura becomes rigid, and the mobility of the lungs during breathing is sharply limited.

Cirrhotic tuberculosis: pathomorphology

Cirrhotic pulmonary tuberculosis, primarily, characterized by the development of connective tissue. Bronchi are deformed, their structure is broken, what causes the development of bronchiectasis. Vessels are narrowed, existing multiple arteriovenous anstomoses. The lung in cirrhotic tuberculosis is reduced in volume, deformed and compacted. In pleurogenic cirrhosis, the pleura is significantly thickened, resembles a shell, covering the entire lung.

According to the degree of development of connective tissue, they distinguish sclerosis, fibrosis and cirrhosis.

Sclerosis (fibrosis) lungs is characterized by diffuse development of gentle: scar tissue, but at the same time their airiness is preserved. Scar tissue grows between the alveoli, as a result, the elasticity of the lung tissue is impaired, and therefore emphysema often develops.

Pulmonary fibrosis is characterized by the development of coarse fibrous connective tissue in a limited area of ​​the lung. The airiness of the affected area remains partially. Cirrhosis of the lungs is characterized by intensive development of connective tissue, resulting in the lung becoming airless.

Cirrhotic tuberculosis: symptoms

Cirrhotic tuberculosis can have a long course with mild symptoms. Most often, patients are concerned about fatigue, cough with sputum production, breathlessness, arrythmia, which indicates the development of pulmonary heart failure. Bacterial excretion is not typical for pulmonary cirrhosis. Presence of bronchiectasis (arise due to a violation of the structure of the bronchi) promotes the addition of a secondary infection. Therefore, periods of exacerbation of the process may be due to activation as a specific, and nonspecific infection.

As a result of lung shrinkage, patients experience retraction of the chest wall. Therefore, on the cirrhosis side, upon examination, there is a lag in the chest in the act of breathing. The heartbeat shifts, and sometimes pulsation of the pulmonary artery is visible in the second intercostal space. Over a cirrhotic lung, voice tremors are increased, percussion turns out to be dullness, auscultatory-sounding cicatricial wheezing, which have a characteristic creaky tone and are heard against the background of bronchial breathing.

A radiological sign of pulmonary cirrhosis is a displacement of the mediastinal organs to the affected side (“fork sign”), described by G. T. Rubinstein, intense darkening and narrowing of the pulmonary field, heaviness from the root of the lung to the diaphragm (symptom “weeping willow”).

Treatment of patients with pulmonary cirrhosis is reduced to prescribing nonspecific therapy aimed at normalizing heart function and reducing cough, pain, shortness of breath. If cirrhosis is unilateral and the general condition of the patient allows, pneumonectomy is indicated. Sometimes you can limit yourself to a lobectomy. In cases of bilateral cirrhosis, partial resection of the lungs is indicated. Sick, for whom surgical treatment cannot be recommended, must periodically recover in sanatoriums, constantly be in the fresh air train the cardiovascular system with dosed physical exercises. In spring and autumn, preventive courses of antibacterial treatment are carried out.

Consequences. Depends on the rate of progression of dysfunction of the cardiorespiratory system. Such patients often die due to circulatory failure of breathing. Cirrhosis of the lungs ranks first among all forms of tuberculosis in terms of the frequency of hemoptysis.

Cirrhotic tuberculosis: differential diagnosis

If persons with cirrhotic changes in the lungs are under observation for a long time in an anti-tuberculosis dispensary, The diagnosis of cirrhotic tuberculosis is relatively simple. The following signs should be taken into account:

• long-term treatment and observation for pulmonary tuberculosis;
• the presence of dense tuberculous foci against the background of cirrhosis or in other parts of the lungs;
• short-term bacterial excretion is occasionally possible.

Differential diagnosis of cirrhotic tuberculosis is carried out with lung cirrhosis after a nonspecific inflammatory process (post-pneumatic cirrhosis), aplasia lungs, stage III sarcoidosis.

Cirrhosis after a nonspecific inflammatory process

Patients with post-pneumatic cirrhosis indicate previous pneumonia, lung abscess, etc.. The process is most often located in the middle and lower parts of the lungs. Rich auscultatory picture (dry and wet wheezing) is also inherent in post-pneumatic, and for tuberculous cirrhosis, however, their localization is not the same (in post-pneumatic cirrhosis, pathological noises are heard more often over the lower parts of the lungs).

With cirrhosis of a specific and nonspecific nature, bronchiectasis is formed, therefore, with cirrhosis of various etiologies, purulent sputum may be discharged during exacerbations, high body temperature, Sweating, significant leukocytosis. Therefore, multiple searches for MBT are necessary to exclude cirrhotic pulmonary tuberculosis, in which short-term bacterial excretion is possible.

During X-ray examination, attention should be paid to the localization of cirrhotic changes, the presence of dense focal shadows against the background of cirrhosis and in other parts of the lungs (sign of cirrhotic tuberculosis). Bronchoscopy for cirrhosis of nonspecific etiology reveals nonspecific endobronchitis, purulent contents in the lumen of the bronchus, in cirrhotic tuberculosis - scar changes after suffering specific bronchitis.

Long-term follow-up is of decisive importance here., which establishes the stability of the process, absence of exacerbations of tuberculosis and stable abacteriality, confirmed by multiple sputum cultures. MBT is absent in sputum (-), there is a nonspecific microflora.

Aplasia of the lung in cirrhotic tuberculosis

Pulmonary aplasia is a congenital defect, which is found more often in young people during preventive fluorographic examination. Subjectively, such persons feel satisfactory, only in old age or when an infection is attached do symptoms of intoxication appear, respiratory failure. As with cirrhotic tuberculosis, The radiograph shows darkening and a decrease in the volume of the pulmonary field, displacement of mediastinal organs towards the affected side. But, unlike cirrhotic tuberculosis, homogeneous shadow, no tuberculosis foci are visible against its background.

Percussion reveals dullness, no breath sounds, while over cirrhosis of a specific and nonspecific nature, numerous dry and moist rales are heard, frequent bronchial breathing. When a contrast agent is injected into the bronchus, its breakage is visible, no bronchial branches. Computed tomography allows you to more accurately identify changes in the bronchial tree and establish a diagnosis.

Diagnostic criteria for pulmonary aplasia:

• asymptomatic, detection at a young age during a random X-ray examination;
• radiologically: homogeneous darkening and decrease in the volume of the corresponding pulmonary field, absence of light focal shadows against its background and in other areas;
• percussion - dullness over the affected area, breath sounds are not audible;
• the developmental anomaly is confirmed by the introduction of a radiopaque substance into the bronchus, CT scan.

Sarkoidoz III ст. Massive cirrhotic changes develop at stage III of respiratory sarcoidosis. They are mostly bilateral, therefore sometimes they resemble cirrhotic tuberculosis, developed against the background of chronic disseminated pulmonary tuberculosis. Anamnesis data is of great importance, long-term follow-up for sarcoidosis, absence of MBT in sputum in the past and at the time of examination. As with cirrhotic changes of a different nature, such patients may have symptoms of chronic bronchitis, respiratory failure, chronic pulmonary heart disease.

However, in cirrhotic tuberculosis, developed against the background of disseminated pulmonary tuberculosis, cirrhotic changes are located in the upper parts of the lungs, the tops are wrinkled, upward dislocations of roots are visible, as “weeping willow branches”, multiple dense tuberculous foci. In sarcoidosis, cirrhotic changes are located predominantly in the root zones, sometimes conglomerates of enlarged and compacted lymph nodes are visible in the roots, lung volume reduced, diaphragm domes raised. Mantoux test for sarcoidosis of all stages is negative or doubtful. Mycobacterium tuberculosis is not detected in sputum.

Diagnostic criteria for sarcoidosis stage III.:

• long-term observation and treatment for sarcoidosis;
• X-ray shows cirrhotic changes mainly in the hilar regions of the lungs, absence of tuberculosis foci;
• absence of MBT, negative or questionable reaction to tuberculin.