Fibrous-cavernous pulmonary tuberculosis - chronic form pathology. It has a wave-like character with stages of exacerbation and phases of remission. A distinctive feature is one or more cavities with thick fibrous membranes, with fibrous tissue replacing the surrounding tissue around the cavity. In that pathological process not only lung tissue is involved, but also the pleura, lymphatic organs, airways.

The etiological factor is mycobacterium, which according to taxonomy belongs to the genus Mycobacterium. It has many species that are common in all external environments. The types of mycobacteria that can cause disease in humans are classified as a separate complex, M. Tuberculosis.

This microorganism can infect various organs: lungs, lymphatic organs, skin, bones, organs genitourinary system, gastrointestinal tract, central nervous system, genitals. The specificity of the lesion is “cold” tuberculosis inflammatory nature with mainly granulomatous processes prone to caseous decay.

Pathogenesis

This form is secondary disease. Most often against the background of recurrent infiltrative tuberculosis or hemato-disseminated form. Against the background of fibrinous-cavernous tuberculosis, an even more severe pathology can develop - caseous pneumonia (according to ICD-10, it is an independent secondary form of tuberculosis infection).

This type of pathology develops over a long period of time, from several months to several years. The duration will depend on the pathogenicity of the strain, as well as the level of immunity of the patient. Based on the localization of the process, one-sided and two-sided forms can be distinguished. During the course of the illness, several cavities may appear. The disease periodically recurs, the intervals between exacerbations vary from person to person.

Fibrous-cavernous tuberculosis is characterized by dropout foci of bronchogenic origin. Against the background of aggravated progressive pathology, pathomorphological changes are also observed lung tissue in the form of pneumosclerosis, emphysema, bronchiectasis.

Symptoms

Experts can distinguish two options for clinical development:

• Clearly limited with a dense capsule. It is quite stable since the process is strictly localized in the cavity. It is difficult to treat anti-tuberculosis chemotherapy because the drugs have a low concentration inside the cavity due to the thick fibrous wall. In such cases, relapses are possible, which is due to the impossibility of complete sterilization.
• Progressive - due to the lack of integrity of the cavity capsule or its periodic melting. Thus, when its contents are released, an exacerbation stage occurs, after which remission occurs. It is more easily amenable to anti-tuberculosis chemotherapy due to access inside the pathological cavity.

IN acute stage the following symptoms are noted:

• fever with high or low-grade fever;
• severe debilitating cough;
• X-ray diagnostics reveal cavities with active infiltration;
• There is a dynamic synthesis of sputum, which is complicated by infections - it has a thick consistency, which makes coughing difficult.

The main complications in patients are hemoptysis and pulmonary hemorrhage, which is caused by ruptures and perforation of vessels of various sizes. With a prolonged intense cough under the pressure of spasms, capillary ruptures are possible. Also, during caseous-necrotic processes they can be subject to destruction blood vessels in this area. The severity of bleeding will proportionally depend on the diameter of the vessel involved in the process of necrosis, which can threaten the patient’s life.

Also, one of the complications may be caseous pneumonia, which is manifested by a sharp deterioration in the patient’s condition, the symptoms are violent and vivid. Symptoms of respiratory failure intensify, noted sharp increase temperatures up to 40 degrees with further persistent fever. The picture of the lungs changes during X-ray diagnostics.

Visually, a patient diagnosed with fibrocavernous tuberculosis looks cachectic, his skin is dry (possibly cracking), muscle atrophy is observed. These obvious manifestations are associated with constant intoxication and metabolic disorders.

Changes in the respiratory and cardiac systems are typical, which is manifested by symptoms of insufficiency of various degrees, depending on the severity of the reactions and the volume of tissue involved in the pathological process. Violations from the side are common circulatory system, which is manifested by acrocyanosis. Hepatomegaly (an increase in the size of the liver) is diagnosed. Due to impaired blood supply to organs and tissues, stagnation in the form of edema is observed. The larynx, intestines, and kidneys are also susceptible to dysfunction.

Diagnostics

To make a diagnosis, a phthisiologist follows the following system:

• Taking anamnesis;
• External research;
• Percussion;
• Auscultation;
• Material collection and laboratory tests (blood, urine, swabs, sputum);
• X-ray diagnostics (computed tomography is possible).

Type of study	Indicators
Anamnesis	Presence of contacts with bacteria carriers. Living and working conditions. Results of regular general and special studies.
External clinical trial	Cachexia, dry skin and mucous membranes, cyanosis, muscle atrophy, hepatomegaly on palpation.
Percussion	Shortening of percussion sound in places where the cavity is localized.
Auscultation	Weakening of respiratory sound in places where cavities and infiltration are localized, bronchial breathing and moist rales are heard. When inhaling and exhaling in the case of an old cavity or massive growth fibrous tissue Specific sounds similar to creaking are heard.
Blood lab tests	The erythrocyte sedimentation rate increases. The logogram shows a significant shift of the nucleus to the left. Leukocytosis and neutrophilia. With bleeding, there is a decrease in the number of red blood cells and hemoglobin.
Urine lab tests	Without kidney damage, the analysis is within normal limits. It is possible that indicators may increase in case of kidney damage (urobilin, protein, red blood cells, sugar, etc.). Protein may be present in amyloidosis.
Lab examinations of sputum and swabs	During microscopy, coral-shaped elastic fibers and mycobacteria are isolated, as well as Koch's bacillus during bacteriological examination. Depending on the type of colony formed on the nutrient medium and its properties, interaction with acids and alkalis, as well as the release of gases, the type of mycobacterium is determined. During the bioassay, the pathogenicity of the strain is clarified.
X-ray diagnostics	The x-ray shows the exact location of the lesions, their number, volume and wall thickness. There are noticeable layers in the pleural area. Wrinkling of the lung tissue affected by fibrosis is observed. Most often, transparency decreases in the upper lobes of the lung (this occurs due to a decrease in air flow and the tissue becomes denser). The pulmonary pattern is disrupted or smoothed depending on the severity of the process. Due to hypoventilation, in some cases, emphysematous changes in the lower lobes of the lungs may be observed as a compensatory phenomenon. It is necessary to note the symptom of a “tight string”; its etiology lies in a violation of trophic function. The walls of the vessels become denser, which prevents the vessel from squirming. Thus, on x-ray they are observed in the form of fairly straight cords. Based on the X-ray picture, it can be identified or differentiated from caseous pneumonia.

Macroscopic specimen: cavities of caseous pneumonia are visible, covered with epithelioid and lymphatic elements and Pirogov-Langhans cells. Aschoff-Poole lesions, places of proliferation of connective tissue, are noted. Noted exudative inflammation, granulomas.

Treatment

Therapy is long-term and continuous. Specialists approach problem solving individually and in a complex manner.

Modern drug regimens for the treatment of tuberculosis can consist of three, four or five components antibacterial therapy. Also, to reduce and prevent symptoms, it includes anti-inflammatory, antipyretic, mucus-dispersing, expectorant, analgesic and other drugs at the discretion of the specialist.

Since this form of tuberculosis is characterized by the presence of a pathological focus with a thick fibrous wall, treatment with chemotherapy is difficult. Since the drugs have a low coefficient of permeability through connective tissue, it is not always possible to achieve complete destruction of mycobacteria inside the cavity. This increases the risk of further relapse. In such cases, surgical intervention is indicated.

The prognosis ranges from cautious to unfavorable. When complicated by caseous pneumonia, the prognosis is extremely unfavorable.

One of the most important steps of therapy is nursing process. The nurse is the link between the patient and the doctor.

The nursing process when treating a patient diagnosed with tuberculosis consists of several tasks:

1. Monitoring the general condition of the patient and recording newly appeared or changed symptoms.
2. Differential diagnosis.
3. Caring for patients in hospital and at home. Control of doses and frequency of drug administration, injection of drugs, treatment of postoperative wounds.
4. Emergency assistance in case of complications.

Treatment for tuberculosis takes a long time. Sometimes patients need help. Thus, the nursing process occupies one of the most important places in the treatment of this disease.

Prevention

For the purpose of prevention, the following measures are taken:

• Promoting information about tuberculosis, carrying out preventive and anti-epidemic measures.
• Timely identification of patients and bacteria carriers.
• Mandatory completion of scheduled studies (especially relevant for professions in animal husbandry and those associated with dusty work).
• Mandatory vaccination schedule.

Fibrous-cavernous tuberculosis

What is Fibrous-cavernous tuberculosis -

Fibrous-cavernous pulmonary tuberculosis- a chronic disease that occurs over a long period of time and in waves, with intervals of subsidence of inflammatory phenomena. It is characterized by the presence of one or several long-standing cavities with pronounced sclerosis of surrounding tissues, fibrous degeneration of the lungs and pleura.

What provokes / Causes of fibrous-cavernous tuberculosis:

Pathogens of tuberculosis are mycobacteria - acid-fast bacteria of the genus Mycobacterium. A total of 74 species of such mycobacteria are known. They are widely distributed in soil, water, people and animals. However, tuberculosis in humans is caused by a conditionally isolated M. tuberculosis complex, which includes Mycobacterium tuberculosis(human species), Mycobacterium bovis (bovine species), Mycobacterium africanum, Mycobacterium bovis BCG (BCG strain), Mycobacterium microti, Mycobacterium canetti. Recently, it has included Mycobacterium pinnipedii, Mycobacterium caprae, which are phylogenetically related to Mycobacterium microti and Mycobacterium bovis. The main species characteristic of Mycobacterium tuberculosis (MBT) is pathogenicity, which manifests itself in virulence. Virulence can vary significantly depending on factors external environment and manifest themselves differently depending on the state of the microorganism that is subject to bacterial aggression.

Tuberculosis in humans most often occurs when infected with human and bovine species of the pathogen. Isolation of M. bovis is observed mainly in residents of rural areas, where the route of transmission is mainly nutritional. Avian tuberculosis is also noted, which occurs mainly in immunodeficient carriers.

MBTs are prokaryotes (their cytoplasm does not contain highly organized organelles of the Golgi apparatus, lysosomes). There are also no plasmids characteristic of some prokaryotes that provide genome dynamics for microorganisms.

Shape: slightly curved or straight rod 1-10 µm × 0.2-0.6 µm. The ends are slightly rounded. They are usually long and thin, but bovine pathogens are thicker and shorter.

MBT are immobile and do not form microspores or capsules.
Differentiates in a bacterial cell:
- microcapsule - a wall of 3-4 layers 200-250 nm thick, firmly connected to the cell wall, consists of polysaccharides, protects mycobacterium from the external environment, does not have antigenic properties, but exhibits serological activity;
- cell wall - limits the mycobacterium from the outside, ensures stability of cell size and shape, mechanical, osmotic and chemical protection, includes virulence factors - lipids, the phosphatide fraction of which is associated with the virulence of mycobacteria;
- homogeneous bacterial cytoplasm;
- cytoplasmic membrane - includes lipoprotein complexes, enzyme systems, forms an intracytoplasmic membrane system (mesosome);
- nuclear substance - includes chromosomes and plasmids.

Proteins (tuberculoproteins) are the main carriers of the antigenic properties of MBT and exhibit specificity in reactions hypersensitivity slow type. These proteins include tuberculin. The detection of antibodies in the blood serum of tuberculosis patients is associated with polysaccharides. Lipid fractions contribute to the resistance of mycobacteria to acids and alkalis.

Mycobacterium tuberculosis is an aerobe, Mycobacterium bovis and Mycobacterium africanum are aerophiles.

In organs affected by tuberculosis (lungs, The lymph nodes, skin, bones, kidneys, intestines, etc.) a specific “cold” tuberculous inflammation develops, which is predominantly granulomatous in nature and leads to the formation of multiple tubercles with a tendency to disintegrate.

Pathogenesis (what happens?) during fibrocavernous tuberculosis:

Pathogenetically, this form does not arise independently, but is a consequence of infiltrative tuberculosis. The hematogenously disseminated form also serves as a source of fibro-cavernous processes in the lungs.

Of course, with an advanced fibro-cavernous form, it is not always easy to determine what caused its development.

The extent of changes in the lungs may vary. The process can be one-sided or two-sided, with the presence of one or many cavities.

Fibrous-cavernous tuberculosis is characterized by foci of bronchogenic dropout of varying duration. As a rule, the bronchus draining the cavity is affected. Other morphological changes in the lungs also develop: pneumosclerosis, emphysema, bronchiectasis.

The anamnesis of patients with fibrous-cavernous lung disease is characterized by complaints about the duration of the tuberculosis disease and its undulating course. The intervals between the outbreak and clinical relief may be very long or, on the contrary, there may be frequent repetition flashes. In some cases, patients do not subjectively feel the severity of the disease.

Symptoms of fibrocavernous tuberculosis:

Clinical manifestations of fibrocavernous tuberculosis are diverse, they are caused by the tuberculosis process itself, as well as developed complications.

There are two clinical variant course of fibrous-cavernous pulmonary tuberculosis:
1) limited and relatively stable, when, thanks to chemotherapy, a certain stabilization of the process occurs and exacerbation may be absent for several years;
2) progressive, characterized by alternating exacerbations and remissions, with different periods between them.

During periods of exacerbation, a rise in temperature is observed, which is explained by specific outbreaks of the process and the development of infiltration around the cavity. The temperature can be high in cases where a secondary infection is associated with the disease.

Damage to the bronchi is accompanied by a protracted “nasty” cough, during which viscous mucopurulent sputum is difficult to separate.

Frequent complications are:
1) hemoptysis;
2) pulmonary hemorrhages caused by perforation of large
vessels due to the caseous-necrotic process.

The appearance of a patient with long-term fibrous-cavernous tuberculosis is very characteristic and is called habitus phthisicus. The patient is distinguished by sudden weight loss, flabby dry skin that easily forms wrinkles, muscle atrophy, mainly of the upper shoulder girdle, back and intercostal groups.

Patients suffer from constant intoxication. With frequent outbreaks of the tuberculosis process, respiratory failure of II and III degrees develops. Congestion and acrocyanosis are noted. Subsequently, the liver enlarges. Swelling may occur. As the process progresses, it is observed specific lesion larynx and intestines, which leads to a sharp decrease in the body's resistance. With the development of cachexia, amyloid nephrosis and pulmonary heart failure, the prognosis becomes dire.

Diagnosis of fibrous-cavernous tuberculosis:

Percussion gives clearly defined symptoms: shortening of the sound in places of thickening of the pleura and massive fibrosis. During outbreaks with a significant extent and depth of pneumonic and infiltrative processes, a shortening of the percussion sound can also be noted. There is no pattern in the distribution of these processes, so we cannot talk about their predominant topography.

Auscultation detects weakened breathing in areas of fibrosis and thickening of the pleura. In the presence of infiltrative-pneumonic exacerbations, bronchial breathing and small moist rales can be detected. Over large and gigantic cavities, bronchial and amphoric breathing and large-bubble, sonorous, moist rales are heard. Above small cavities, wheezing is less sonorous, not abundant, and is better heard when coughing. Above the old cavity, a “creaking cart” and “squeaking” can be heard, caused by cirrhosis of the cavity wall and surrounding tissue.

Thus, during the fibrocavernous process, an abundance of stetoacoustic symptoms can be detected. However, there are “silent” and “pseudonymous” cavities that do not give either percussion or auscultation symptoms.

An x-ray usually reveals a picture of fibrosis and shrinkage of the lung, an old fibrous cavity (one or more), and pleural layers.

Radiologically, the picture of fibrosis and shrinkage of the lung is most often found in the upper lobes, with a predominant lesion of one of them. The mediastinum and trachea are displaced towards the larger lesion. The upper lobes are reduced in volume, their transparency is sharply reduced due to hypoventilation. The pattern of lung tissue is sharply deformed as a result of the development of severe fibrosis. IN lower parts The transparency of the lungs is often increased, which indicates emphysema. The roots are usually shifted upward.

Large vessels are defined as straight, even shadows - the so-called “tight string” symptom. Typically, groups of lesions of varying size and intensity are visible in both lungs.

In the fibrous-cavernous process, the cavity is located among severe fibrosis of the lungs, its walls are deformed, dense, and most often thickened. Often a small level of liquid is detected at the bottom of the cavity. With exacerbation and progression of the process, areas of infiltration are visible around the cavity. During treatment, slow resorption of these changes, partial reduction and wrinkling of the cavity are noted. Sometimes a fibrous cavity is detected only with tomography, since on a regular radiograph the shadow of the cavity can be covered by overlapping shadows of foci, fibrosis and pleural layers.

Laboratory examination of sputum reveals constant bacilli secretion, sometimes massive, as well as coral-shaped elastic fibers.

Blood. The state of the blood in patients with fibrous-cavernous tuberculosis depends on the phase of the disease. During an outbreak, it is the same as with active tuberculosis, but with a change in the formula towards lymphopenia, left shift and accelerated ESR to 30-40 mm/h. With severe bleeding, anemia is detected, sometimes very pronounced. With secondary infection, a higher leukocytosis is observed - up to 19,000-20,000 and an increase in neutrophils.

In urine with renal amyloidosis, which often develops in patients with fibrous-cavernous pulmonary tuberculosis, the protein content is usually high.

Treatment of fibrocavernous tuberculosis:

Before starting chemotherapy average duration The life of such patients was limited to 2-3 years. Currently, there are all possibilities to prevent the development of the fibrocavernous process. To do this, at the very beginning of one or another form of the disease, good contact between the doctor and the patient must be established. It is equally important that the doctor ensures full compliance with his appointments and instructions regarding the regimen and time of taking medications. A reputable doctor can and should convince the patient to quit bad habits (alcohol abuse, smoking, etc.).

Patients whose fibrocavernous tuberculosis was not prevented in a timely manner can also be treated effectively. Their treatment must be comprehensive, continuous and long-term. If patients have resistance to or intolerance to essential drugs, care should be taken to antibacterial drugs 2nd row.

The healing of cavities with a fibrous wall is always very slow. If necessary general therapy supplemented with surgical intervention. With a unilateral process and good functional indicators, lung resection of varying volumes is performed. Currently, operations with a bilateral process also give in most cases quite satisfactory results: the patient remains able to work, his life expectancy is significantly extended, and the release of mycobacteria stops.

Prevention of fibrocavernous tuberculosis:

Tuberculosis is one of the so-called social diseases, the occurrence of which is associated with the living conditions of the population. The reasons for the epidemiological problems with tuberculosis in our country are the deterioration of socio-economic conditions, a decrease standard of living population, an increase in the number of people without a fixed place of residence and occupation, and the intensification of migration processes.

Men in all regions suffer from tuberculosis 3.2 times more often than women, while the growth rate of incidence in men is 2.5 times higher than in women. The most affected are persons aged 20 - 29 and 30 - 39 years.

The morbidity rate of contingents serving sentences in penal institutions of the Ministry of Internal Affairs of Russia is 42 times higher than the Russian average.

For the purpose of prevention, the following measures are necessary:
- carrying out preventive and anti-epidemic measures adequate to the current extremely unfavorable epidemiological situation regarding tuberculosis.
- early detection patients and allocation of funds for drug provision. This measure will also be able to reduce the incidence of illness among people who come into contact with sick people in outbreaks.
- carrying out mandatory preliminary and periodic examinations upon entry to work on livestock farms affected by bovine tuberculosis.
- increasing the allocated isolated living space for patients suffering from active tuberculosis and living in crowded apartments and dormitories.
- timely implementation (up to 30 days of life) of primary vaccination for newborn children.

Which doctors should you contact if you have fibrocavernous tuberculosis:

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Other diseases from the group Respiratory diseases:

Agenesis and Aplasia

Actinomycosis

Alveococcosis

Alveolar proteinosis of the lungs

Amoebiasis

Arterial pulmonary hypertension

Ascariasis

Aspergillosis

Gasoline pneumonia

Blastomycosis North American

Bronchial asthma

Bronchial asthma in a child

Bronchial fistulas

Bronchogenic cysts of the lung

Bronchiectasis

Congenital lobar emphysema

Hamartoma

Hydrothorax

Histoplasmosis

Wegener's granulomatosis

Humoral forms of immunological deficiency

Accessory lung

Echinococcosis

Idiopathic pulmonary hemosiderosis

Idiopathic fibrosing alveolitis

Infiltrative pulmonary tuberculosis

Cavernous pulmonary tuberculosis

Candidiasis

Pulmonary candidiasis (pulmonary candidiasis)

Cystic Hypoplasia

Coccidioidosis

Combined forms of immunological deficiency

Coniotuberculosis

Cryptococcosis

Laryngitis

Pulmonary eosinophilic infiltrate

Leiomyomatosis

Cystic fibrosis

Mucorosis

Nocardiosis (atypical actinomycosis)

Reversed lung position

osteoplastic tracheobronchopathy

Acute pneumonia

Acute respiratory diseases

Acute abscess and gangrene of the lungs

Acute bronchitis

Acute miliary pulmonary tuberculosis

Acute nasopharyngitis (runny nose)

Acute obstructive laryngitis (croup)

Acute tonsillitis (tonsillitis)

Focal pulmonary tuberculosis

Paragonimiasis

Primary bronchopulmonary amyloidosis

Primary tuberculosis complex

Pleurisy

Pneumoconiosis

Pneumosclerosis

Pneumocytosis

Subacute disseminated pulmonary tuberculosis

industrial gas damage

Lung damage due to side effects of medications

lung damage due to diffuse connective tissue diseases

- This is not an independent disease. In most cases, it does not affect a person’s quality of life and does not affect the functionality of organs.

However, when issuing an x-ray report, patients think about Pulmonary fibrosis: what is it and how to treat it this disease, and what are the prognosis regarding its course and what outcome to expect.
Fibrosis is formed as a result of an inflammatory process in the lungs or exposure to them negative factors(smoking, inhalation of toxic substances, radiation, etc.). Very often, pulmonary fibrosis is a consequence of tuberculosis.
Many patients fear that this may lead to relapse. But in fact, their fears are in vain, since fibrosis is a common connective tissue, in which there are no bacteria.

Treatment of pulmonary fibrosis

Usually this condition goes unnoticed, but in some cases fibrosis can grow and then a prescription is necessary complex treatment. It is important to understand that scar tissue does not resolve and is not replaced by normal tissue. Therefore everything further measures will be aimed at stopping the growth of fibrosis and improving the quality of human life.

Severe fibrosis can cause a decrease in the ability of lung tissue to stretch and loss normal level elasticity. This may complicate admission carbon dioxide and oxygen through the walls of the alveoli. As a result, the patient suffers from a lack of oxygen and the breathing process is disrupted. In the first stages of the disease, a person may not feel any discomfort or complain of slight shortness of breath when physical activity. As the disease progresses, symptoms such as cough, chest pain appear, and the patient often begins to suffer from bronchitis. This makes a person think about a relapse (if he has had tuberculosis). To diagnose pulmonary fibrosis, a chest x-ray is prescribed.

Complicated pulmonary fibrosis is accompanied by the following symptoms:

• frequent shortness of breath;
• possible weight loss;
• wheezing when breathing;
• discomfort in the chest area;
• dry cough with little sputum;
• fast fatiguability.

• Organization healthy image life: balanced nutrition, good rest with 7 to 9 hours of sleep.
• Treatment of inflammatory processes in the lungs and bronchi, if present.
• Prescription of corticosteroid drugs.
• Breathing exercises.
• Oxygen therapy.

Fibrosis after tuberculosis: How dangerous is this?

After suffering from tuberculosis, fibrosis is diagnosed in the vast majority of patients. Usually it affects a very small part of the lungs and does not cause concern on the part of doctors and patients themselves. It does not require treatment. Surgical removal affected areas is recommended in severe cases, with an increase in the above symptoms and the growth of fibrosis. It is impossible to make a diagnosis based on the presence of scar tissue alone, so in the future no one will suspect that the patient suffered from tuberculosis.

Fibrous-cavernous pulmonary tuberculosis is chronic disease, which manifests itself in the form of the formation of hollow cavities on the surface of the organ. This pathology is established in 7% of patients with diagnosed tuberculosis and is quite dangerous. This is due to the fact that when cavities form, a large volume of the organ is affected, resulting in difficulty breathing.

Fibrous-cavernous pulmonary tuberculosis develops against the background of penetration into the body of bacteria that are resistant to an acidic environment. They can be found not only in soil or water, but also in living organisms. The disease begins to develop as a result of a decrease in protective forces.

Pathology is characterized by the presence of pathogenicity, which manifests itself in the ability to be transmitted. When making a diagnosis, many patients are interested in whether this form of tuberculosis is contagious or not? It is this property that poses a great danger to others.

The disease can also change shape depending on the action of factors environment. Once an infection enters the body, inflammation begins and spreads. In this case, the disease takes on a necrosing form.

The cavernous form of pulmonary tuberculosis is the next stage of the disease. An infiltrative type begins to develop, which is not contagious. It is the result of the spread of pathogenic microorganisms against the background of the penetration of a primary infection.

It is worth considering that a small number of pathogenic microorganisms are present in the body of every person. With fibrous-cavernous pulmonary tuberculosis, the following occurs:

1. Fibrous sclerosis.
2. Increased airiness.
3. Rejection of dead tissue.

The pathology is characterized by a wave-like course, when periods of remission and exacerbation replace each other. Many patients at the initial stages of development do not notice the symptoms that have arisen; the pathology is mild.

In medicine, two forms of fibrous-cavernous pulmonary tuberculosis are known:

1. Limited. The pathology has a stable course. Treatment is carried out with chemotherapy, which gives positive results. But the period of exacerbation occurs after several years.
2. Progressive. The disease develops rapidly and is accompanied by pronounced symptoms. Patients complain of fever, dry cough and bleeding. It is also possible that a secondary infection may occur due to decreased immunity.

With a progressive form, dry skin, muscle atrophy and sudden weight loss are also noted. Patients develop bruises under their eyes. Outbreaks of fibrocavernous pulmonary tuberculosis are characterized by pulmonary insufficiency, and the skin becomes earthy in color, the liver enlarges.

Clinical picture

Cavernous tuberculosis lungs, depending on the nature of the course, may manifest itself in the form of shortness of breath, constant weakness and the production of large amounts of sputum.

The patient's condition is often assessed as satisfactory. But with extensive damage to the lung tissue, it is characterized as moderate.

Patients experience a slight increase in body temperature. Indicators can increase to 37 degrees. Also, when diagnosing, the doctor pays special attention to the presence of the following symptoms, since treatment directly depends on the clinical picture:

1. Weakness and rapid weight loss. The skin becomes moist and acrocyanosis occurs.
2. With the prolonged development of pathology, conditions that are dangerous to life and health, such as cachexia, can develop. It is characterized by exhaustion of the body.
3. Region chest takes the shape of a barrel.
4. On the side affected by the pathological process, temporary or permanent retraction of the cavities of the subclavian or supraclavicular type is established.

In addition, cavernous pulmonary tuberculosis is determined by the lag of the infected area of ​​the chest during respiratory function.

Over time, the disease is characterized by an undulating course. At the same time, foci of inflammation and cavities begin to form on the surface of the lungs. A dangerous sign is the constant production of sputum, which contains pathogenic microorganisms. They negatively affect body functions, including respiratory.

As the inflammatory process spreads general state the patient's condition worsens, the risk of developing complications in the form of respiratory failure and the appearance of blood clots in the sputum increases.

Diagnostics

Cavernous pulmonary tuberculosis is diagnosed based on clinical manifestations and external examination. To confirm the diagnosis and establish the nature of the course of the disease, the following are prescribed:

1. Bacterioscopic examination of sputum. Necessary to identify the type and number of bacteria.
2. Urine and blood tests and tuberculin test.
3. Radiography.
4. Tomography.

X-ray examination helps to determine the presence of specific signs. The type of tuberculosis is determined based on the images obtained. An indirect manifestation of the disease includes a horizontal shadow that is located inside the cavity. The image also shows the draining bronchi, which represent two shadows.

Treatment

Timely therapy and the use of modern drugs make it possible to achieve resorption of the fluid located in the cavities. But in cases where a large amount of it is established, surgical intervention is performed.

When diagnosing fibrous-cavernous pulmonary tuberculosis, patients are advised to take Streptomycin. The antibiotic is used only as prescribed by a doctor in the indicated dosages. Prednisolone and Phtivazid may also be prescribed.

The course of therapy is three weeks. During this period, the patient must be under the supervision of a doctor in a hospital. Experts recommend stopping smoking and drinking alcohol. This will help increase the likelihood of recovery and eliminate the development of complications.

Cavernous pulmonary tuberculosis in the case when treatment was started on late stages, also has the ability to heal. The main condition is complete, continuous and comprehensive treatment.

But the healing process of cavities is quite long. If indicated, surgical intervention is performed. This involves excision of part of the lung.

The prognosis for life after therapy is favorable. Patients are able to return to normal life even after surgery.

Fibrous-cavernous pulmonary tuberculosis is also serious illness, which, if left untreated, can cause respiratory failure. When timely treatment It is possible to stop the pathological process and significantly increase the patient’s life expectancy.

Multicomponent antibiotic regimens can effectively cure tuberculosis by destroying mycobacteria, both during reproduction and during the dormant period. This provides a favorable prognosis after long-term treatment. The exception is running forms when the growth of cavities wears chronic nature, there are extensive foci of contamination. With insufficient therapy, fibrous-cavernous pulmonary tuberculosis is a stage preceding the cirrhotic type, in which the lesions are irreversible.

Etiology

Initially, the cause of the development of pathology is infection with a pathogen that belongs to the class of prokaryotes. It is an acid-fast, virulent pathogen that is protected by a three-layer cell wall. The membrane is based on polysaccharides. It is not capable of producing antigenic bodies, but has serological properties. Thanks to the protein compound tuberculin, the pathogen exhibits high resistance, which makes treatment difficult.

Fibrous-cavernous tuberculosis develops due to a previous form, usually infiltrative. There may be several reasons for this:

• Deformation processes occur due to the proliferation of connective tissue when scarring is absent or delayed.
• Presence of open cavities with a large strain population.
• The time period for the development of previous forms of tuberculosis ranges from one and a half to three years.

Pathogenesis

If the cavity formed as a result of infiltrative manifestations does not heal, connective tissue begins to grow around it. Among such areas there are vast zones with a large area of ​​infestation. As a rule, the initial penetration of mycobacteria into the lungs does not manifest any special symptoms. Early detection of the pathogen is quickly stopped, treatment of the disease is successful, the process has no complications.

If the progression of the pathology is prolonged, it develops into fibrous-cavernous pulmonary tuberculosis with characteristic lesion muscle fibers, the formation of tubercles on the bronchial mucous membranes. As a result, caseous necrosis is formed with narrowing and obliteration of the lumens and the occurrence of bronchiectasis. Further development of the disease leads to the formation of huge cavities, which often occupy both lungs.

The cavities consist of several walls covered with a network of capillaries and vessels with signs of an aneurysm. Often, damaged arteries cause bleeding that is difficult to stop. Massive fibrosis does not allow complete scarring; all parts of the pleural tissue are involved in the process. They develop inflammation, areas of fusion, which distinguish fibrous-cavernous tuberculosis. Because of this, mobility is limited, stretching increases and healing is inhibited.

In open caverns, a constant process of division and reproduction of the strain occurs, and the population of mycobacteria rapidly increases. Therefore, an inflammatory process with necrotic signs is maintained in the walls, which is difficult to stop. With each new exacerbation, the following areas are involved in the process, which entails the formation of new disseminated zones. These lesions eventually merge into larger areas, and as a result of destruction, more and more cavities appear.

The cavernous membranes consist of three layers. The caseous part is characterized by melting of tissues and structures. The breakdown and rejection of tissue is accompanied by the formation of cavities through which the organs are filled with air. The granulation part consists of giant epithelial cells. When purulent masses are cleared, a fibrous layer is formed. Because drainage functions worsen, release becomes impossible. With infiltrative changes, the cavities are not able to close, therefore fibrous-cavernous tuberculosis is accompanied by the formation of replacement tissues. The classification of the pathogenesis of the disease is based on the following factors:

• Progressive cavities with blurred boundaries in the decay phase in the presence of infiltrates.
• Cavities lined with a granulation layer.
• Three-layer encapsulated formations.
• The predominance of fibrous walls and necrosis is characteristic of a long-term progressive process.
• Residual changes, cleared of granulation masses with partially preserved walls as a result of treatment.

Due to extensive epithelial growths, fibrous-cavernous pulmonary tuberculosis is accompanied by bleeding that is difficult to stop conservative method. Due to a violation of integrity, the vessels do not collapse, the cavities are covered purulent exudate, which serves as a breeding ground for the proliferation of mycobacteria and other pathogens. As this form progresses, complications often develop - cardiac and respiratory failure, pneumothorax, amyloid dystrophy.

Clinical picture

Pathology can occur in several ways. The first is a limited option due to successful treatment preliminary form, which is characterized by the absence of clear symptoms. The progressive type is characterized by frequent relapses and wave-like manifestations. Periods of remission are followed by moments of attenuation. Despite the serious destructive process, a patient diagnosed with fibrous-cavernous pulmonary tuberculosis may feel satisfactory for a long time. It is customary to distinguish 3 clinical forms of the disease:

• The stable process is accompanied by rare outbreaks, the spread of mycobacteria is insignificant. The interval between exacerbations can drag on for several months or even years. Subject to compliance with the regimen and regular chemotherapy, there are no signs, patients have no complaints.
• Progression can be short or long. During outbreaks, the patient suffers from severe intoxication, shortness of breath is accompanied by a cough with sputum. Bloody clots may appear in the discharge. During the inflammatory process, pleurisy develops, there is a lack of appetite, tachycardia, and chest deformation. Next, hypoxemia and pulmonary hypertension appear, and the endocrine and nervous systems are involved in the process.
• Complicated pathology is severe degree development with decompensated stages, circulatory disorders, muscle dystrophy. The patient begins to have amyloidosis and multiple pulmonary hemorrhages. This is the most dangerous form of the disease, as the risk of death is very high. In addition, cachexia, arthralgia, and periostitis are often diagnosed.

Diagnostics

The basic principle of identifying this form of pathology lies in x-ray examination. If light areas are found against the background of darkened areas, this indicates that fibrous-cavernous pulmonary tuberculosis has begun to develop. But the cavities are visible in the image when the melting of the tissues began and air entered the cavity. The shadow has the appearance of a ring with clearly defined solid boundaries. Also signs of the development of fibrosis are the following indicators:

• Accumulation of fluid within the lungs
• Sclerotic and infiltrative formations in the bronchi, converging towards the caverns
• Large, locally fused foci of dissemination with vague contours
• Alternating fibrous and emphysema zones
• Compaction and deformation of the root and pleural areas
• Presence of ectasis with to varying degrees severity and prevalence
• Displacement of organs towards the affected side.

Reactions to tuberculin in such patients are moderate. At the time of remission, sensitivity is positive, with progression - negative. Mycobacteria in sputum are constantly sown, but can change. In most cases, they show resistance to the antibiotics used in the treatment process. Therefore, the phthisiatrician often replaces medications.

Biochemical analysis shows an increase in leukocyte and neutrophil elements, while lemphocyte and eosinophil compounds increase. When pneumonia is associated, anemia is observed due to bleeding. Patients are characterized by dysfunction of the pituitary gland, immune and digestive systems.

Since most patients already have a history of tuberculosis, diagnosis of this form is carried out quickly. The only difficulty is differentiation from a lung abscess. Both pathologies have similar symptoms, they distinctive feature is bleeding. But fibrous-cavernous tuberculosis is usually accompanied by low-grade fever, and with an abscess the patient always suffers from fever. On x-ray, purulent inflammation has no foci, differs in the nature of scarring and the shape of the cavity walls. In addition, the abscess responds well to treatment, and the patient recovers quickly.

Principles of therapy

Previously, before the creation of combination regimens using anti-tuberculosis drugs, a patient with this form of tuberculosis could live no more than 3 years. It should be borne in mind that the healing process of cavities is very slow. If one lung has undergone destruction, it is advisable to perform resection. There are several methods for this, the most effective of which are the following:

Pneumolysis

Surgical intervention involves detachment of damaged pleural and pulmonary tissues by injecting a nitrogenous mixture into the cavity. But such an operation turned out to have low results, so it was decided to perform paraffin sealing. The procedure is carried out through preliminary resection of part of the rib. To prevent liquid from accumulating blood clots at the site of detachment, regular punctures with additional injection of air are necessary. The formed bubble helps maintain the pneumothorax process in the desired state.

If the operation proceeds without complications, the patient is transferred to ambulatory treatment under the supervision of a phthisiatrician. The created air cavity lasts about one and a half years. Thanks to pneumolysis, further growth of fibrous tissue stops and decay stops.

Thoracoplasty

The principle of the technique is that the parameters of the chest decrease, as a result of which elasticity decreases. This creates conditions for compression and reduction of cavities. The fact is that against the background clinical therapy cavities rarely heal without consequences. More often, there are no scars, no closure is observed, and in place of the cavity a narrow lumen is formed, lined epithelial tissue. Inside it there are granulation formations with traces of necrosis. Such a gap can turn into metastasis during outbreaks of pathology.

Thoracoplasty is indicated when resection of part of the lung is impossible; the patient can be operated on only with stable stabilization. Fresh lesions and infiltrates are extinguished by antibacterial therapy. For limited processes, large-scale surgical intervention is not advisable. For weakened patients with extensive organ damage, the procedure is carried out in several stages. As a result, the condition of patients, even with bilateral intervention, remains satisfactory.

Resection

In the presence of tuberculomas, chemotherapy is ineffective in most cases. Surgery indicated for all signs of progressive development, symptoms of intoxication, massive release of mycobacteria. Currently, it is advisable to carry out local resections when cavities are formed within one or two fields, but provided that there is no contamination. The operations are well tolerated by young and middle-aged patients, much worse by older people.

The results of surgical intervention are favorable, mortality is no more than 1%. Recurrent processes and exacerbations are extremely rare. For any operation, preliminary and subsequent antibiotic therapy is required for 6 months to a year. Treatment is carried out in specialized hospital and involves the use of 3-4-5-component regimens with first- or second-line drugs. The following medications are used for this:

• The antituberculosis drug Pyrazinamide remains active in an acidic environment and may exhibit bactericidal or bacteriostatic properties, depending on the concentration. The active substance quickly penetrates into the lesions, where they destroy the cell membranes of the pathogen. Used in combination with other compounds. The dosage is 1-2 g per day, taken in the morning, after meals, with water.
• A derivative of isonicotinic acid, isoniazid, has been used to treat tuberculosis for many years. Intra- and extracellular microorganisms are exposed to its effects, but it exhibits the highest activity against dividing pathogens. It is able to suppress the synthesis of mycolic acid, necessary for the construction of bacterial structures. Dosage – 15-40 mg/kg 2-3 times a week, depending on the age and condition of the patient.
• Another antibiotic, Rifampicin, is effective in combination with other drugs. Suppresses the production of polymerase compounds, thereby stopping the reproduction and growth of the pathogen. It is recommended to take it half an hour before meals, on an empty stomach at a dosage of 10 mg/kg once a day.

Prognosis and prevention

The only way to prevent the development of this form of pathology is timely diagnosis and complete treatment of the previous disease. In order to prevent destructive damage to organs, it is necessary to strictly adhere to the doctor’s instructions; it is forbidden to interrupt the therapeutic course. It is necessary to follow a diet, stop drinking alcohol and smoking.

The prognosis is favorable after the operation. But in some cases, intervention is fraught with complications. The most dangerous of them are cirrhotic lung disease, cancer, spontaneous pneumothorax, pleural empyema. In addition, there is a risk of death due to bleeding.