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Secondary pulmonary TB Lu hua

Secondary pulmonary TB Lu hua. Dept. of Pathology Three Gorges University Medical College. ( 一) Outline usually results from reactivation of dormant 休眠 , endogenous 内生 tubercle bacilli in a sensitized patient who has had previous contact with the

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Secondary pulmonary TB Lu hua

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  1. Secondary pulmonary TBLu hua Dept. of Pathology Three Gorges University Medical College

  2. (一) Outline usually results from reactivation of dormant休眠, endogenous内生tubercle bacilli in a sensitized patient who has had previous contact with the tubercle bacillus. Secondary pulmonary TB

  3. 1. Reinfection usually adults adult type pulmonary TB Initiated发起from apex of lung secondary focus

  4. 2. Pathogenesis ① Exogenous reinfection not related to primary infection ② Endogenous reinfection PP TB spread via bloodstream Primary → bronchial Extrapulmonary TB→blood→lung

  5. (二) Features of lesion

  6. 1. Initial focus: Site : apex of the lung local resistence↓ ① Stand A pressure↓ poor circulation macrophage↓Ab↓ ② Bad ventilation通风

  7. 2. Features of lesion Hypersensitivity: Easily caseous necrosis, liquefy,cavity↑ Immune response: stronger localized focus proliferation tubercle

  8. 3. The ways of spread Lymphatics Bloodstream less prominently involved Bronchia : main

  9. 4. Clinical course long period of time better or worse new and old lesion mixed up

  10. Pathological change and types 1.Focal pulmonary TB 2.Infiltrative pulmonary TB 3. Chronic fibro-cavitative 4. Caseous pneumonia 5. Tuberculoma 6. Tuberculous pleuritis

  11. 1.Focal pulmonary TB initial lesion of secondary pulmonary TB (1) Lesion usually below apex 2-4cm , 0.5-1cm in size , clear edge proliferation → main Pathological change and types

  12. (2) Results Healing in most cases: fibrosis, calcification Progress infiltrative pulmonary TB

  13. 2. Infiltrative pulmonary TB most common type of active pulmonary TB Arising in: progress of focal pulmonary TB few cases occur initially

  14. (2) Lesion site→below clavicle, unclear edge center: smaller caseous necrosis surrounding: surrounded by inflammation exudative serous fluid, monocytes, LC, neutrophils

  15. (3) Clinical features Symptoms: low-grade fever, anorexia厌食, fatigue疲劳, weight loss, night sweats , general malaise， cough . hemoptysis咯血(cavitary disease). Tubercle bacilli (+)

  16. (4) Results ① Healing: treatment earlier absorption, fibrosis, encapsulation, calcification

  17. ② Progress Caseous necrosis liquefied bronchial→caseous pneumonia destroy pleura→ spontaneous pneumothorax自发性气胸 thoracic cavity胸腔→tuberculous pyopneumothorax脓气胸 persistent→chronic fibro-cavitative pulmonary TB

  18. Final result: • Most healing • Less solution and spread fibrosis absorbed calcification spread

  19. 3. Chronic fibro-cavitative pulmonary TB adult, common type (1) Arising in: usually acute cavity of infiltrative pulmonary TB

  20. ① Formation of thick wall cavity one or more bilateral lung upper lobe of lung variation in size irregular shape (2) Features of lesion

  21. Cavity wall (LM) : three layers 1.inner:caseous necrosis 2.midial:tuberculous granulation tissue 3.outer: fibrous tissue 1 2 3

  22. 2 3 1

  23. within cavity: bridge like appearance vessels which have thrombosis organization

  24. ② Unilateral or bilateral lung: new or old, variation in size, different types of lesion ③ Adjacent tissue widely fibrosis pleura thickened sclerosing pulmonary TB

  25. (3) Clinical features ① Origin of infection open pulmonary tuberculosis ② Hemoptysis (eroding large vessels) Death

  26. An 80-year-old female who exsanguinated from massive hemoptysis due to tuberculosis and bronchiectasis.

  27. ③ Widely fibrosis pulmonary hypertension cor pulmonale ④ Small cavity→scar Large cavity→open healing

  28. ⑤ Sputum with bacteria throat and intestinal TB ⑥ Destroy pleura: pneumothorax气胸 pyopneumothorax脓气胸

  29. 4. Caseous pneumonia (1) Arising in: immunity↓↓, allergy↑↑ infiltrative type pulmonary TB bacteria in acute or chronic cavity, disseminated播散by bronchi

  30. (2) Lesions lobular lobar Gross: enlargement of lobe, consolidation ,acute cavity LM: alveoli filled with serofibrous exudates, many macrophages, widely caseous necrosis necrosisexudation, Bac (+)

  31. (3) Clinical features bad prognosis death galloping consumption奔马痨

  32. 5. Tuberculoma (1) Arising in: Infiltrative P.TB large necrotic focus F. encapsulation Cavity: draining bronchi blocked cavity filled with necrosis Fusion of several focus

  33. (2) Lesions solitary, fibrous encapsulated, clear edge, round, caseous necrosis focus diameter: 2-5cm number: usually one, sometime multiple site: upper lobe

  34. (3) Clinical fertures relative motionless静止 healing: organization, calcification development: Necrosis , focus extension Liquefied→cavity Spread by bronchi

  35. 6. Tuberculous pleuritis (1) Arising in: primary and all stage of secondary pulmonary TB

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