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sequelae
Complications/sequelae
Pulmonary
Extrapulmonary
Pulmonary sequelae
Hemoptysis
Bronchiectasis
Bronchostenosis
Destroyed lung
Aspergilloma
Calcification
Open negative syndrome
Pulmonary sequelae
Scar carcinoma
Chronic airway obstruction
Chronic respiratory failure
Cor pulmonale
TB relapse
Pyogenic abscess
Tubercular endobronchitis & tracheitis
Extrapulmonary
Pleural fibrosis
Pneumothorax
Amyloidosis
Cardiac
Abdominal
Skeletal
Neurological/TBM
Genitourinary
Hemoptysis
Common, potentially fatal
More common in young
Incidence 30-35%
Causes : Rasmussens aneurysm, scar
carcinoma, bronchiectasis, broncholith,
aspergilloma
Hemoptysis : Rx
Bed rest
Diseased side be dependent
Sedation
Rule out bleed from UR tract
Restoration of fluid balance
Antifibrinolytics
Bronchoscopy : diagnostic and therapeutic : (i)localizes
lesion, (ii)can place balloon catheter/CO2 laser, (iii)
arterial embolotherapy : successful in 98%
Surgery : last but definite Rx
Bronchiectasis
Increases with increase in severity of parenchymal
involvement
No relation to age,sex or presence of cavity
Causes : fibrosis, atelectasis, bronchostenosis, rupture
of calcified node into bronchus
Bronchiectasis sicca
Diagnosis : CxR, bronchography, CECT
Management : postural drainage, infection control,
complications management
Bronchostenosis
Most serious complication of endobronchial TB
60-95 % of endobronchial TB
Occurs in spite of chemotherapy : as late as 3
years after treatment
Tracheal involvement : respiratory failure,
retention of secretions, failure of endotracheal
intubation
Treatment : cortiocosteroids have no role :
repeated dilatation, end to end anastomosis
Destroyed lung
Massive destruction of one lung
Left bronchus syndrome : Ieft bronchus
longer, 15% narrower, decreased
peribonchial space : review of 172 cases
showed 109 (63%) cases on the left :
perfusion to the affected side absent
Management : of complications
Aspergilloma
Majority of fungal balls in TB cavities are
aspergilloma
Mucormycosis has also been implicated
Cavities >2.5 cm +ve serology : precipitins in
25%; radiological evidence in 11%
Asymptomatic presentation
Hemoptysis(5-90%), cough, weight loss
Air crescent (Monod) sign, Halo sign, bell like
image with fungus ball as clapper inside bell.
Aspergilloma
Diagnosis : CxR, sputum culture, serology,
bronchoscpy
Contents : dead and live mycelial elements,
fibrin, mucus, inflammatory cells, degenerated
blood and epithelial elements
Management : (i)asymptomatic : spontaneous
lysis(7-10%) followed radiologically,
(ii)symptomatic : intracavitary instillation of
antifungals(amphotericin B, nystatin), resection
surgery, radiotherapy
Calcification
Healed tubercular lesions
Pleural diseases : descrete radioopaque
shadows or sheet-like calcification
Can erode bronchial wall or arterial wall resulting
in hemoptysis
Coughed-out calcified stones(broncholiths)
Extensive calcification can result in respiratory
failure and cor pulmonale
Scar carcinoma
Peripherally located tumour with no
evidence of bronchial origin, occurring
around a true hyalinized scar
More common in upper lobes
Usually adenocarcinoma and at
presentation frequently have extra
pulmonary manifestations.
Asthma
Clinical deterrioration : suggestive of
asthma : 2-6 months after endobronchial
TB Rx
No significantly increased bronchial
reactivity
Response to bronchodilators poor
Good clinical response to corticosteroids
Pleural fibrosis
Most common sequel of pleural effusion
50% unilateral
Neither clinical feature nor fluid characters
can predict extent of fibrosis
No relation to drugs used in chemotherapy
Due to DTH
Pleural fibrosis
Visceral pleura involved
Spontaneous resolution in 6 months
Steroids have no role
Rx : patient symptomatic & lung healthy :
decortication(even in long standing
fibrothorax)
Major operation with morality of 3.5%
Spontaneous pneumothorax
Pulmonary tuberculosis(5-15%)
Due to rupture of thin healed cavity/bleb/
bulla(secondary to fibrosis)
Male>female
Increases with increasing age
Rt>It
Spontaneous pneumothorax :
Rx
ICD : High failure rate(fibrosis &
adhesions), longer duration(5d-5mth),
frequent BPF
Failed ICD : decortication/space- reducing
thoracoplasty
Amyloidosis
Deposition of extracellular, aposerum AA type
proteinaceous substance
Renal amyloidosis in 8-33%
Tuberculosis most common cause in India
Decreased incidence with modern
chemotherapy
Diagnosis : abdominal fatpad/rectal mucosal/
liver/kidney biopsy
Rx : supportive
Abdominal TB
Chronic : stricture, blind loop; Rx surgical
Acute : intestinal perforation/obstruction,
peritonitis; Rx conservative till infection
subsides with chemotherapy
Tubercular meningitis
20-25%
Psychologic/psychiatric disturbances
Visual/hearing/other neurologic deficit
Endocrine(pituitary/hypothalamic etc)
disturbances
Seizures
Intracranial calcification
Cardiac
Chronic constrictive pericarditis
Pericardial effusion
Skeletal
Deformity
Paresis/paralysis(paraplegia etc)
Genitourinary
Infertility
Stricture