Chronic Cavitary Tuberculosis Research Articles

Change in lung function early after endoscopic bronchial valve placement in patients with chronic cavitary tuberculosis

The goal of this study was to analyze qualitative and quantitative changes in pulmonary ventilation and gas exchange early after endobronchial valve (EBV) placement intended to induce artificial local collapsed lung in patients with cavitary pulmonary tuberculosis. Methods. The study involved 74 patients with cavitary pulmonary tuberculosis underwent EBV placement to achieve cavity closure. As a result of EBV placement, one to two lung segments were blocked in 25 patients, three lung segments were blocked in 37 patients, and four to five lung segments were blocked in 12 patients. Pulmonary function and blood gases were measured in all patients before and 4 to 6 weeks after placing EVB. Results. Pulmonary ventilation and gas exchange parameters changed early after EBV placement in > 50% of patients. FVC and blood gas parameters changed more often than spirometry parameters. Functional improvement was considered in cases of blood gas improvement and, less frequently, in cases of VC improvement. Functional worsening was considered in cases in lung function decrease and development of mixed (coexisting obstructive and restrictive) abnormalities. Conclusion. In patients with cavitary pulmonary tuberculosis, EBV placement caused functional worsening more likely in patients with normal lung function at baseline. Functional worsening after EBV placement was 3- to 10-fold less likely in those with pulmonary ventilation abnormalities, such as VC decrease or bronchial obstruction, at baseline. Functional improvement after EBV placement was more often seen in moderately decreased lung functional parameters at baseline but not in patients with normal lung function.

Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report

BackgroundPulmonary artery aneurysms constitute <1% of aneurysms occurring in the thoracic cavity. Congenital cardiac defects are responsible for the majority (>50%) of cases, however, pulmonary artery aneurysm is a rare sequelae of pulmonary tuberculosis reported in about 5% of patients with chronic cavitary tuberculosis on autopsy. The natural history of this potentially fatal condition remains poorly understood and guidelines for optimal management are controversial.Case presentationA 24-year-old man, a nursing student of African descent, was referred to us from an up-country regional hospital with a 4-week history of recurrent episodes of breathlessness, awareness of heartbeats and coughing blood 3 weeks after completing a 6-month course of anti-tuberculosis drugs. A physical examination revealed conjuctival and palmar pallor but there were no stigmata of connective tissue disorders, systemic vasculitides or congenital heart disease. An examination of the cardiovascular system revealed accentuated second heart sound (S2) with early diastolic (grade 1/6) and holosystolic (grade 2/6) murmurs at the pulmonic and tricuspid areas respectively. Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia. A chest radiograph revealed bilateral ovoid-shaped perihilar opacities while a computed tomography scan showed bilateral multiple pulmonary artery pseudoaneurysms with surrounding hematoma together with adjacent cystic changes, consolidations, and tree-in-bud appearance. Our patient refused to undergo surgery and died of aneurismal rupture after 9 days of hospitalization.ConclusionsThe presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm. Furthermore, despite of its rarity, early recognition and timely surgical intervention of pulmonary artery aneurysm is crucial to reducing morbidity and preventing the attributed mortality.

Pulmonary Aspergillosis: An Analysis of 41 Patients

During the period 1969 to 1974, 41 patients having cultures positive for aspergillus were seen on the thoracic surgical services of the University of Maryland and Mt. Wilson State Hospitals. Intracavitary mycetoma was present in 36 patients. In 32 the underlying disease was chronic cavitary tuberculosis, 5 had decreased immunity due to other diseases, and in 3 no underlying disease was noted. One final patient developed a mycetoma following repair of tetralogy of Fallot. Hemoptysis, the predominant symptom, occurred in 23 patients, all of whom were from the group with intracavitary mycetoma. Hemoptysis was life-threatening in 8 patients, severe but not life-threatening in 12, and minimal in 3. Fifteen patients underwent pulmonary resection with 2 deaths. Both patients who died had undergone emergency resection for life-threatening hemoptysis; the fungus ball had developed following a previous resection for tuberculosis, and both had poor pulmonary reserve. Of 10 patients with hemoptysis who were not treated surgically, chiefly because they were poor operative risks, 4 died. This study suggests that pulmonary aspergillosis, particularly of the intracavitary type, is a potentially life-threatening disease. Because of the suddenness with which massive hemoptysis may occur, pulmonary resection is recommended for all patients with intracavitary mycetoma who do not constitute prohibitive operative risks.

The Rising Incidence of Isoniazid Resistance: Its Clinical Significance

SUMMARY 1.In a series of 322 consecutive patients, an incidence of primary resistance to isoniazid of 10 per cent was demonstrated. 2.Newly diagnosed cases of pulmonary tuberculosis respond well to combined drug regime in spite of initial resistance to isoniazid. 3.Patients with chronic cavitary tuberculosis of long duration who are initially resistant to INH may respond well to combined chemotherapy; however, most of them require surgical help to effect an arrest of their disease. 4.Drug resistance has thus far not become a public health problem in newly discovered untreated patients.