In this article, we consider that it is pulmonary tuberculoma. The consequences of this ailment will also be presented. Tuberculoma, or as the disease is also commonly called, caseoma, is a consequence of tuberculosis in the form of a residual phenomenon in the lung. However, in medicine, pathological education is considered an independent type of disease.
Who is diagnosed?
Pulmonary tuberculoma is diagnosed in 5% of people who have had a primary infection. Most often, it occurs in patients aged 20-40 years, especially those who suffer from a variety of immune disorders. This disease is characterized by a wave-like course of symptoms and the same stages of danger and safety for surrounding people. Tuberculoma is determined, as a rule, on a planned fluorography, since it is asymptomatic. After this, treatment of the disease and systematic monitoring of the situation is required.
Causes of the disease
Pulmonary tuberculoma is a consequence of a prolonged stay of mycobacterium tuberculosis in the human body in a vegetative state. It is a focus of a round or oblong shape, usually single, but it also occurs in the form of multiple formations, larger than 1 cm, which are localized in the lower or upper parts of this organ. We can say that tuberculoma is a separate process in the lungs. The inflammatory process takes place inside the body, in an isolated capsule.
Thus, this is a caseous-necrotic formation, which is surrounded by two layers - fibrous fibers and tuberculous granulations. The disease can be primary or secondary type.
In medical science, several causes of this pathology are described:
- Transformation of secondary tuberculosis, for example, infiltrative, disseminated, focal, tricky.
- Hypersensitivity of the body.
- Diabetes.
- Violation of metabolic processes in the body.
Is the disease contagious?
If pulmonary tuberculoma occurs, it is impossible to give an exact answer whether the disease is contagious or not. At least until a full diagnosis is made. In case of violation of the membrane of such a formation under the action of phagocytes in the upper lobes of the lungs, the tuberculoma cavity can connect to the bronchial cavity. In this case, the person becomes dangerous to others, that is, the disease becomes contagious. The patient himself during this period may develop pulmonary tuberculosis as a fibro-cavernous type of pathology, which is contagious at the time of its disintegration.
The danger of pulmonary tuberculoma is interesting to many. It forms in about two to three years and 80% of cases of its occurrence are due to incorrect therapy of the initial forms of tuberculosis.
A pathological formation does not have an epidemiological status, which distinguishes it from active open forms of tuberculosis.
Varieties of tuberculoma
It can be simplified to say that pulmonary tuberculoma is the boundary stage between the norm and the anomaly, which is active tuberculosis. In medicine, there are several classifications of this disease. By structure, it can be:
- infiltrative-pneumonic, which occurs against a background of untreated infiltrative tuberculosis;
- homogeneous;
- layered;
- conglomerate.
Features of each form
The first forms are characterized by the layered spread of caseosis and granulomas from epithelial cells, as well as a fibrous capsule.
Tuberculoma of the second type is a substance consisting of a nucleus and a membrane.
The third can be characterized by the occurrence of caseous formations with fibrous layers, and this form is characterized by a wave-like course.
Conglomerate tuberculoma is a few caseous formations in one capsule.
According to other classifications, infiltrative-pneumatic, true and filled tuberculomas are distinguished. The first is characterized by the formation of a stable focus and a tendency to progression, and the pathology begins clinically acutely. The second type is characterized by encapsulation and totality. The third is due to the filling of the tuberculoma cavity with caseosis, as well as coagulated lymph and various mucous fluids.
By the size of the formation, there are small (no more than 2 cm), medium (no more than 4 cm), large (no more than 6 cm), very large (more than 6 cm) tuberculomas.
According to the nature of the course of the disease, stable (without observed dynamics in the x-ray), progressive (characterized by thinning of the capsule, rupture of the nucleus, release of the substance into the lumen of the bronchi), dying (they are characterized by calcification and hyalinization) tuberculomas are distinguished.
The formation of tuberculoma directly depends on the type of tuberculosis that precedes it. For example, against the background of caseous-pneumonic type, a sharp onset of the disease is observed. Tuberculoma, which arose against the background of focal tuberculosis, is usually asymptomatic and is detected by accident. The content follows from a caseous formation, and only then its clinical symptoms appear.
Symptoms of pathology
This disease is characterized by scanty symptoms or even an asymptomatic course. However, the symptoms of developing tuberculoma depend on the type of this anomaly, as well as its location.
With a disease that occurs with minor symptoms, the following phenomena are observed:
- Decrease in working capacity and appetite.
- Excessive sweating.
- Periodic hyperthermia (up to 38 degrees).
- Dry cough (sputum production may sometimes appear).
- Pain of aching or pulling character in the sternum.
With the collapse of pulmonary tuberculoma, severe intoxication, high temperature (more than 38 degrees), a wet cough, often with blood impurities, are noted. The severity of such symptoms depends on the state of immunity and the type of disease.
Proper treatment in most cases gives a positive effect and prognosis. Otherwise, the development of various complications is guaranteed. For example, in the form of caseous pneumonia, disseminated or fibro-cavernous tuberculosis. Negative factors for the occurrence of possible complications are weakened immunity and hormonal failure.
Is pulmonary tuberculoma removal always required?
Diagnosis of the disease
An anamnesis of pathology in this case is uninformative, since it, as a rule, does not provide sufficient data on the pathology, as for the Mantoux injection test, which shows either a pronounced positive or hyperergic reaction. However, when taking anti-TB drugs, there may be a weak positive or moderate result.
The main diagnostic methods for such a pathology are:
- Tapping, as well as listening, which is applicable to pathological formations of large sizes. At the same time, pulmonary sound is shorter, and breathing over the focus of infection is weakened. The sounds of friction and wheezing are possible, and sometimes there is noticeable fluid in the lung (wet sound).
- A blood test that is effective in progressive types of the disease. In this study, there is a decrease in lymphocytes and white blood cells, monocyte growth and erythrocyte sedimentation rate, hypoalbuminemia.
- Sputum for sowing is uninformative, since even in the decay phase of the formation of mycobacterium tuberculosis, sometimes go unnoticed.
- X-ray, which is the main and most indicative method for all varieties and stages of this pathology. The focus of the image is clearly visualized in the form of an oval or round dimming with pronounced boundaries and a flat surface. A similar picture is characteristic of the period of remission. With an exacerbation of the disease, the outlines become less clear.
The purpose of diagnostic methods is to differentiate the disease. Clinical signs are very non-specific. Therefore, it is very important to distinguish pulmonary tuberculoma from other pathological phenomena, which can be a variety of benign or malignant neoplasms, aspergillosis, cysts, parasites, fungus, heart attacks, etc. A TB specialist, thoracic surgeon or pulmonologist is involved in the diagnosis and treatment of the pathological process.
Additional research
Additionally, various instrumental studies are carried out:
- Bronchoscopy
- Magnetic resonance imaging.
- CT scan.
- Thoracoscopy
- Fence of biomaterial.
Now it’s clear that this is pulmonary tuberculoma. The consequences and reviews will be considered below.
Tuberculoma treatment
In the absence of therapy, this disease in most cases passes into active tuberculosis. Treatment is usually conservative and surgical. In determining the direction of the course of therapy, the following factors are taken into account:
- The size of the focus.
- Stage of the disease.
- Type of neoplasm.
- Duration and severity of clinical symptoms.
Small-sized pulmonary tuberculosis treatment is usually conservative. At the same time, a short course of chemotherapy is enough, which implies taking for two months such medications as Isoniazid, Ethambutol, Pyrazinamide, Rifampicin. Over the next four to six months, the use of anti-TB drugs — Isoniazid, Rifampicin, or Ethambutol — is indicated.
The second stage of tuberculoma is supported by various physiotherapy, restorative and immuno-strengthening therapy. However, at each of these stages, mandatory monitoring of the patient's condition is carried out.
The ineffectiveness of conservative therapy is due to anatomy. As a rule, vessels are not suitable for caseoses, which makes it impossible for the active substances of drugs to penetrate them.
With medium to large tuberculomas, surgical treatment is indicated. Of great importance is the progressive nature of this pathology, the absence of positive dynamics from conservative treatment methods, as well as the presence of multiple formations. Even if a favorable picture in the form of a latent course of the disease is observed on x-rays, signs of intoxication are often noted. In this case, an operation to remove any type of tuberculosis is indicated.
Alternative methods of additional therapy
Treatment of this pathology with medicines is well complemented by all kinds of folk remedies in the form of decoctions, teas, infusions. Various treatment mixtures may also be used.
There is one good folk remedy that helps get rid of tuberculoma - kvass from celandine. To prepare it, you need to mix celandine (half a glass) with sugar (a glass) and pour three liters of water. Cover tightly with two layers of gauze. The preparation takes about 10-12 days. Drink three times a day for half an hour before meals, one tablespoon.
Other natural medicines include teddy bear, milk, propolis, tar, moss, etc. Before using them, it is very important to consider the individual tolerance of substances.
Surgery to remove pulmonary tuberculoma
Today, there are several varieties of operations to remove such pathological neoplasms. Applied, for example, resection, lobectomy (removal of the lobe) and segmentectomy (removal of the part).
So, the operation of pulmonary tuberculoma can be as follows:
- Thoracoplasty, which is a method of innovative minimally invasive surgery.
- Resection is a classic type of surgical treatment.
- Lobectomy, which is indicated to remove large tumors.
- Pleurectomy is a technique that is prescribed in the presence of destructive changes.
- Thoracoplasty - is prescribed in cases where traditional surgical intervention is impossible (if there are contraindications), as well as with signs of decay.
- Removal of lymph nodes is performed when the inflammatory process goes on them.
Reviews for pulmonary tuberculoma are presented below.
Reviews
Reviews about this disease are contradictory. Very many people are diagnosed with it, and people do not confirm contacts with patients with tuberculosis. The removal operation is usually successful, but the recovery period is often quite difficult. Complications are not excluded.
This is an unpleasant disease, and many do not even know what it is. The consequences of pulmonary tuberculoma can be very serious (decreased immunity, respiratory failure, the formation of a cancerous tumor, etc.).