Secondary pulmonary TB Lu hua

Secondary pulmonary TB

Lu huaDept. of Pathology Three Gorges University Medical College

www.rxdentistry.blogspot.com

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


1. Reinfectionusually adults adult type pulmonary TBInitiated from apex of lung secondary focus


2. Pathogenesis Exogenous reinfection not related to primary infection Endogenous reinfection PP TB spread via bloodstream Primary bronchial Extrapulmonary TBbloodlung


() Features of lesion


1. Initial focus: Site : apex of the lung local resistence Stand A pressure poor circulation macrophageAb Bad ventilation


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


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


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


Pathological change and types1.Focal pulmonary TB2.Infiltrative pulmonary TB3. Chronic fibro-cavitative4. Caseous pneumonia5. Tuberculoma6. Tuberculous pleuritis


Pathological change and types1.Focal pulmonary TBinitial lesion of secondary pulmonary TB(1) Lesion usually below apex 2-4cm , 0.5-1cm in size , clear edge proliferation main


(2) Results Healing in most cases: fibrosis, calcification Progressinfiltrative pulmonary TB


2. Infiltrative pulmonary TBmost common type of active pulmonary TB

Arising in:progress of focal pulmonary TBfew cases occur initially


(2) Lesion sitebelow clavicle, unclear edge center: smaller caseous necrosis surrounding: surrounded by inflammation exudative serous fluid, monocytes, LC, neutrophils


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


(4) Results Healing: treatment earlier

absorption, fibrosis, encapsulation, calcification


Progress Caseous necrosis liquefied

bronchialcaseous pneumonia

destroy pleura spontaneous pneumothorax

thoracic cavitytuberculous pyopneumothorax

persistentchronic fibro-cavitative pulmonary TB


fibrosisabsorbedcalcificationspreadFinal result:Most healingLess solution and spread


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


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


Cavity wall (LM) : three layers1.inner:caseous necrosis

2.midial:tuberculous granulation tissue

3.outer: fibrous tissue123


123


within cavity: bridge like appearance

vessels which have thrombosis organization


Unilateral or bilateral lung: new or old, variation in size, different types of lesion Adjacent tissue widely fibrosis pleura thickened

sclerosing pulmonary TB


(3) Clinical features

Origin of infection open pulmonary tuberculosis Hemoptysis (eroding large vessels)

Death


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


Widely fibrosis pulmonary hypertension cor pulmonale Small cavityscar Large cavityopen healing


Sputum with bacteria throat and intestinal TB Destroy pleura: pneumothorax pyopneumothorax


4. Caseous pneumonia(1) Arising in:immunity, allergyinfiltrative type pulmonary TBbacteria in acute or chronic cavity, disseminated by bronchi


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


(3) Clinical features bad prognosis

deathgalloping consumption


5. Tuberculoma(1) Arising in:Infiltrative P.TB large necrotic focus F. encapsulationCavity: draining bronchi blocked cavity filled with necrosisFusion of several focus


(2) Lesions solitary, fibrous encapsulated, clear edge, round, caseous necrosis focusdiameter: 2-5cm

number: usually one, sometime multiple site: upper lobe


(3) Clinical ferturesrelative motionlesshealing: organization, calcificationdevelopment: Necrosis , focus extensionLiquefiedcavitySpread by bronchi


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


(2) Lesions Exudative TB pleuritis(siccus) Source: primary pulmonary TB ( primary focus or TB of LN )

same side pleura


bacilli of focus or hilar lymphonodusspreadpleura sensitive reaction: bacteria protein


Lesion: serofibrous inflammationResults: absorption completely: hydrothorax organization: thicken, adhesion


Proliferative TB pleuritis (humectus) source: focus below pleura extending directly

lesions: usually apex of lung, localized proliferation mainly, less hydrothorax

results: fibrosispleura thicken, adhesion

Caseous pleurisy: not frequently seen special type


Primary SecondaryInfection Primary SecondaryPatients Children Adult Immune or None Establishedhypersensitivity Characteristics Primary complex VariableInitial focus Lower part of upper lobe Apex of the lung upper part of lower lobe close to the pleuraFeatures Exudation and necrosis Proliferation and necrosisDissemination Lymphatic or hematogenous BronchialClinical course Short,spontaneous healing Long, instable


primary PTBsecondary PTBextrapulmonaryderived from. Hematogenous TB


1. Acute systemic miliary TBprimary focuseroding vein of lungleft heartall the organs (lung, liver, brain, spleen, kidney)miliary TBv


(1) Gross: scattered uniformly , similar size resemblance to millet , yellow-white with clear edge(2) LM: main :proliferative lesion tubercle exudation or necrosis


(3) Clinical course: obvious symptoms treatment in time well prognosis lesstuberculous meningitisdeath


2. Chronic systemic miliary TB: common in adultexudation + proliferation + necrosislesionuneven


3. Acute pulmonary miliary TBa part of acute systemic miliary TB: commonlimited in lung: less


Caseous necrosis of tracheo-bronchial and mediastinal, hilar LN vein corner right heartlungacute miliary tuberculosis


Gross: both lung congestion, increasing weight, cut surface dark-red in color, numerous grey or grey-yellow miliary nodules in size rising on surface of lung


4. Chronic pulmonary miliary TB common in adultExtrapulmonary-TBTB bacilli (outside lung)long period intermissionbloodnew or old lesion


Import knowledges:Tuberculoma2. Caseous pneumoniaQuestion:The difference between Primary P TB and Secondary P TB .


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Secondary pulmonary TB Lu hua