3. Clinical FORMS of tuberculosis
Ïåðåõîä ê ðàçäåëàì / Go to3.1. Clinical classification of tuberculosis
3.2.2. Primary tuberculousis complex
3.2.3. Tuberculosis of intrathoracic lymph nodes (bronchoadenitis)
3.2.4. Disseminated pulmonary tuberculosis
3.2.5. Focal pulmonary tuberculosis
3.2.6. Infiltrative pulmonary tuberculosis
3.2.7. Lung tuberculoma
3.2.8. Cavernous pulmonary tuberculosis
3.2.9. Fibrous-cavernous pulmonary tuberculosis
3.2.10. The cirrhotic pulmonary tuberculosis
3.2.11. Tubercular pleurisy (including
3.2.12. Bronchus, trachea, upper respiratory tract tuberculosis
3.2.13. Respiratory apparatus tuberculosis combined with professional lung diseases (Coniotuberculosis)
3.3. MCQ – “Clinical manifestations of tuberculosis”
3.2. Clinical classification of tuberculosis of the respiratory organs
3.2.7. Lung tuberculoma
Lung tuberculoma unites etiologically various capsulated caseous foci of more than 1 cm in diameter (see
brief summary about pathological anatomy of tuberculoma is presented
The source of tuberculoma formation is mainly of two forms of pulmonary tuberculosis: infiltrative-pneumonic and focal. Besides this, tuberculoma form from cavernous pulmonary tuberculosis by means of filling the cavity with caseous masses.
Filled cavities refer to tuberculoma only conditionally, as the filling of a cavity occurs mechanically, while tuberculomas are an original phenomenon in lung tissue.
There are three clinical variants of tuberculoma course:
1) progressing, described by occurrence of disintegration at some stage of illness, perifocal inflammation around tuberculoma, bronchogenic dissemination in surrounding lung tissue.
2) stable – absence of tuberculoma X-ray changes or rare aggravations without signs of tuberculoma progressing;
3) regressing tuberculoma is characterized by its slow reduction in size, with subsequent formation of focus or group of foci, induration field or combination of these changes .
The prevalence of tuberculoma among all forms of pulmonary tuberculosis is 6 – 10 %. This tendency is explained by the fact that vast infiltrative pneumonic processes, under treatment and increased body resistance, become limited, condensed, lose their aggravated course. However, the process does not heal completely and precisely outlined dense formation remains.
Clinical pattern. As tuberculoma itself is a parameter of high body resistance, patients with this form of pulmonary tuberculosis frequently are revealed accidentally, at fluorography examinations, preventive examinations, and in presence of other diseases. Practically, patients have no complaints.
At physical examination of a patient, there are no pathological signs in lungs. Crackles are heard only at massive flare-up with extensive infiltrative changes in lung tissue around tuberculoma.
X-ray image of tuberculoma looks like rounded shadow with precise contours. Inside focus enlightenment could be observed due to disintegration. Sometimes perifocal inflammation and small amount of bronchogenic focuses, and calcification sites can be defined.
Blood picture is also without peculiarities. Sometimes moderate elevation of ESR and moderate leukocytosis are observed at acute stages.
Mycobacterium tuberculosis is not found in sputum at stable course of tuberculoma. Discharge of bacilli exists in tuberculoma at presence of disintegration if there is connection with drainage of bronchus.
Tuberculin tests. Patients with lung tuberculoma in most cases positively react to tuberculin. Mantoux test is often hyperergic.
Treatment. Before the discovery of anti-tuberculosis drugs, the forecast of tuberculoma was bad. Tuberculoma gave massive flare-up with subsequent transition in heavy forms of pulmonary tuberculosis. Now course of tuberculoma regresses or proceeds chronically without aggravations among 80% of patients.
When tuberculoma is diagnosed the patient must be hospitalized for long term treatment. Surgery is recommended if disintegration remains for along time in tuberculoma and the patient continues to expectorate MBT and there is no desirable results to long therapy.
Principles and method of treatment of tuberculous patients see in the section
Surgical treatment. Usually operation is made with minimal removal of lung tissue. It is segmental resection. Surgical treatment is used also in cases, when there is no certainty that the patient has tuberculosis because it is difficult to differentiate tuberculoma from other lung diseases, especially tumor.
Differential diagnostics. X-ray picture of tuberculoma is isolated rounded focus in lung tissue. It’s typical for many diseases. Practically patients more often have cancer of lung, benign tumors, pneumonia complicated by an abscess, and parasitic lung diseases. It is necessary to collect detailed anamnesis, carefully examine all organs and systems of the patient to differentiate one disease from another. X-ray examination is especially important. Sputum is investigated for MBT, atypical cells and fungi. In some cases pneumonocentesis is made. The ex juvantibus treatment of tuberculosis is often used and if the focus in lungs under the influence of specific treatment decreases, it testifies its tubercular origin.
For diagnosis of tuberculoma, bronchological examination with catheter biopsy and puncture of bifurcation lymph nodes has received high development. These techniques allow to put correct diagnosis almost in 90% of cases.