Tuberculoma of the lungs

The clinical form of tuberculosis, which unites diverse in origin caseous forms of encapsulated character more than one centimeter in diameter-tuberculoma of the lungs. It has a long asymptomatic course. Tuberculoma is rare (6% of cases).

With this disease in the lungs are determined large foci of caseous, which in most cases are single, sometimes there are multiple forms. Tuberculoma of the lungs has a different origin. They are formed from infiltrative focal and disseminated forms of tuberculosis. The development of a cavern can proceed in two ways. In the first of these, the obliterated draining bronchus is filled with caseous masses. In this case they are called "pseudotuberculomas". They have a long torpid current, a thin capsule of connective tissue around foci of necrosis or infiltrates. Depending on the form, tuberculomas can be right or wrong. The structure distinguishes between solitary, infiltratopneumonic, conglomerate, layered caseous formations.

Tuberculoma of the lungs has a homogeneous structure in which the shadows of the preceding structures of the alveolar type are revealed, and surrounded by a capsule of fibrous tissue. The laminated form is characterized by a concentric arrangement of mass, which alternates with layers of fibrous tissue. This indicates a wavy development of the tuberculous process, which is accompanied by periods of exacerbation and healing. Conglomerate tuberculoma has in its structure several foci with casein content, which are united by one capsule. The capsule of this formation has two layers: the inner layer, which adjoins the caseous section and consists of specific granulations with giant and epithelioid cells, and the outer one, which is represented by a fibrous layer. In a separate species, tuberculoma is released, which forms when the cavity is filled, in which caseous masses accumulate due to the closing of the draining bronchus. Verification of such education is possible with the help of histological methods.

Tuberculoma of the lung can progressively decompose, melt and transform into a cavern that has a crescent shape. Also, caseous pneumonia, disseminated and fibrous-cavernous tuberculosis can develop. Clinical signs in this period: a symptom of intoxication, cough, sputum, hemoptysis. In good conditions, the regress of this education is possible.

The results of the histological examination determine the extent of the subsequent surgical intervention. Treatment of tuberculoma is carried out in anti-tuberculosis facilities. The standard mode of chemotherapy is applied. It provides for the appointment of four anti-tuberculosis drugs that belong to the main series (ethambutol, pyrazinamide, rifampicin, isoniazid). In the continuation phase of therapy, rifampicin and isoniazid or ethambutol and isoniazid are administered within 6 months. When selecting drugs should take into account all adverse reactions, as they can lead to a significant deterioration of the condition.

Anti-inflammatory therapy with delayed remission in the continuation phase is also prescribed for patients who have pulmonary tuberculoma. Treatment in this case consists of tuberculin therapy, administration of lidase, BCG vaccine, physiotherapy methods (inductometry or ultrasound). In more severe cases, surgery is indicated, which includes lobectomy or resection of the lung segment. With the timely administration of treatment, the prognosis of the disease is favorable, and complete clinical recovery is achieved.