Post Tubercular Sequelae.123175034

8/9/2019 Post Tubercular Sequelae.123175034

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Complications/Complications/sequelaesequelae

PulmonaryPulmonary

ExtrapulmonaryExtrapulmonary



PulmonaryPulmonary sequelaesequelae

HemoptysisHemoptysis

BronchiectasisBronchiectasis

BronchostenosisBronchostenosis

Destroyed lungDestroyed lung

Aspergilloma Aspergilloma

CalcificationCalcificationOpen negative syndromeOpen negative syndrome



PulmonaryPulmonary sequelaesequelae’’

Scar carcinomaScar carcinoma

Chronic airway obstructionChronic airway obstruction

Chronic respiratory failureChronic respiratory failure

Cor Cor pulmonalepulmonale

TB relapseTB relapse

PyogenicPyogenic abscessabscessTubercularTubercular endobronchitisendobronchitis && tracheitistracheitis



ExtrapulmonaryExtrapulmonary

Pleural fibrosisPleural fibrosis

PneumothoraxPneumothorax Amyloidosis Amyloidosis

CardiacCardiac

Abdominal Abdominal

SkeletalSkeletal

Neurological/TBMNeurological/TBM

GenitourinaryGenitourinary



BronchiectasisBronchiectasis

Increases with increase in severity ofIncreases with increase in severity of parenchymalparenchymal

involvementinvolvement

No relation to age,sex or presence of cavityNo relation to age,sex or presence of cavity

Causes : fibrosis,Causes : fibrosis, atelectasisatelectasis,, bronchostenosisbronchostenosis, rupture, rupture

of calcified node into bronchusof calcified node into bronchus

BronchiectasisBronchiectasis siccasicca

Diagnosis :Diagnosis : CxRCxR,, bronchographybronchography, CECT, CECT

Management :Management : postural drainage, infection control,postural drainage, infection control,complications managementcomplications management



BronchostenosisBronchostenosis

Most serious complication ofMost serious complication of endobronchialendobronchial TBTB

6060--95 % of95 % of endobronchialendobronchial TBTBOccurs in spite of chemotherapy : as late as 3Occurs in spite of chemotherapy : as late as 3years after treatmentyears after treatment

Tracheal involvement : respiratory failure,Tracheal involvement : respiratory failure,retention of secretions, failure ofretention of secretions, failure of endotrachealendotrachealintubationintubation

Treatment :Treatment : cortiocosteroidscortiocosteroids have no role :have no role :repeated dilatation, end to endrepeated dilatation, end to end anastomosisanastomosis



Destroyed lungDestroyed lung

Massive destruction of one lungMassive destruction of one lung

Left bronchus syndrome :Left bronchus syndrome : IeftIeft bronchusbronchuslonger, 15% narrower, decreasedlonger, 15% narrower, decreasedperibonchialperibonchial space : review of 172 casesspace : review of 172 cases

showed 109 (63%) cases on the left :showed 109 (63%) cases on the left :perfusion to the affected side absentperfusion to the affected side absent

Management : of complicationsManagement : of complications



Aspergilloma Aspergilloma’’

Diagnosis :Diagnosis : CxRCxR, sputum culture, serology,, sputum culture, serology,

bronchoscpybronchoscpyContents : dead and liveContents : dead and live mycelialmycelial elements,elements,

fibrin, mucus, inflammatory cells, degeneratedfibrin, mucus, inflammatory cells, degenerated

blood and epithelial elementsblood and epithelial elementsManagement :Management : ((i)asymptomatici)asymptomatic : spontaneous: spontaneous

lysis(7lysis(7--10%) followed10%) followed radiologicallyradiologically,,

(ii)symptomatic :(ii)symptomatic : intracavitaryintracavitary instillation ofinstillation of

antifungals(amphotericinantifungals(amphotericin B,B, nystatinnystatin), resection), resection

surgery, radiotherapysurgery, radiotherapy



CalcificationCalcification

Healed tubercular lesionsHealed tubercular lesions

Pleural diseases :Pleural diseases : descretedescrete radioopaqueradioopaqueshadows or sheetshadows or sheet--like calcificationlike calcification

Can erode bronchial wall or arterial wall resultingCan erode bronchial wall or arterial wall resulting

inin hemoptysishemoptysis

CoughedCoughed--out calcifiedout calcified stones(broncholithsstones(broncholiths))

Extensive calcification can result in respiratoryExtensive calcification can result in respiratoryfailure andfailure and cor cor pulmonalepulmonale



Open negative syndromeOpen negative syndrome

Thin walled cavities withThin walled cavities withepithelialization(preventingepithelialization(preventing cavity collapse)cavity collapse)

More frequent in chemotherapy eraMore frequent in chemotherapy era

CxRCxR : thin walled ring shadows: thin walled ring shadows

Histology : incomplete epithelial lining withHistology : incomplete epithelial lining withnecrotic foci withnecrotic foci with M tuberculosisM tuberculosis

Complications : secondary infection,Complications : secondary infection,

aspergillomaaspergilloma, scar carcinoma,, scar carcinoma, pneumothoraxpneumothorax,,lung volume losslung volume loss



Scar carcinomaScar carcinoma

Peripherally locatedPeripherally located tumour tumour with nowith no

evidence of bronchial origin, occurringevidence of bronchial origin, occurringaround a truearound a true hyalinizedhyalinized scar scar

More common in upper lobesMore common in upper lobesUsuallyUsually adenocarcinomaadenocarcinoma and atand at

presentation frequently have extrapresentation frequently have extra

pulmonary manifestations.pulmonary manifestations.



Chronic airway obstructionChronic airway obstruction3030--60% have diffuse airway obstruction60% have diffuse airway obstruction

Restrictive defect : diffuseRestrictive defect : diffuse parenchymalparenchymalfibrosis, pleural fibrosisfibrosis, pleural fibrosis

BronchiectasisBronchiectasis : mixed defect: mixed defectCan present as recurrent infection,Can present as recurrent infection,

respiratory insufficiency andrespiratory insufficiency and

cor cor

pulmonalepulmonale



Asthma Asthma

ClinicalClinical deterriorationdeterrioration : suggestive of: suggestive of

asthma : 2asthma : 2--6 months after6 months after endobronchialendobronchialTB RxTB Rx

No significantly increased bronchialNo significantly increased bronchial

reactivityreactivityResponse to bronchodilators poorResponse to bronchodilators poor

Good clinical response to corticosteroidsGood clinical response to corticosteroids



Chronic respiratory failure/Chronic respiratory failure/cor cor

pulmonalepulmonale

Causes : airway obstruction,Causes : airway obstruction, parenchymalparenchymalfibrosis, loss of effective lung volume due tofibrosis, loss of effective lung volume due tocavities andcavities and parenchymalparenchymal destruction, pleuraldestruction, pleural

fibrosisfibrosisPulmonary artery hypertension : destructionPulmonary artery hypertension : destructionof vascular bed, occlusion by fibrosis,of vascular bed, occlusion by fibrosis,

vasculitisvasculitis and endarteritisand endarteritisUsually detected lateUsually detected late

Radiological and ECG changes difficult toRadiological and ECG changes difficult tointerpret due to architectural distortioninterpret due to architectural distortion



Pleural fibrosisPleural fibrosis

Most common sequel of pleural effusionMost common sequel of pleural effusion

50% unilateral50% unilateralNeither clinical feature nor fluid charactersNeither clinical feature nor fluid characters

can predict extent of fibrosiscan predict extent of fibrosisNo relation to drugs used in chemotherapyNo relation to drugs used in chemotherapy

Due to DTHDue to DTH



Pleural fibrosisPleural fibrosis’’

Visceral pleura involvedVisceral pleura involved

Spontaneous resolution in 6 monthsSpontaneous resolution in 6 monthsSteroids have no roleSteroids have no role

Rx :Rx : patient symptomatic & lung healthy :patient symptomatic & lung healthy :decortication(evendecortication(even in long standingin long standing

fibrothoraxfibrothorax

))

Major operation with morality of 3.5%Major operation with morality of 3.5%



SpontaneousSpontaneous pneumothoraxpneumothorax

Pulmonary tuberculosis(5Pulmonary tuberculosis(5--15%)15%)

Due to rupture of thin healed cavity/bleb/Due to rupture of thin healed cavity/bleb/bulla(secondary to fibrosis)bulla(secondary to fibrosis)

Male>femaleMale>femaleIncreases with increasing ageIncreases with increasing age

RtRt>It>It



Amyloidosis Amyloidosis

Deposition ofDeposition of extracellular extracellular ,, aposerumaposerum AA type AA typeproteinaceousproteinaceous substancesubstance

RenalRenal amyloidosisamyloidosis in 8in 8--33%33%

Tuberculosis most common cause in IndiaTuberculosis most common cause in India

Decreased incidence with modernDecreased incidence with modernchemotherapychemotherapy

Diagnosis : abdominalDiagnosis : abdominal fatpadfatpad/rectal mucosal//rectal mucosal/

liver/kidney biopsyliver/kidney biopsyRx : supportiveRx : supportive



Tubercular meningitisTubercular meningitis

2020--25%25%

PsychologicPsychologic/psychiatric disturbances/psychiatric disturbancesVisual/hearing/otherVisual/hearing/other neurologicneurologic deficitdeficit

Endocrine(pituitary/hypothalamic etc)Endocrine(pituitary/hypothalamic etc)disturbancesdisturbances

SeizuresSeizuresIntracranial calcificationIntracranial calcification



CardiacCardiac

Chronic constrictiveChronic constrictive pericarditispericarditis

Pericardial effusionPericardial effusion



SkeletalSkeletal

DeformityDeformity

Paresis/paralysis(paraplegia etc)Paresis/paralysis(paraplegia etc)



GenitourinaryGenitourinary

InfertilityInfertility

StrictureStricture



All the best.. All the best..

Post Tubercular Sequelae.123175034

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