tuberculous dry pleurisy
Introduction
Introduction to tuberculous dry pleurisy Tuberculous dry pleurisy is often caused by the spread of tuberculosis to the pleura. It occurs at most in the posterior part of the lung tip, followed by the pleura in the lower chest. Sometimes lung tuberculosis is found due to further examination of chest pain. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: droplet spread Complications: pleurisy tuberculosis
Cause
Causes of tuberculous dry pleurisy
pathology
Pleural congestion, edema, leukocyte infiltration and most of the endothelial cells fall off, the pleural surface loses its original luster. A small amount of fibrin exuded on the surface of the pleura, causing the pleura to thicken and rough. Pleural adhesions form after healing, but can sometimes be absorbed without leaving traces.
Prevention
Tuberculous dry pleurisy prevention
1. Control the source of infection and reduce the chance of infection
Tuberculosis smear-positive patients are the main source of tuberculosis. Early detection and rational treatment of smear-positive tuberculosis patients is a fundamental measure to prevent tuberculosis. Infants and young children suffer from active tuberculosis, and their family members should be examined in detail (thoracic film, PPD). Etc.) Regular physical examinations of primary and child care institutions should be conducted to detect and isolate infection sources in a timely manner, which can effectively reduce the chance of tuberculosis infection.
2. Popularization of BCG vaccination
Practice has proved that vaccination with BCG is an effective measure to prevent tuberculosis in children. BCG was invented by French physicians Calmette and Guerin in 1921, so it is also called BCG. China has vaccinated BCG in the neonatal period and inoculated BCG in the upper left arm of the left upper arm. Intradermal injection, the dose is 0.05mg / time, the scratch method is rarely used, the Ministry of Health notified in 1997 to cancel the 7-year-old and 12-year-old BCG re-integration plan, but if necessary, the child with negative age test Multiple cropping can be given, and BCG vaccine can be injected in the same day as the hepatitis B vaccine.
Complication
Tuberculous dry pleurisy complications Complications pleurisy tuberculosis
pleurisy
It can form interlobular pleurisy, mediastinal pleurisy, encapsulated effusion and lung fund.
Symptom
Tuberculous dry pleural inflammatory symptoms Common symptoms Fever with cough, slightly... Chest pain with chest tightness, palpitations, difficulty breathing, night sweats
The onset is often more urgent, and the symptoms vary. When you get sick, you often have chills, mild, moderate fever, and dry cough. The main symptom is chest pain, caused by friction between the parietal and visceral pleura. Chest pain often occurs in the area with the largest degree of thoracic expansion, such as the lower part of the chest. If the lesion is in the center of the diaphragm, it can be radiated to the shoulder of the same side; for example, in the peripheral part of the diaphragm, it can be radiated to the upper abdominal wall and the heart. The nature of the pain is sharp and sharp acupuncture-like pain, especially when breathing deep and coughing. Shallow inhalation, lying or lying on the affected side, the degree of dilation of the thorax is reduced, and chest pain can be alleviated. Because patients with chest pain do not dare to take a deep breath, the breathing is superficial.
Respiratory movements on the affected side were restricted, local tenderness and decreased breath sounds. There is often a limited, constant pleural friction sound in the lower part of the chest. Exhale and inhale can be heard. The friction sound is enhanced when the stethoscope is pressed against the chest wall; the patient can also be heard by closing the nose for abdominal movement. After the cough, the friction sound is unchanged and can be distinguished from the rales.
Examine
Examination of tuberculous dry pleurisy
Pleural examination
The appearance of pleural fluid is mostly grass yellow, transparent or slightly turbid, or frosted glass. A few pleural fluids can be yellow, dark yellow, serous blood and even blood. The specific gravity is above 1.018. The Rivalta test is positive, the pH is about 7.00~7.30, and there are nucleated cells. Number (0.1 ~ 2.0) × 109 / L, the acute phase is dominated by neutrophils, and then lymphocytes predominate, protein quantitation 30g / L or more, such as greater than 50g / L, more support for the diagnosis of tuberculous pleurisy, glucose Content <3.4mmol/L, lactate dehydrogenase (LDH)>200U/L, adenosine deaminase (ADA)>45U/L, interferon->3.7/ml, carcinoembryonic antigen (CEA)<20g /L, flow cytometry cells are polyploid, tuberculosis antigens and antibodies have been reported to measure pleural effusion, although the concentration of pleural effusion in tuberculous pleurisy is significantly higher than non-tuberculous, but the specificity is not High, limiting its clinical application, the positive rate of Mycobacterium tuberculosis in pleural effusion is less than 25%, such as smear after pleural effusion centrifugation, pleural effusion or pleural tissue culture, polymerase chain reaction (PCR), etc. Positive rate, pleural effusion mesothelial cell count <5%.
Pleural biopsy
Acupuncture pleural biopsy is an important method for the diagnosis of tuberculous pleurisy. In addition to feasible pathological examination, biopsy pleural tissue can also be cultured with tuberculosis. For example, changes in parietal pleural granuloma suggest the diagnosis of tuberculous pleurisy, although other diseases such as fungi. Sexual disease, sarcoidosis, tuaremia and rheumatic pleurisy can have granulomatous lesions, but more than 95% of pleural granulomatous lesions are tuberculous pleurisy, such as pleural biopsy failed to detect granulomatous lesions, biopsy Specimens should be stained with acid, because tuberculosis can be found in the specimen by accident. The first pleural biopsy can detect 60% of tuberculous granuloma changes, and biopsy 3 times is about 80%, such as biopsy specimen culture plus microscopy. The positive rate of tuberculosis diagnosis is 90%. The pleural biopsy can also be performed under thoracoscopic direct vision. The positive rate is higher.
X-ray examination
When the pleural effusion is below 300ml, there may be no positive findings in the posterior anterior X-ray film. When the effusion is small, the rib angle becomes dull, and the effusion volume is more than 500ml. The supine position is observed in perspective, due to the accumulation of liquid in the lower part of the chest cavity. Spreading, seeing sharp rib angles, can also suffer from lateral lie, showing a strip of shadow on the outside of the lungs. The medium effusion shows a uniform density increase in the lower part of the chest, and the shadow is covered. The liquid has a high outer side of the upper edge and a low arc shadow on the inner side. When a large amount of pleural effusion occurs, most of the lung field is evenly densely shadowed, the shadow is covered, and the mediastinum is displaced to the healthy side.
Some tuberculous pleural effusions can be expressed as special types. Common ones are:
1. Inter-leaf effusion: The fluid accumulates in one or more leaf spaces, showing a sharp-shaped fusiform shadow or a round shadow. The position of the effusion on the lateral chest radiograph is related to the leaf space.
2, sub-pulmonary effusion: the liquid mainly accumulates between the lung base and the diaphragm, often with the pleural pleural effusion at the same time, in the upright position, the performance of the affected side is increased, the apex is moved from the normal 1/3 To the outer 1/3, the middle is relatively flat, and the effusion on the left side of the lung is characterized by an increase in the distance between the shadow and the gastric vesicle, and the flank angle of the affected side becomes dull, such as suspected subpulmonary effusion, the affected side of the patient After 20 minutes in the supine position, chest or chest X-ray examination was performed. At this time, the liquid was scattered, and the outer edge of the affected side showed a band-like shadow, and the diaphragm was visualized. The thicker the band shadow, the more the fluid accumulated.
3, encapsulated effusion: the formation of pleural adhesions formed by the limited pleural effusion, rib pleural cavity enveloped effusion often occurs in the lower posterior lateral wall, a small number can occur in the front chest wall, X-ray signs upright position or appropriate tilt position It can be shown that the bottom edge is attached to the chest wall, the inner edge protrudes sharply to the lung field, and the uniform density is fusiform or elliptical shadow, and the shadow edge and the chest wall are obtuse.
4, mediastinal effusion: the mediastinal pleural effusion, anterior mediastinal effusion as a shadow along the heart and large blood vessels, the right anterior mediastinal effusion shadow is similar to the thymus shadow or right upper lung without shadow, take the right side Position, the left front oblique 30 ° position 20 ~ 30min, the posterior anterior chest radiograph of the position, showing that the upper mediastinal shadow is significantly widened, the anterior mediastinal effusion must be differentiated from the heart to increase the shadow or pericardial effusion, posterior mediastinum The effusion appears as a triangular or ribbon shadow along the spine.
Ultrasound examination
Ultrasound detection of pleural effusion is highly sensitive, accurate positioning, and can estimate the depth of pleural effusion and the amount of fluid accumulation, suggesting that the puncture site can also be differentiated from pleural thickening.
Diagnosis
Diagnosis and diagnosis of tuberculous dry pleurisy
According to the history of fever, dry cough, sharp and sharp acupuncture-like chest pain and pleural friction sound and tuberculin test positive characteristics, can make a diagnosis.
Dry pleurisy should be distinguished from the following diseases.
(a) herpes zoster
Both intercostal herpes zoster and dry pleurisy have chest tingling, but the chest pain of herpes zoster is distributed along the intercostal nerves, and there are clusters of blisters in the affected nerve distribution area.
(B) epidemic pleural pain (Epidemic pleurodynia)
Caused by Coxsackie Group B virus infection, a small epidemic. Often there are fever, sore throat, fatigue, and poor appetite. Chest pain often rises and is exacerbated by breathing, coughing or turning, and can be radiated to the neck, shoulders and upper abdomen. Chest muscles can have tenderness. No abnormal findings were found on the X-ray examination or the rib angle was dull. Chest pain can be relieved by itself in about 1 week. The diagnosis was based on the isolation of the virus in the throat swab or feces, as well as the serological examination.
(three) bronchial carcinoma with pleural metastasis
More slowly onset, often no fever, progressive weight loss, persistent acupuncture-like chest pain. The pleural fluid is often bloody and can be found in cancer cells.
(4) pneumococcal pneumonia
It may be confused with dry pleurisy only in the early stages of the disease. First, there is fever, chest pain, and then there are cough, cough and rust, and there are signs of lung consolidation. Such as pneumonia combined with fibrin pleurisy, the number of white blood cells in the exudate increased, mainly neutrophils, sometimes can find pathogenic bacteria.
