THE THREE COMPONENTS OF A SPECIFIC LESION IN A PRIMARY TUBERCULOSIS COMPLEX:
1.Primary affect with perifocal infiltration.
2.Tuberculosis of a regional lymph node.
3.Associated zone of tuberculous lymphangitis.
There are four stages (according to K.V. Pomeltsov) in the X-ray picture of PTC:
1.Pneumonic stage - when the shadow of the primary affect merges with the shadow of enlarged intrathoracic lymph nodes and the radiological picture looks like pneumonia.
2.Resorption or "bipolarity" phase - when the zone of perifocal non-specific inflammation around the TB changes begins to dissolve and the shadow of the primary affect decreases and moves away from the dilated root of the lung, so that the radiograph shows the shadow of a lung focus or focus, enlarged lymph nodes in the lung root or mediastinum and a linking "track" between them.
3.The thickening phase - the shadow of the primary affect and enlarged lymph nodes gradually decreases, the contour of the shadow becomes clearer.
4.The formation phase of the Gon foci (calcification, petrification) - when calcium salts start to deposit in the area of the tuberculosis lesion.
COMPLICATIONS OF PRIMARY
TUBERCULOSIS:
1.PLEURISY.
2.LYMPHOHEMATOGENIC AND BRONCHOGENIC DISSEMINATION.
3.ATELECTASIS WITH SUBSEQUENT DEVELOPMENT OF INFLAMMATORY AND CIRRHOTIC CHANGES.
4.BRONCHIAL TUBERCULOSIS.
5.NODULOBRONCHIAL FISTULA.
6.PRIMARY CAVERN IN A LUNG OR LYMPH NODE.
7.CASEOUS PNEUMONIA.
8.TUBERCULOUS MENINGITIS.
9.COMPRESSION BY ENLARGED LYMPH NODES ON TRACHEA, OESOPHAGUS, VAGUS NERVE.
10.PERFORATION OF A NECROTIC CASEOUS NODE INTO THE LUMEN OF THE THORACIC AORTA.
DIFFERENTIAL DIAGNOSIS OF INTRATHORACIC
LYMPH NODE TUBERCULOSIS.
THE ANTERIOR MEDIASTINUM:
1.Thyroid tumours
2.Thyroid hyperplasia
3.Teratomas and dermoid cysts
4.Pericardial cysts
5.Mediastinal fatty tumours
6.Aneurysm of the ascending aorta
DIFFERENTIAL DIAGNOSIS OF INTRATHORACIC
LYMPH NODE TUBERCULOSIS.
THE ANTERIOR MEDIASTINUM:
1.Intrathoracic lymph node tuberculosis
2.Lymphogranulomatosis
3.Haemodynamic abnormalities with cardiac defects
4.Nonspecific adenopathies
5.Lymphosarcoma
6.Lympholeukosis
7.Sarcoidosis
8.Coarctation of the aorta
9.Mediastinal cancer
10.Aortic arch aneurysm
DIFFERENTIAL DIAGNOSIS OF INTRATHORACIC
LYMPH NODE TUBERCULOSIS.
THE POSTERIOR MEDIASTINUM:
1.Neurogenic masses
2.A natectal abscess
3.Aortic aneurysm
4.Tumours of the oesophagus
5.Broncho- and enterogenic cysts
DIFFERENTIAL DIAGNOSIS OF A PRIMARY
TUBERCULOSIS COMPLEX
1.Pneumonia.
2.Peripheral lung cancer.
Tuberculosis in young children.Anatomo- physiological features in young children:
1.Immaturity of cellular and humoral immunity.
2.Delayed and reduced migration of blood cells to the site of inflammation.
3.Incomplete phagocytosis (developed absorption phase, reduced digestion phase).
4.Deficiency of the main components of complement.
5.Upper airways and trachea short and wide, other airways narrow and long.
6.Relative dryness of bronchial mucosa due to insufficient mucociliary glands, low viscosity of secretion.
7.The acini are poor in elastic fibres.
8.Insufficient surfactant leads to mild atelectasis.
9.Virtually undeveloped intersegmental pleura, poorly developed interlobular pleura; not all pleural layers are formed.
10.The cough reflex is poorly developed.
11.Relative dryness of bronchial mucosa due to insufficient mucociliary glands, low secretion viscosity.
12.The acini are poor in elastic fibres.
13.Insufficient surfactant leads to mild atelectasis.
14.Virtually undeveloped intersegmental pleura, poorly developed interlobular pleura; not all pleural layers are formed.
15.The cough reflex is poorly developed.