RT Book, Section
A1 Cohen, Daniel M.
A1 McNamee, Ciaran J.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Colson, Yolonda L.
A2 Jaklitsch, Michael T.
A2 Krasna, Mark J.
A2 Mentzer, Steven J.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1105844286
T1 Adjuvant Surgery for Tuberculosis
T2 Adult Chest Surgery, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-178189-3
LK accesssurgery.mhmedical.com/content.aspx?aid=1105844286
RD 2024/04/19
AB Pulmonary  tuberculous  diseases  are  contagious  infections  caused  by  bacterial  organisms  or  bacilli  of  the  Mycobacterium  family  (Mycobacteriaceae).  The  most  common  species  is  tuberculosis  but  other  types  produce  similar  pathologic  changes.  The  disease  is  spread  by  the  aerolization  of  respiratory  secretions,  and  infection  occurs  by  inhalation  of  the  tubercle  bacilli  (TB).  Not  everyone  infected  with  TB  will  become  sick  immediately.  Most  patients  are  asymptomatic  because  of  the  host's  immune-cell-mediated  defense  mechanisms,  which  entrap  and  wall  off  the  bacilli,  thereby  containing  the  infection.  The  isolated  bacilli  may  form  granulomas  which  may  lie  dormant  for  years.  Others  will  experience  a  short  illness  associated  with  malaise,  low-grade  fever,  cough,  and  weight  loss.  If  the  body's  immunity  becomes  compromised,  a  full-blown  infection  may  ensue.  Most  frequently,  these  patients  will  develop  extensive  pulmonary  infiltrates  with  a  febrile  illness  and  dyspnea  associated  with  the  concomitant  pneumonia.  If  the  walled-off  granulomas  break  down,  cavities  form  and  accumulate  secretions  causing  a  productive  cough.  Infection  of  the  pleural  lining  (pleurisy)  may  result  in  chest  wall  pain  or  pleural  effusions  with  shortness  of  breath.  Spontaneous  pneumothorax  may  occur  as  a  consequence  of  excessive  coughing  and  will  present  with  acute  dyspnea.  Long-standing  infections  may  result  in  parenchymal  destruction,  bronchiectasis  with  erosion  into  adjacent  pulmonary  arteries  (Rasmussen's  aneurysm)1,  and  massive  hemoptysis.2  These  large  cavities  may  lead  to  secondary  fungal  infection  with  Aspergillus  (see  Chapter  102).  In  some  patients,  extensive  lung  destruction  can  produce  chronic  lung  collapse  and  contraction.