Post tubercular Post tubercular sequelaesequelae

Complications/Complications/sequelaesequelae

Pulmonary Pulmonary ExtrapulmonaryExtrapulmonary

Pulmonary Pulmonary sequelaesequelae

HemoptysisHemoptysisBronchiectasisBronchiectasisBronchostenosisBronchostenosisDestroyed lungDestroyed lungAspergillomaAspergillomaCalcificationCalcificationOpen negative syndromeOpen negative syndrome

Pulmonary Pulmonary sequelaesequelae’’

Scar carcinomaScar carcinomaChronic airway obstructionChronic airway obstructionChronic respiratory failureChronic respiratory failureCorCor pulmonalepulmonaleTB relapseTB relapsePyogenicPyogenic abscessabscessTubercular Tubercular endobronchitisendobronchitis & & tracheitistracheitis

ExtrapulmonaryExtrapulmonary

Pleural fibrosisPleural fibrosisPneumothoraxPneumothoraxAmyloidosisAmyloidosisCardiacCardiacAbdominalAbdominalSkeletalSkeletalNeurological/TBMNeurological/TBMGenitourinaryGenitourinary

HemoptysisHemoptysis

Common, potentially fatalCommon, potentially fatalMore common in youngMore common in youngIncidence 30Incidence 30--35%35%Causes : Causes : RasmussensRasmussens aneurysm, scar aneurysm, scar carcinoma, carcinoma, bronchiectasisbronchiectasis, , broncholithbroncholith, , aspergillomaaspergilloma

HemoptysisHemoptysis : Rx : Rx Bed restBed restDiseased side be dependentDiseased side be dependentSedationSedationRule out bleed from UR tractRule out bleed from UR tractRestoration of fluid balanceRestoration of fluid balanceAntifibrinolyticsAntifibrinolyticsBronchoscopyBronchoscopy :: diagnostic and therapeutic : (i)localizes diagnostic and therapeutic : (i)localizes lesion, (ii)can place balloon catheter/CO2 laser, (iii) lesion, (ii)can place balloon catheter/CO2 laser, (iii) arterial arterial embolotherapyembolotherapy :: successful in 98%successful in 98%Surgery : last but definite RxSurgery : last but definite Rx

BronchiectasisBronchiectasisIncreases with increase in severity of Increases with increase in severity of parenchymalparenchymal involvementinvolvementNo relation to age,sex or presence of cavityNo relation to age,sex or presence of cavityCauses : fibrosis, Causes : fibrosis, atelectasisatelectasis, , bronchostenosisbronchostenosis, rupture , rupture of calcified node into bronchusof calcified node into bronchusBronchiectasisBronchiectasis siccasiccaDiagnosis : Diagnosis : CxRCxR, , bronchographybronchography, CECT, CECTManagement : Management : postural drainage, infection control, postural drainage, infection control, complications managementcomplications management

BronchostenosisBronchostenosisMost serious complication of Most serious complication of endobronchialendobronchial TB TB 6060--95 % of 95 % of endobronchialendobronchial TBTBOccurs in spite of chemotherapy : as late as 3 Occurs in spite of chemotherapy : as late as 3 years after treatmentyears after treatmentTracheal involvement : respiratory failure, Tracheal involvement : respiratory failure, retention of secretions, failure of retention of secretions, failure of endotrachealendotracheal intubationintubationTreatment : Treatment : cortiocosteroidscortiocosteroids have no role : have no role : repeated dilatation, end to end repeated dilatation, end to end anastomosisanastomosis

Destroyed lungDestroyed lung

Massive destruction of one lungMassive destruction of one lungLeft bronchus syndrome : Left bronchus syndrome : IeftIeft bronchus bronchus longer, 15% narrower, decreased longer, 15% narrower, decreased peribonchialperibonchial space : review of 172 cases space : 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 absentManagement : of complications Management : of complications

AspergillomaAspergillomaMajority of fungal balls in TB cavities are Majority of fungal balls in TB cavities are aspergillomaaspergillomaMucormycosisMucormycosis has also been implicatedhas also been implicatedCavities >2.5 cm +Cavities >2.5 cm +veve serology : precipitins in serology : precipitins in 25%; radiological evidence in 11%25%; radiological evidence in 11%Asymptomatic presentationAsymptomatic presentationHemoptysis(5Hemoptysis(5--90%), cough, weight loss90%), cough, weight lossAir crescent (Air crescent (MonodMonod) sign, Halo sign, bell like ) sign, Halo sign, bell like image with fungus ball as clapper inside bell.image with fungus ball as clapper inside bell.

AspergillomaAspergilloma’’

Diagnosis : Diagnosis : CxRCxR, sputum culture, serology, , sputum culture, serology, bronchoscpybronchoscpyContents : dead and live Contents : dead and live mycelialmycelial elements, elements, fibrin, mucus, inflammatory cells, degenerated fibrin, mucus, inflammatory cells, degenerated blood and epithelial elementsblood and epithelial elementsManagement :Management : ((i)asymptomatici)asymptomatic : spontaneous : spontaneous lysis(7lysis(7--10%) followed 10%) followed radiologicallyradiologically, , (ii)symptomatic : (ii)symptomatic : intracavitaryintracavitary instillation of instillation of antifungals(amphotericinantifungals(amphotericin B, B, nystatinnystatin), resection ), resection surgery, radiotherapysurgery, radiotherapy

CalcificationCalcification

Healed tubercular lesionsHealed tubercular lesionsPleural diseases : Pleural diseases : descretedescrete radioopaqueradioopaque shadows or sheetshadows or sheet--like calcificationlike calcificationCan erode bronchial wall or arterial wall resulting Can erode bronchial wall or arterial wall resulting in in hemoptysishemoptysisCoughedCoughed--out calcified out calcified stones(broncholithsstones(broncholiths))Extensive calcification can result in respiratory Extensive calcification can result in respiratory failure and failure and corcor pulmonalepulmonale

Open negative syndromeOpen negative syndromeThin walled cavities with Thin walled cavities with epithelialization(preventingepithelialization(preventing cavity collapse)cavity collapse)More frequent in chemotherapy eraMore frequent in chemotherapy eraCxRCxR : thin walled ring shadows: thin walled ring shadowsHistology : incomplete epithelial lining with Histology : incomplete epithelial lining with necrotic foci with necrotic foci with M tuberculosisM tuberculosisComplications : secondary infection, Complications : secondary infection, aspergillomaaspergilloma, scar carcinoma, , scar carcinoma, pneumothoraxpneumothorax, , lung volume loss lung volume loss

Scar carcinoma Scar carcinoma

Peripherally located Peripherally located tumourtumour with no with no evidence of bronchial origin, occurring evidence of bronchial origin, occurring around a true around a true hyalinizedhyalinized scarscarMore common in upper lobesMore common in upper lobesUsually Usually adenocarcinomaadenocarcinoma and at and at presentation frequently have extra presentation frequently have extra pulmonary manifestations.pulmonary manifestations.

Chronic airway obstructionChronic airway obstruction3030--60% have diffuse airway obstruction 60% have diffuse airway obstruction Restrictive defect : diffuse Restrictive defect : diffuse parenchymalparenchymal fibrosis, pleural fibrosisfibrosis, pleural fibrosisBronchiectasisBronchiectasis : mixed defect: mixed defectCan present as recurrent infection, Can present as recurrent infection, respiratory insufficiency and respiratory insufficiency and corcor pulmonalepulmonale

AsthmaAsthma

Clinical Clinical deterriorationdeterrioration : suggestive of : suggestive of asthma : 2asthma : 2--6 months after 6 months after endobronchialendobronchial TB RxTB RxNo significantly increased bronchial No significantly increased bronchial reactivityreactivityResponse to bronchodilators poor Response to bronchodilators poor Good clinical response to corticosteroidsGood clinical response to corticosteroids

Chronic respiratory failure/Chronic respiratory failure/corcor pulmonalepulmonale

Causes : airway obstruction, Causes : airway obstruction, parenchymalparenchymal fibrosis, loss of effective lung volume due to fibrosis, loss of effective lung volume due to cavities and cavities and parenchymalparenchymal destruction, pleural destruction, pleural fibrosisfibrosisPulmonary artery hypertension : destruction Pulmonary artery hypertension : destruction of vascular bed, occlusion by fibrosis, of vascular bed, occlusion by fibrosis, vasculitisvasculitis and endarteritisand endarteritisUsually detected late Usually detected late Radiological and ECG changes difficult to Radiological and ECG changes difficult to interpret due to architectural distortion interpret due to architectural distortion

Pleural fibrosisPleural fibrosis

Most common sequel of pleural effusionMost common sequel of pleural effusion50% unilateral50% unilateralNeither clinical feature nor fluid characters Neither 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 chemotherapyDue to DTH Due to DTH

Pleural fibrosisPleural fibrosis’’

Visceral pleura involved Visceral pleura involved Spontaneous resolution in 6 monthsSpontaneous resolution in 6 monthsSteroids have no roleSteroids have no roleRx :Rx : patient symptomatic & lung healthy : patient symptomatic & lung healthy : decortication(evendecortication(even in long standing in long standing fibrothoraxfibrothorax))Major operation with morality of 3.5%Major operation with morality of 3.5%

Spontaneous Spontaneous 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 ageRtRt>It>It

Spontaneous Spontaneous pneumothoraxpneumothorax : : RxRx

ICD : ICD : High failure rate(fibrosis & High failure rate(fibrosis & adhesions), longer duration(5dadhesions), longer duration(5d--5mth), 5mth), frequent BPFfrequent BPFFailed ICD :Failed ICD : decorticationdecortication/space/space-- reducing reducing thoracoplastythoracoplasty

AmyloidosisAmyloidosisDeposition of Deposition of extracellularextracellular, , aposerumaposerum AA type AA type proteinaceousproteinaceous substancesubstanceRenal Renal amyloidosisamyloidosis in 8in 8--33%33%

Tuberculosis most common cause in IndiaTuberculosis most common cause in IndiaDecreased incidence with modern Decreased incidence with modern chemotherapychemotherapyDiagnosis : abdominal Diagnosis : abdominal fatpadfatpad/rectal mucosal/ /rectal mucosal/ liver/kidney biopsyliver/kidney biopsyRx : supportiveRx : supportive

Abdominal TBAbdominal TB

Chronic :Chronic : stricture, blind loop; Rx surgicalstricture, blind loop; Rx surgicalAcute :Acute : intestinal perforation/obstruction, intestinal perforation/obstruction, peritonitis; Rx conservative till infection peritonitis; Rx conservative till infection subsides with chemotherapysubsides with chemotherapy

Tubercular meningitisTubercular meningitis

2020--25%25%PsychologicPsychologic/psychiatric disturbances/psychiatric disturbancesVisual/hearing/other Visual/hearing/other neurologicneurologic deficitdeficitEndocrine(pituitary/hypothalamic etc) Endocrine(pituitary/hypothalamic etc) disturbancesdisturbancesSeizuresSeizuresIntracranial calcification Intracranial calcification

CardiacCardiac

Chronic constrictive Chronic constrictive pericarditispericarditisPericardial effusionPericardial effusion

SkeletalSkeletal

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

GenitourinaryGenitourinary

InfertilityInfertilityStrictureStricture

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