1、Tuberculous Pleural EffusionFor Grade 20001I.Etiology and Pathogenesis Etiology:Mycobacterium tuberculosis Discovered by Dr.Koch in 1882 Acid-fast Pathogenesis:two theories Delayed hypersensitive reaction Pleural infection2II.PathologyPleural congestion with cell infiltration,unilateral in most case
2、s.In the early stage,polymorphs predominate.Typically,lymphocytes predominate.Tuberculous nodulesExudative effusion3III.Clinical Features4Symptoms1.Age,often seen in young people,but also in elderly people2.Fever,typically 37-38 C,but can be 39 C3.Chest pain,more severe when there is only little flu
3、id.4.Breathlessness,when there is a lot of fluid.5Physical signs1.Inspection:fullness of chest in the involved side.2.Palpation:trachea shifts to the other side,weakness of vocal fremitus.3.Percussion:dullness in the involved side.4.Auscultation:disappearance of breathing sound 6IV.Lab.Examinations1
4、.Chest X-ray Fluid is not visible when less than 300 ml.CT is needed in a few cases.782.Ultrasonic examinationMore accurate than X-rays.Can provide vital information for thoracentesis.93.Thoracentesis and fluid examination-essential(1)Fluid routine-exudate specific gravity 1.018;WBC 500/cmm,predomin
5、ated by polymorphs at early stage and lymphocytes later;protein 3gram/dl.10(2)Acid-fast staining for acid-fast bacilli(not sensitive).(3)Culture for tuberculous bacilli(time consuming).(4)Others:culture for bacteria,cytological exam,etc.114.Pleural needle biopsy-tub.granuloma 5.Others:Eos.count,live
6、r function,immunoglobulin,12V.Diagnosis symptoms+physical signs+fluid exam.retrospective,exclusive.13VI.Differential diagnosis See Table 2-13-1 in p13614Transudate 1.Heart diseases 2.Kidney diseases 3.Liver diseases 4.Malnutrition 5.Endocrine diseases15Exudate1.tumorous diseases2.bacterial infection
7、 empyema purulent fluid reactive pleural fluid3.connective tissue diseases4.p a r a s i t e i n f e c t i o n,s u c h a s paragonimiasis5.others16VII.Treatment1.anti-tuberculous chemotherapyin the same way as pul.tuberculosis2.drainage of pleural fluid3.corticosteroids-controversial17VIII.Prognosis Good in most cases.18Home Work1.Read Chapter 13(p135141)carefully.2.Review Chapter 9(p84104)19
