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Complications/Complications/sequelaesequelae
PulmonaryPulmonary
ExtrapulmonaryExtrapulmonary
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PulmonaryPulmonary sequelaesequelae
HemoptysisHemoptysis
BronchiectasisBronchiectasis
BronchostenosisBronchostenosis
Destroyed lungDestroyed lung
Aspergilloma Aspergilloma
CalcificationCalcificationOpen negative syndromeOpen negative syndrome
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PulmonaryPulmonary sequelaesequelae’’
Scar carcinomaScar carcinoma
Chronic airway obstructionChronic airway obstruction
Chronic respiratory failureChronic respiratory failure
Cor Cor pulmonalepulmonale
TB relapseTB relapse
PyogenicPyogenic abscessabscessTubercularTubercular endobronchitisendobronchitis && tracheitistracheitis
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ExtrapulmonaryExtrapulmonary
Pleural fibrosisPleural fibrosis
PneumothoraxPneumothorax Amyloidosis Amyloidosis
CardiacCardiac
Abdominal Abdominal
SkeletalSkeletal
Neurological/TBMNeurological/TBM
GenitourinaryGenitourinary
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BronchiectasisBronchiectasis
Increases with increase in severity ofIncreases with increase in severity of parenchymalparenchymal
involvementinvolvement
No relation to age,sex or presence of cavityNo relation to age,sex or presence of cavity
Causes : fibrosis,Causes : fibrosis, atelectasisatelectasis,, bronchostenosisbronchostenosis, rupture, rupture
of calcified node into bronchusof calcified node into bronchus
BronchiectasisBronchiectasis siccasicca
Diagnosis :Diagnosis : CxRCxR,, bronchographybronchography, CECT, CECT
Management :Management : postural drainage, infection control,postural drainage, infection control,complications managementcomplications management
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BronchostenosisBronchostenosis
Most serious complication ofMost serious complication of endobronchialendobronchial TBTB
6060--95 % of95 % of endobronchialendobronchial TBTBOccurs in spite of chemotherapy : as late as 3Occurs in spite of chemotherapy : as late as 3years after treatmentyears after treatment
Tracheal involvement : respiratory failure,Tracheal involvement : respiratory failure,retention of secretions, failure ofretention of secretions, failure of endotrachealendotrachealintubationintubation
Treatment :Treatment : cortiocosteroidscortiocosteroids have no role :have no role :repeated dilatation, end to endrepeated dilatation, end to end anastomosisanastomosis
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Destroyed lungDestroyed lung
Massive destruction of one lungMassive destruction of one lung
Left bronchus syndrome :Left bronchus syndrome : IeftIeft bronchusbronchuslonger, 15% narrower, decreasedlonger, 15% narrower, decreasedperibonchialperibonchial space : review of 172 casesspace : 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 absent
Management : of complicationsManagement : of complications
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Aspergilloma Aspergilloma’’
Diagnosis :Diagnosis : CxRCxR, sputum culture, serology,, sputum culture, serology,
bronchoscpybronchoscpyContents : dead and liveContents : dead and live mycelialmycelial elements,elements,
fibrin, mucus, inflammatory cells, degeneratedfibrin, mucus, inflammatory cells, degenerated
blood and epithelial elementsblood and epithelial elementsManagement :Management : ((i)asymptomatici)asymptomatic : spontaneous: spontaneous
lysis(7lysis(7--10%) followed10%) followed radiologicallyradiologically,,
(ii)symptomatic :(ii)symptomatic : intracavitaryintracavitary instillation ofinstillation of
antifungals(amphotericinantifungals(amphotericin B,B, nystatinnystatin), resection), resection
surgery, radiotherapysurgery, radiotherapy
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CalcificationCalcification
Healed tubercular lesionsHealed tubercular lesions
Pleural diseases :Pleural diseases : descretedescrete radioopaqueradioopaqueshadows or sheetshadows or sheet--like calcificationlike calcification
Can erode bronchial wall or arterial wall resultingCan erode bronchial wall or arterial wall resulting
inin hemoptysishemoptysis
CoughedCoughed--out calcifiedout calcified stones(broncholithsstones(broncholiths))
Extensive calcification can result in respiratoryExtensive calcification can result in respiratoryfailure andfailure and cor cor pulmonalepulmonale
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Open negative syndromeOpen negative syndrome
Thin walled cavities withThin walled cavities withepithelialization(preventingepithelialization(preventing cavity collapse)cavity collapse)
More frequent in chemotherapy eraMore frequent in chemotherapy era
CxRCxR : thin walled ring shadows: thin walled ring shadows
Histology : incomplete epithelial lining withHistology : incomplete epithelial lining withnecrotic foci withnecrotic foci with M tuberculosisM tuberculosis
Complications : secondary infection,Complications : secondary infection,
aspergillomaaspergilloma, scar carcinoma,, scar carcinoma, pneumothoraxpneumothorax,,lung volume losslung volume loss
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Scar carcinomaScar carcinoma
Peripherally locatedPeripherally located tumour tumour with nowith no
evidence of bronchial origin, occurringevidence of bronchial origin, occurringaround a truearound a true hyalinizedhyalinized scar scar
More common in upper lobesMore common in upper lobesUsuallyUsually adenocarcinomaadenocarcinoma and atand at
presentation frequently have extrapresentation frequently have extra
pulmonary manifestations.pulmonary manifestations.
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Chronic airway obstructionChronic airway obstruction3030--60% have diffuse airway obstruction60% have diffuse airway obstruction
Restrictive defect : diffuseRestrictive defect : diffuse parenchymalparenchymalfibrosis, pleural fibrosisfibrosis, pleural fibrosis
BronchiectasisBronchiectasis : mixed defect: mixed defectCan present as recurrent infection,Can present as recurrent infection,
respiratory insufficiency andrespiratory insufficiency and
cor cor
pulmonalepulmonale
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Asthma Asthma
ClinicalClinical deterriorationdeterrioration : suggestive of: suggestive of
asthma : 2asthma : 2--6 months after6 months after endobronchialendobronchialTB RxTB Rx
No significantly increased bronchialNo significantly increased bronchial
reactivityreactivityResponse to bronchodilators poorResponse to bronchodilators poor
Good clinical response to corticosteroidsGood clinical response to corticosteroids
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Chronic respiratory failure/Chronic respiratory failure/cor cor
pulmonalepulmonale
Causes : airway obstruction,Causes : airway obstruction, parenchymalparenchymalfibrosis, loss of effective lung volume due tofibrosis, loss of effective lung volume due tocavities andcavities and parenchymalparenchymal destruction, pleuraldestruction, pleural
fibrosisfibrosisPulmonary artery hypertension : destructionPulmonary artery hypertension : destructionof vascular bed, occlusion by fibrosis,of vascular bed, occlusion by fibrosis,
vasculitisvasculitis and endarteritisand endarteritisUsually detected lateUsually detected late
Radiological and ECG changes difficult toRadiological and ECG changes difficult tointerpret due to architectural distortioninterpret due to architectural distortion
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Pleural fibrosisPleural fibrosis
Most common sequel of pleural effusionMost common sequel of pleural effusion
50% unilateral50% unilateralNeither clinical feature nor fluid charactersNeither 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 chemotherapy
Due to DTHDue to DTH
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Pleural fibrosisPleural fibrosis’’
Visceral pleura involvedVisceral pleura involved
Spontaneous resolution in 6 monthsSpontaneous resolution in 6 monthsSteroids have no roleSteroids have no role
Rx :Rx : patient symptomatic & lung healthy :patient symptomatic & lung healthy :decortication(evendecortication(even in long standingin long standing
fibrothoraxfibrothorax
))
Major operation with morality of 3.5%Major operation with morality of 3.5%
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SpontaneousSpontaneous 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 age
RtRt>It>It
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Amyloidosis Amyloidosis
Deposition ofDeposition of extracellular extracellular ,, aposerumaposerum AA type AA typeproteinaceousproteinaceous substancesubstance
RenalRenal amyloidosisamyloidosis in 8in 8--33%33%
Tuberculosis most common cause in IndiaTuberculosis most common cause in India
Decreased incidence with modernDecreased incidence with modernchemotherapychemotherapy
Diagnosis : abdominalDiagnosis : abdominal fatpadfatpad/rectal mucosal//rectal mucosal/
liver/kidney biopsyliver/kidney biopsyRx : supportiveRx : supportive
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Tubercular meningitisTubercular meningitis
2020--25%25%
PsychologicPsychologic/psychiatric disturbances/psychiatric disturbancesVisual/hearing/otherVisual/hearing/other neurologicneurologic deficitdeficit
Endocrine(pituitary/hypothalamic etc)Endocrine(pituitary/hypothalamic etc)disturbancesdisturbances
SeizuresSeizuresIntracranial calcificationIntracranial calcification
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CardiacCardiac
Chronic constrictiveChronic constrictive pericarditispericarditis
Pericardial effusionPericardial effusion
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SkeletalSkeletal
DeformityDeformity
Paresis/paralysis(paraplegia etc)Paresis/paralysis(paraplegia etc)
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GenitourinaryGenitourinary
InfertilityInfertility
StrictureStricture
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All the best.. All the best..