Tuberculosis bronchi

Tuberculosis bronchi can occur at any age, no appreciable difference in incidence in men and women is not observed.
The etiology and pathogenesis. Tuberculosis bronchi is caused by Mycobacterium tuberculosis (see) and develops as a complication of various forms of primary and secondary (mainly bacillary, cavernous, destructive) tuberculosis of the lungs. The pathogenesis of tuberculosis B. associated with pulmonary tuberculosis and tuberculosis of tracheo-broncho-pulmonary lymph nodes. Tuberculosis B. violated ventilation and drainage function that contributes to the formation of atelectasis, the emergence blocked, bloated caverns, and in valvular stenosis B. the emergence of fluid in the cavity, emphysema, bronchiectasis and other pathological changes. At primary tuberculosis, in addition to mechanical pressure on a wall of a bronchial tube, often there is a breakthrough affected by TB mediastinal lymph nodes in the Baltic, then in the sputum and bronchial lavage found Mycobacterium tuberculosis. In these cases, TB changes in the lungs sometimes it's not.
The emergence of tuberculosis bronchi contribute to developing lung tuberculosis dystrophic changes intramural nervous system B., mucous membrane irritation coughing and sputum. Known for playing a role in the General or local cooling on the background of the decreased resistance to infection.
Ways of infection: 1) intracanalicular infection of the bronchi infected sputum most often occurs through the mucous glands and is Central to the cavernous, destructive forms of pulmonary tuberculosis; 2) lymphogenous spread through the lymphatic perivascular and peribronchial vessels is usually observed at the primary tuberculosis, tuberculosis of tracheo-broncho-pulmonary lymph nodes; 3) distribution per continuitatem and contact when the process continues with caverns on draining the bronchi or lymph nodes on the wall of the adjacent bronchus; 4) haematogenous dissemination are very rare (miliary TB and extra-pulmonary lesions). Histologically detected TB bumps in the connective tissue layer of the mucous membrane B.
Pathological anatomy. Postmortem tuberculosis bronchi is manifested mainly in the form of productive or mainly pericardial tissue reaction. These reactive processes are usually observed in two main forms - infiltrative (82,3% of cases) and ulcers (17.7% of cases); however, there may be complications in the form bronholiticeski fistula and stenosis. However, one should not equate the exudative phase with malignant and productive - with benign course of the process and a favorable outcome.
These phases are not Autonomous reactions, but only the stages in the development of the unified process.
Productive process usually (to 90,5% of cases) is characterized by a chronic occurrence and over. The mucous membrane of affected areas pale pink, plump, without significantly expressed inflammatory changes. Infiltrates in the productive nature of the process in most cases, flat, limited, plotnosti, wrong, round or elongated (printing. table, Fig. 1). Sores typically superficial, limited, inflammatory phenomenon in the circle of their minor or absent, but often glabrous or covered with granulations, edge little saped (printing. table, Fig. 2).
Exudative the process is characterized by acute or subacute onset and progressive course; there is much less (9.5% of cases). Infiltrates in exudative process usually bright red, swollen, soft, gelatinous, in most cases, diffuse and quickly disintegrate. Sometimes on the surface swollen infiltrate visible submucosal miliary tubercles (printing. table, Fig. 3). Ulcers often multiple, but may be isolated, quickly join in a solid, deep, crater ulcers often penetrate to nadgraditi and cartilage, with a dirty-gray bloom, bleeding granulations, less whitish-yellow potowatami or roscovitine cheesy masses (printing. table, Fig. 4). In such cases, a biopsy find areas of necrosis; sometimes cellular elements are missing, but with special colouring of Mycobacterium tuberculosis last detected in large quantities.
In the healing of ulcers can occur scars usually in the form of single surface, off-white, shiny strips of irregular shape (printing. table, Fig. 5). Rarely are formed massive concentric scars, substantially narrowing clearance bronchi (printing. table, Fig. 6). Fistulas occur most often in patients with primary TB at the break of tracheo-broncho-pulmonary lymph nodes. In secondary tuberculosis this complication is rare.
Fistulas are of various character: from a barely visible bronchoscopically point perforation (printing. table, Fig. 7) to massive wounded infiltrate, covered with lush, lush granulations and caseosa (printing. table, Fig. 8). In such cases, not always at the first bronchoscopy can diagnose fistula. When emerging perforation first bronchoscopy revealed swelling of the mucous membrane serving bronchus lumen, in the future, shaped like a polypoid a boil (printing. table, Fig. 9) or cone-shaped ledge with caseosa (printing. table, Fig. 10).
Localization of TB changes observed in the home and in the left main, Stalowa, inferior, in the mouths of equity and segment B., and often in the right upper lobe of the lung. Bronholiticeski fistulas are found in the area of mediastinal lymph nodes (bifurcation, the inner side of the main B. and so on).

tuberculosis, bronchial
Fig. 1. Productive infiltrate the inner wall of the right main bronchus. Fig. 2. Productive ulcer inner wall of the right main bronchus. Fig. 3. Exudative infiltrate with miliary knots of the lower wall of the mouth of the right upper lobe lung; stenosis of the II degree. Fig. 4. Exudative ulcer right side of the trachea and rear-inner wall of the right main bronchus; stenosis And degree. Fig. 5. The scar of the lower wall of the mouth of the right upper lobe lung. Fig. 6. Cicatricial stenosis of the II degree mouth right inferior bronchus.

Fig. 7. Broncho-lymph fistula left main bronchus. Fig. 8. Broncho-lymph productive fistula with granulations and caseosa on the right wall of the bifurcation of the trachea. Fig. 9, Broncho-lymph productive infiltrate (polypoid) of the left main bronchus. Fig. 10. Broncho-lymph exudative infiltrate (in the form of a boil with caseosa on top) over the mouth of the right upper lobe lung; stenosis of the III degree. Fig. 11. Fibrous seal mucosal surface scarring of the lower wall of the mouth of the right upper lobe lung and the outer wall of the right main bronchus. Fig. 12. Injected capillary network vessel inner wall of the left main bronchus.