And in those patients whose cavity does not heal during chemotherapy, cavernous tuberculosis persists. It is characterized by a wave-like course, i.e. the appearance of periodic outbreaks and exacerbations. The frequency of outbreaks depends on the technique, duration and effectiveness of chemotherapy. With more successful treatment, there may be no exacerbations for a long time; stabilization of the process may remain for a long time. When chemotherapy is less effective, especially when treatment is erratic or absent, patients experience periodic flare-ups. During the outbreak, intoxication syndrome is observed. body temperature rises, weakness and loss of appetite occur. We can say that this syndrome is not very pronounced and can disappear quite quickly, especially with a well-chosen combination of chemotherapy drugs. During the outbreak, the patient develops chest symptoms. cough, production of a small amount of sputum. There may be hemoptysis (some patients periodically experience hemoptysis even during intervals).
Most often this is due to either vascular changes such as aneurysms of small arteries or varicose veins in the walls of the bronchi. In addition, hemoptysis may be the result of destruction of the vascular wall located in the wall of the cavity. When examining a patient with cavernous tuberculosis, studying the dynamics of leukograms is of great importance. Signs such as an increase in ESR, a shift to the left, lymphopenia, even with clinical well-being, are signs of active tuberculosis, an exacerbation of the disease, so a repeated blood test is of great importance.
The lung is an elastic organ, and the size of the rounded shadow of the cavity does not always exactly correspond to the amount of destruction. If, with appropriate treatment of endobronchitis in a patient with a swollen or stretched cavity, the drainage function of the bronchus is restored, the size of the cavity decreases sharply. Sometimes such a decrease occurs immediately after bronchoscopy, because theronchoscopy is a powerful irritant of the bronchi and after it the drainage function is sometimes restored, especially if the secretion is sucked out or if anti-inflammatory drugs are introduced into the bronchial lumen.
11am CT
When assessing radiographs and tomograms, it is necessary to pay attention to the external and internal contours of the annular shadow of the cavity, as well as the condition of the surrounding lung tissue. There are methods that make it possible to study the elasticity of lung tissue, which is sometimes very important in determining the prognosis in terms of the possibility of cavity healing or the lack of such possibility. Cavernous tuberculosis requires that the patient first be hospitalized. In a hospital setting, after examination, it is necessary to begin chemotherapy; this chemotherapy should be aimed at healing the cavity. If it is not possible to achieve healing of the cavity, it must be assumed that chemotherapy is ineffective, and surgical intervention is indicated for such patients.
The phenomenon of a stretched or swollen cavity occurs only with elastic cavities. Therefore, if the size of the cavity changes rapidly, this is a sign of an elastic cavity. It is necessary to pay attention not only to the size of the cavity, but also to its localization, and it must be borne in mind that the subpleural localization of the cavity creates extremely unfavorable conditions for healing. Subpleural cavities rarely heal even with elastic cavities.
How long can a patient be treated with chemotherapy? How long does it take for the cavity to heal? The instructions allow 6 months for this. In some cases, the question of surgery can be raised earlier. if the patient has a fibrous or rigid cavity and it is clear that there will be no healing, if the patient can hardly tolerate a hospital stay, if the patient is undisciplined, carelessly treated with chemotherapy and there is no hope that he will receive chemotherapy for the entire required time. Finally, the question of surgery may arise when chemotherapy is ineffective, bacterial excretion continues, and, especially, if drug resistance of mycobacteria is detected. The last circumstance is poor tolerability of chemotherapeutic agents.
Very often, we consider the issue of surgical treatment of cavernous tuberculosis after 6 months of treatment, but we postpone the operation to a later date. In which cases? Firstly, if positive dynamics are noted and the size of the cavity decreases. First, the perifocal inflammation resolves, the lesions heal, and the size of the cavity decreases. If we see a decrease in the size of the cavity, there is no need to rush into surgery. In some cases, the cavity closes with a scar quickly, in others the cavity slowly, gradually decreases in size. In patients with healing cavities, in addition to chemotherapy, it is often necessary to carry out pathogenetic treatment. tuberculin therapy, BCG administration, the use of ultrasound, inductothermy, laser irradiation.
Hidden, undetected drug resistance is one of the reasons for non-healing of the cavity in such patients. Therefore, in the absence of healing of the cavity, in the absence of dynamics, it makes sense not only to use pathogenetic agents, but also to change chemotherapy drugs during the treatment process. If chemotherapy fails to achieve healing of the cavity, such patients need to undergo surgery. On the one hand, you can refrain from surgery only if there are direct contraindications. On the other hand, the question of surgery can be postponed if an abacillated cavity is formed, i.e. if bacilli secretion persistently stops - a process takes place that approaches the so-called open healing of the cavity, when the inner wall of the cavity is cleaned, undergoes epithelization and the cavity turns into a cyst . True, the outcome of the disease in some patients is not very good. there may be suppuration, aspergillosis may develop, and cyst filling may occur.
