RESUMEN
Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. Although primarily a disease of the respiratory system it may be found in any organ or tissue. Global population movements and the emergence of resistant strains are contributing to increasing numbers of cases in certain populations. Subtlety of symptoms and signs, chronicity of disease and failure to seek medical assistance may result in the diagnosis only being made at the time of autopsy. For this reason forensic pathologists need to understand the protean manifestations of the disease and the variable mechanisms by which TB may cause death. This atlas overview provides descriptions of the pathological manifestations of TB in a variety of organs with accompanying illustrations. It serves as a summary of conditions that should be checked for at autopsy in suspected or confirmed cases.
Asunto(s)
Tuberculosis/patología , Autopsia , Encéfalo/microbiología , Encéfalo/patología , Transmisión de Enfermedad Infecciosa/prevención & control , Empiema Tuberculoso/patología , Epididimitis/microbiología , Epididimitis/patología , Patologia Forense , Granuloma/patología , Humanos , Hidrocefalia/microbiología , Hidrocefalia/patología , Control de Infecciones , Riñón/microbiología , Riñón/patología , Rodilla/microbiología , Rodilla/patología , Pulmón/patología , Ganglios Linfáticos/microbiología , Ganglios Linfáticos/patología , Masculino , Meninges/microbiología , Meninges/patología , Microscopía , Mycobacterium tuberculosis/patogenicidad , Necrosis/patología , Columna Vertebral/microbiología , Columna Vertebral/patología , Tráquea/microbiología , Tráquea/patologíaRESUMEN
Tuberculous empyema (TE) is associated with high mortality and morbidity. In the retrospective cohort study, we aimed to find risk factors for TE among pleural tuberculosis (TB) patients. Between July 2011 and September 2015, all culture-confirmed pleural TB patients (474 cases) were enrolled in our study. Empyema was defined as grossly purulent pleural fluid. Demographic and epidemiological data were collected for further analysis. Multivariate logistic regression analysis was used to evaluate risk factors of TE in pleural TB, age-adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to show the risk. The mean age was 35.7 ± 18.1 years old, males comprised 79.1% of the participants (375 cases). Forty-seven patients (9.9%) were multidrug-resistant TB (MDR-TB), 29 (6.1%) had retreatment TB, 26 (5.5%) had diabetes mellitus. The percentage of empyema patients was 8.9% (42 cases). Multivariate analysis revealed that male (adjusted OR = 4.431, 95% CI: 1.411, 13.919), pleural adenosine deaminase (ADA, >88 U/L) (adjusted OR = 3.367, 95% CI: 1.533, 7.395) and white blood cell (WBC, >9.52 109/L) (adjusted OR = 5.763, 95% CI: 2.473, 13.431) were significant risk factors for empyema in pleural TB, while pulmonary TB (adjusted OR = 0.155, 95% CI: 0.072, 0.336) was the protective factor for the patients. TE remains a serious threat to public health in China. Male sex is a significant risk factor for TE while the presence of pulmonary TB is protective, and high levels of pleural ADA and WBC count could aid in early diagnosis of TE. This finding would help towards reducing the mortality and morbidity associated with TE.
Asunto(s)
Empiema Tuberculoso/microbiología , Empiema Tuberculoso/patología , Mycobacterium tuberculosis/patogenicidad , Tuberculosis Pleural/microbiología , Tuberculosis Pleural/patología , Adolescente , Adulto , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto JovenAsunto(s)
Empiema Tuberculoso/diagnóstico por imagen , Hemangiosarcoma/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Anciano , Biopsia , Empiema Tuberculoso/patología , Resultado Fatal , Fibrosis , Hemangiosarcoma/patología , Humanos , Pulmón/patología , Masculino , Radiografía Torácica , Neoplasias Torácicas/patología , Pared Torácica/diagnóstico por imagen , Pared Torácica/patología , Tomografía Computarizada por Rayos XAsunto(s)
Humanos , Masculino , Anciano , Empiema Tuberculoso/diagnóstico por imagen , Hemangiosarcoma/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Biopsia , Empiema Tuberculoso/patología , Resultado Fatal , Fibrosis , Hemangiosarcoma/patología , Pulmón/patología , Radiografía Torácica , Neoplasias Torácicas/patología , Pared Torácica/diagnóstico por imagen , Pared Torácica/patología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: To investigate the efficacy and value of thoracoscopic hybrid surgery in the treatment of stage III chronic tuberculous empyema (CTE). METHODS: 48 patients diagnosed as CTE with pleural thickening and encysted abscess cavity from were treated by hybrid operation (HO). Small incision operation was first used for resection of thickening pleural fibreboard and decortication of parietal pleura. Then, thoracoscopy was guided into chest to decorticate the visceral pleurali. Additional 25 patients with open operation of pleurectomy were set as control. RESULTS: The average operation time of HO group was 70 ± 22 min compared to 130 ± 32 min of control. The amount of bleeding, hospitalization time and chest tube drainage of HO group (200 ± 55 ml, 18 ± 1.2 days, 3.5 ± 1.5 days) were significantly decreased compared to control (400 ± 45 ml, 28 ± 4.5 days, 6.5 ± 2.5 days). Post operation complications occurred in 5 (10.42%) and 3 (12%) cases for HO group and control, respectively. CONCLUSIONS: In stage III CTE, the small incision assisted thoracoscopic hybrid surgery help to remove thickening parietal pleura, promote the application of thoracoscopy, which has obvious advantages compared to traditional surgery.
Asunto(s)
Empiema Tuberculoso/cirugía , Toracoscopía/métodos , Adolescente , Adulto , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Drenaje/estadística & datos numéricos , Empiema Tuberculoso/diagnóstico por imagen , Empiema Tuberculoso/patología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias , Tomografía Computarizada por Rayos X , Adulto JovenAsunto(s)
Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/patología , Mycobacterium tuberculosis/aislamiento & purificación , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Biopsia con Aguja Fina , Empiema Tuberculoso/tratamiento farmacológico , Humanos , Masculino , Radiografía Torácica , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Empiema Tuberculoso/cirugía , Procedimientos Quirúrgicos Pulmonares , Empiema Tuberculoso/patología , Humanos , Tiempo de Internación , Músculos/trasplante , Procedimientos Quirúrgicos Pulmonares/efectos adversos , Procedimientos Quirúrgicos Pulmonares/métodos , Reoperación , Trasplante de Piel , Colgajos Quirúrgicos , Cirugía Torácica Asistida por Video , Toracotomía , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: The aim of this study was to describe the features of lung cancers associated with chronic tuberculous pyothorax. METHODS: Clinicopathological data from patients with coexisting lung cancer and chronic latent pyothorax caused by tuberculosis (TB) were analysed, and cancer tissue samples were investigated for the presence of Epstein-Barr virus. RESULTS: Twelve patients were identified, and all had a history of tuberculous pleuritis or surgical intervention for TB. The interval between the onset of TB and lung cancer was more than 30 years in nine patients and the most frequent symptom was chest pain (six patients). All cancers were in the ipsilateral lung to the pyothorax, and in nine of the 12 patients the cancers were located adjacent to the pyothorax. In situ hybridization analysis for Epstein-Barr virus-encoded small RNA failed to show positive signals in any of the six cancer tissues examined. CONCLUSIONS: Lung cancer associated with chronic pyothorax always developed in the ipsilateral lung to the pyothorax, and there was no evidence for the presence of Epstein-Barr virus in the cancer tissues examined.
Asunto(s)
Empiema Tuberculoso/epidemiología , Neoplasias Pulmonares/epidemiología , Adulto , Anciano , Enfermedad Crónica , Comorbilidad , Empiema Tuberculoso/patología , Infecciones por Virus de Epstein-Barr/epidemiología , Femenino , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Hibridación in Situ , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/virología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Empyema necessitatis refers to a collection of exudative fluid that extends directly from the pleural cavity to the thoracic wall to form a mass in the extrapleural soft tissue of the chest. It was an uncommon complication of tuberculous pleural effusion even in the pre-antibiotic era, and has also been associated with bacterial lung abscess, actinomycosis, blastomycosis, and malignancies. METHODS: Seven instances of chest wall mass lesion secondary to empyema necessitatis, diagnosed by fine-needle aspiration biopsy (FNAB), are reported. RESULTS: Three cases were tuberculous, two were mesotheliomatous, one was caused by pulmonary small cell carcinoma, and another was due to coexisting Actinomyces and Actinobacillus. In all patients, subsequent pleural fluid cytologies demonstrated empyema with the respective etiologies identified. CONCLUSIONS: The usefulness of FNAB in the diagnosis of empyema necessitatis, supported by radiographic imaging and ancillary procedures, is well illustrated by these seven cases.
Asunto(s)
Mama/patología , Empiema Pleural/patología , Empiema Tuberculoso/patología , Mastitis/patología , Tórax/patología , Infecciones por Actinobacillus/complicaciones , Actinomicosis/complicaciones , Adulto , Anciano , Biopsia con Aguja Fina , Carcinoma de Células Pequeñas/complicaciones , Carcinoma de Células Pequeñas/patología , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/etiología , Empiema Pleural/microbiología , Empiema Tuberculoso/complicaciones , Empiema Tuberculoso/diagnóstico por imagen , Resultado Fatal , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Mastitis/etiología , Mastitis/microbiología , Mesotelioma/complicaciones , Mesotelioma/patología , Persona de Mediana Edad , RadiografíaRESUMEN
Pleural effusions in tuberculosis are commonly seen in young adults as an immunological phenomenon occurring soon after primary infection. However, the epidemiology and demographics of tuberculous pleurisy are changing due to the impact of HIV co-infection and the increasing number of pleural effusions seen as part of re-activation disease. Pleural biopsy for histology and culture is the mainstay of diagnosis with closed needle biopsy adequate in the majority of cases. Techniques such as PCR of biopsy specimens and the role of pleural fluid ADA are still being evaluated as a diagnostic aid. Tuberculous empyema is less commonly seen in the western world and the diagnostic yield from pleural fluid here is greater than in "primary" effusions. Treatment with appropriate antituberculous chemotherapy is generally successful though there is currently insufficient evidence to recommend the routine use of corticosteroids in this condition.
Asunto(s)
Tuberculosis Pleural , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Adulto , Factores de Edad , Anciano , Antituberculosos/administración & dosificación , Antituberculosos/uso terapéutico , Biopsia con Aguja , Niño , Ensayos Clínicos como Asunto , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/tratamiento farmacológico , Empiema Tuberculoso/epidemiología , Empiema Tuberculoso/patología , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Incidencia , Persona de Mediana Edad , Pleura/patología , Derrame Pleural/diagnóstico , Derrame Pleural/patología , Factores de Riesgo , Factores de Tiempo , Prueba de Tuberculina , Tuberculosis Pleural/diagnóstico , Tuberculosis Pleural/tratamiento farmacológico , Tuberculosis Pleural/epidemiología , Tuberculosis Pleural/patologíaRESUMEN
The outcomes of treatment were analyzed in 108 patients with disseminated and complicated pulmonary tuberculosis. The patient's mean age was 38.3 +/- 4.2 years. Transsternal occlusion of the main bronchus was performed. Concurrently, the following draining interventions were made: thoracostomy, cavernotomy, cavernostomy, or stepwise thoracoplasty. Nine (8.3%) patients intraoperatively died; 20 (18.5%) patients developed recanalization of the main bronchus. Twenty-four (22.2%) patients had a progressive tuberculous process in the contralateral lung. The operation was effective and ensured recovery or stabilization of the tuberculous process in 55 (50.9%) patients. After surgery, dilatation of the pulmonary trunk was 2.8 cm; stroke volume in the pulmonary trunk was 42.4 ml and its distribution along the branches was 83% on the side of the least affection and 17% on that of the greatest affection. At diastole, there was a retrograde blood flow in the branch of the pulmonary artery of the collapsed lung in the volume of 61% of the systolic stroke volume. The calculated pulmonary pressure was 52 mm Hg. Transsternal occlusion of the main bronchus, involving stepwise draining interventions, should be considered the method of choice in treating these patients.
Asunto(s)
Enfermedades Bronquiales/patología , Enfermedades Bronquiales/cirugía , Circulación Colateral/fisiología , Tuberculosis Pulmonar/fisiopatología , Tuberculosis Pulmonar/cirugía , Adulto , Enfermedades Bronquiales/epidemiología , Constricción Patológica/patología , Empiema Tuberculoso/epidemiología , Empiema Tuberculoso/patología , Empiema Tuberculoso/cirugía , Femenino , Estudios de Seguimiento , Hemodinámica/fisiología , Humanos , Masculino , Toracotomía , Tuberculosis Pulmonar/epidemiologíaRESUMEN
BACKGROUND: The nonsurgical medical approach with use of fibrinolytic agent is an alternative modality in management of chronic empyemas. With the introduction of purer forms of streptokinase, there has been renewed interest generated in the use of intrapleural thrombolytics with documented successful drainage of difficult to drain chronic empyemas. To evaluate the utility of streptokinase in the management of chronic difficult to drain empyemas in a single blind randomized case control study. MATERIAL AND METHODS: Twenty four cases of chronic/multiloculated empyema were included which had cases preferred having loculations or multiloculations and failure of drainage via thoracostomies for less than 100 ml during last 24 hours. Cases were randomized into two groups as 12 cases of streptokinases group and 12 cases of placebo group. Streptokinase given as 2.5 lac units in 100 ml of normal saline instilled intrapleurally for 6 consecutive days. In control group, 100 ml of normal saline without streptokinase was instilled intrapleurally through intercostal drain for 6 days. They were assessed by amount of drainage through intercostal drain for six days after instillation of streptokinase/placebo, duration of intercostal drainage in situ, and radiological improvement by standard x-ray chest. RESULTS: The study revealed increased drainage through intercostal drain in streptokinase group compared to control group. The mean duration of intercostal drainage in situ was shorter in streptokinase group compared to control group. Radiologically, streptokinase group revealed score 3 improvement in eight out of twelve cases and score 2 improvement in rest of the four cases. In control group, score 1 improvement was seen in two out of twelve cases and no improvement was seen in rest of the 10 cases. The observation difference is found to be highly significant statistically (p <0.001). No major adverse effects were noted in the streptokinase group. CONCLUSION: The study concludes the safety, efficacy, reduced hospital stay and decreased morbidity in patients treated with intrapleural streptokinase as compared to control group.
Asunto(s)
Empiema Tuberculoso/tratamiento farmacológico , Fibrinolíticos/uso terapéutico , Estreptoquinasa/uso terapéutico , Adolescente , Adulto , Enfermedad Crónica , Drenaje , Empiema Tuberculoso/diagnóstico por imagen , Empiema Tuberculoso/patología , Femenino , Fibrinolíticos/efectos adversos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Radiografía , Método Simple Ciego , Estreptoquinasa/efectos adversos , Resultado del TratamientoRESUMEN
We describe a case of a diabetic man with a 40-year history of chronic tuberculous empyema presented with fever, chest pain and bulging soft tissue of the right chest wall. CT scan revealed a huge chest wall mass showing extensive necrosis with air-bubbles and destruction of the ribs. Decortication and extirpation of the chest wall mass were performed, and histopathologic examination confirmed diffused large cell type non-Hodgkin's lymphoma.
Asunto(s)
Empiema Tuberculoso/diagnóstico , Linfoma de Células B Grandes Difuso/diagnóstico , Neoplasias Torácicas/diagnóstico , Pared Torácica , Enfermedad Crónica , Diagnóstico Diferencial , Empiema Tuberculoso/etiología , Empiema Tuberculoso/patología , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Modern epidemiologic data about prevalence and etiology of the nonspecific pleural exudates syndrome were suggested in patients of phthisio-pulmonary specialty, and also its dynamic during last 7 years. The main trends of change of frequency of the different etiology pleural exudates occurrence taking into account the patients gender were determined. The most wide spread forms of pleural exudates: parapneumonic, purulent, reactive, phthisic, cardiogenic were detailed.
Asunto(s)
Derrame Pleural , Adulto , Enfermedades Cardiovasculares/epidemiología , Empiema Tuberculoso/epidemiología , Empiema Tuberculoso/etiología , Empiema Tuberculoso/patología , Femenino , Humanos , Masculino , Derrame Pleural/epidemiología , Derrame Pleural/etiología , Derrame Pleural/patología , PrevalenciaRESUMEN
Empyema necessitatis is a rare complication of tuberculous empyema. We present a very rare case of empyema necessitatis into the retroperitoneal space through the diaphragm. The fistula between the thoracic empyema cavity and the retroperitoneal abscess was clearly identified by magnetic resonance imaging.
Asunto(s)
Absceso/complicaciones , Empiema Pleural/complicaciones , Empiema Tuberculoso/complicaciones , Fístula del Sistema Respiratorio/etiología , Espacio Retroperitoneal , Absceso/patología , Anciano , Empiema Pleural/patología , Empiema Tuberculoso/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Pleurales/etiología , Enfermedades Pleurales/patología , Fístula del Sistema Respiratorio/patologíaRESUMEN
Chronic pyothorax associated with pulmonary tuberculosis was recently proposed to be one of the predisposing factors of angiosarcoma arising in the chest wall. Separately, several authors have reported pleural angiosarcoma that has a close resemblance to mesothelioma, the latter having no apparent association with a history of pyothorax. I present a detailed pathologic description of an autopsy case of thoracic angiosarcoma arising after long-standing tuberculous pyothorax, for the purpose of better illustrating this condition. In this case, the main tumor mass was situated on the soft tissue of the chest wall outside the rib girdle. On the pleuropulmonary tissue, tumor infiltration was grossly observable as a dark patch, 2 cm in diameter, on the outer surface of the wall of the pyothorax (pleural peel). Infiltration of the tumor was found in the soft tissue just outside of the peel and in the attached rib. However, the tumor was not found in the peel itself, nor was it found in the necrotic content of the pyothorax. This case suggests that angiosarcoma associated with pyothorax is not similar to primary pleural angiosarcoma and shows the rather ordinary feature of the tumor's arising in the soft tissue.
Asunto(s)
Empiema Tuberculoso/complicaciones , Hemangiosarcoma/diagnóstico , Hemangiosarcoma/etiología , Neoplasias Pleurales/diagnóstico , Neoplasias Pleurales/etiología , Antígenos CD34/análisis , Biomarcadores/análisis , Empiema Tuberculoso/patología , Factor VIII/análisis , Resultado Fatal , Hemangiosarcoma/química , Hemangiosarcoma/patología , Hemoptisis/etiología , Humanos , Inmunohistoquímica , Queratinas/análisis , Masculino , Persona de Mediana Edad , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/análisis , Neoplasias Pleurales/química , Neoplasias Pleurales/patología , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: The purpose of this work was to describe CT findings of the parietal pleura and extrapleural space in patients with chronic tuberculous empyema and to compare them with histopathologic findings following decortication. METHOD: Chest CT scans obtained from 13 patients with chronic tuberculous empyema who underwent decortication were retrospectively reviewed. All patients were men from 18 to 67 years old (mean 42 years old). CT findings of the parietal pleura and extrapleural space were correlated with histopathologic findings in all patients. RESULTS: Histopathologically, the enhanced parietal pleural peel on CT was fibrous collagenous tissue, and a low attenuated layer with 2 mm thickness within the parietal pleural peel (n = 2) was either a layer of histiocytes or caseation necrosis. The extrapleural space seen as an intermediate attenuation in six patients on CT was the proliferation of vessels, inflammatory cells, and granulomas in loose collagen background. The linear soft tissue attenuation interrupting the extrapleural fat (n = 5) on CT was a collagenous fibrous layer with proliferation of vessels and inflammatory cells. CONCLUSION: A layer of low attenuation in the parietal pleural peel may be due to different episodes of infection. The extrapleural space with intermediate attenuation may indicate ongoing inflammation. Linear soft tissue attenuation interrupting the extrapleural fat represents a fibrous layer rather than the subcostalis muscle.
Asunto(s)
Empiema Tuberculoso/diagnóstico por imagen , Pleura/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Enfermedad Crónica , Medios de Contraste , Empiema Tuberculoso/diagnóstico , Empiema Tuberculoso/patología , Humanos , Aumento de la Imagen , Masculino , Persona de Mediana Edad , Pleura/patología , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Empyema necessitatis is a relatively rare entity. Two instances of mastitis secondary to empyema necessitatis, diagnosed by fine needle aspiration biopsy are reported. CASES: One case was tuberculous in etiology and was initially recognized by cytologic findings of epithelioid and granulomatous cellular reactions and the presence of acid-fast bacilli, which were subsequently cultured and speciated as Mycobacterium tuberculosis. The other case was due to coexisting Actinomyces and Actinobacillus. These organisms were cytologically suggested by "sulfur" granules of filamentous, gram-positive bacilli, admixed gram-negative coccobacilli and Splendore-Hoeppli phenomenon in an exudative cell background and were confirmed by microbiologic culture as Actinomyces israelii and Astinomyces actinomycetemcomitans, respectively. CONCLUSION: The usefulness of fine needle aspiration cytology in the diagnosis of empyema necessitatis, supported by ancillary microbial culture, histochemistry, and radiographic imaging, is well illustrated by these two cases.
Asunto(s)
Empiema Pleural/patología , Empiema Tuberculoso/patología , Mastitis/patología , Actinobacillus/aislamiento & purificación , Actinomyces/aislamiento & purificación , Anciano , Biopsia con Aguja , Empiema Pleural/complicaciones , Empiema Pleural/microbiología , Empiema Tuberculoso/complicaciones , Empiema Tuberculoso/microbiología , Humanos , Masculino , Mastitis/etiología , Mastitis/microbiología , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Derrame Pericárdico/diagnóstico por imagen , Derrame Pericárdico/patología , Derrame Pleural/diagnóstico por imagen , Derrame Pleural/patología , Radiografía Torácica , Tomografía Computarizada por Rayos XRESUMEN
We report a case of 64-year-old man with chronic hemorrhagic empyema. T1- and T2-weighted MR images showed variably hyperintense areas in the tumor that reflected the presence of fresh and old hematoma. Gd-DTPA-enhanced MRI revealed capillary bleeding in the periphery of the mass.