Post tubercular

sequelae

Complications/sequelae
Pulmonary
Extrapulmonary

Pulmonary sequelae
Hemoptysis
Bronchiectasis
Bronchostenosis
Destroyed lung
Aspergilloma
Calcification
Open negative syndrome

Pulmonary sequelae
Scar carcinoma
Chronic airway obstruction
Chronic respiratory failure
Cor pulmonale
TB relapse
Pyogenic abscess
Tubercular endobronchitis & tracheitis

Extrapulmonary
Pleural fibrosis
Pneumothorax
Amyloidosis
Cardiac
Abdominal
Skeletal
Neurological/TBM
Genitourinary

Hemoptysis
Common, potentially fatal
More common in young
Incidence 30-35%
Causes : Rasmussens aneurysm, scar
carcinoma, bronchiectasis, broncholith,
aspergilloma

Hemoptysis : Rx
Bed rest
Diseased side be dependent
Sedation
Rule out bleed from UR tract
Restoration of fluid balance
Antifibrinolytics
Bronchoscopy : diagnostic and therapeutic : (i)localizes
lesion, (ii)can place balloon catheter/CO2 laser, (iii)
arterial embolotherapy : successful in 98%
Surgery : last but definite Rx

Bronchiectasis
Increases with increase in severity of parenchymal
involvement
No relation to age,sex or presence of cavity
Causes : fibrosis, atelectasis, bronchostenosis, rupture
of calcified node into bronchus
Bronchiectasis sicca
Diagnosis : CxR, bronchography, CECT
Management : postural drainage, infection control,
complications management

Bronchostenosis
Most serious complication of endobronchial TB
60-95 % of endobronchial TB
Occurs in spite of chemotherapy : as late as 3
years after treatment
Tracheal involvement : respiratory failure,
retention of secretions, failure of endotracheal
intubation
Treatment : cortiocosteroids have no role :
repeated dilatation, end to end anastomosis

Destroyed lung
Massive destruction of one lung
Left bronchus syndrome : Ieft bronchus
longer, 15% narrower, decreased
peribonchial space : review of 172 cases
showed 109 (63%) cases on the left :
perfusion to the affected side absent
Management : of complications

Aspergilloma
Majority of fungal balls in TB cavities are
aspergilloma
Mucormycosis has also been implicated
Cavities >2.5 cm +ve serology : precipitins in
25%; radiological evidence in 11%
Asymptomatic presentation
Hemoptysis(5-90%), cough, weight loss
Air crescent (Monod) sign, Halo sign, bell like
image with fungus ball as clapper inside bell.

Aspergilloma
Diagnosis : CxR, sputum culture, serology,
bronchoscpy
Contents : dead and live mycelial elements,
fibrin, mucus, inflammatory cells, degenerated
blood and epithelial elements
Management : (i)asymptomatic : spontaneous
lysis(7-10%) followed radiologically,
(ii)symptomatic : intracavitary instillation of
antifungals(amphotericin B, nystatin), resection
surgery, radiotherapy

Calcification
Healed tubercular lesions
Pleural diseases : descrete radioopaque
shadows or sheet-like calcification
Can erode bronchial wall or arterial wall resulting
in hemoptysis
Coughed-out calcified stones(broncholiths)
Extensive calcification can result in respiratory
failure and cor pulmonale

Open negative syndrome

Thin walled cavities with
epithelialization(preventing cavity collapse)
More frequent in chemotherapy era
CxR : thin walled ring shadows
Histology : incomplete epithelial lining with
necrotic foci with M tuberculosis
Complications : secondary infection,
aspergilloma, scar carcinoma, pneumothorax,
lung volume loss

Scar carcinoma
Peripherally located tumour with no
evidence of bronchial origin, occurring
around a true hyalinized scar
More common in upper lobes
Usually adenocarcinoma and at
presentation frequently have extra
pulmonary manifestations.

Chronic airway obstruction

30-60% have diffuse airway obstruction
Restrictive defect : diffuse parenchymal
fibrosis, pleural fibrosis
Bronchiectasis : mixed defect
Can present as recurrent infection,
respiratory insufficiency and cor pulmonale

Asthma
Clinical deterrioration : suggestive of
asthma : 2-6 months after endobronchial
TB Rx
No significantly increased bronchial
reactivity
Response to bronchodilators poor
Good clinical response to corticosteroids

Chronic respiratory failure/cor

pulmonale
Causes : airway obstruction, parenchymal
fibrosis, loss of effective lung volume due to
cavities and parenchymal destruction, pleural
fibrosis
Pulmonary artery hypertension : destruction
of vascular bed, occlusion by fibrosis,
vasculitis and endarteritis
Usually detected late
Radiological and ECG changes difficult to
interpret due to architectural distortion

Pleural fibrosis
Most common sequel of pleural effusion
50% unilateral
Neither clinical feature nor fluid characters
can predict extent of fibrosis
No relation to drugs used in chemotherapy
Due to DTH

Pleural fibrosis
Visceral pleura involved
Spontaneous resolution in 6 months
Steroids have no role
Rx : patient symptomatic & lung healthy :
decortication(even in long standing
fibrothorax)
Major operation with morality of 3.5%

Spontaneous pneumothorax
Pulmonary tuberculosis(5-15%)
Due to rupture of thin healed cavity/bleb/
bulla(secondary to fibrosis)
Male>female
Increases with increasing age
Rt>It

Spontaneous pneumothorax :
Rx
ICD : High failure rate(fibrosis &
adhesions), longer duration(5d-5mth),
frequent BPF
Failed ICD : decortication/space- reducing
thoracoplasty

Amyloidosis
Deposition of extracellular, aposerum AA type
proteinaceous substance
Renal amyloidosis in 8-33%
Tuberculosis most common cause in India
Decreased incidence with modern
chemotherapy
Diagnosis : abdominal fatpad/rectal mucosal/
liver/kidney biopsy
Rx : supportive

Abdominal TB
Chronic : stricture, blind loop; Rx surgical
Acute : intestinal perforation/obstruction,
peritonitis; Rx conservative till infection
subsides with chemotherapy

Tubercular meningitis
20-25%
Psychologic/psychiatric disturbances
Visual/hearing/other neurologic deficit
Endocrine(pituitary/hypothalamic etc)
disturbances
Seizures
Intracranial calcification

Cardiac
Chronic constrictive pericarditis
Pericardial effusion

Skeletal
Deformity
Paresis/paralysis(paraplegia etc)

Genitourinary
Infertility
Stricture

All the best..