Post tubercular Post tubercular sequelae sequelae Complications/ Complications/ sequelae sequelae Pulmonary Pulmonary Extrapulmonary Extrapulmonary Pulmonary Pulmonary sequelae sequelae Hemoptysis Hemoptysis Bronchiectasis Bronchiectasis Bronchostenosis Bronchostenosis Destroyed lung Destroyed lung Aspergilloma Aspergilloma Calcification Calcification Open negative syndrome Open negative syndrome Pulmonary Pulmonary sequelae sequelae ’ ’ Scar carcinoma Scar carcinoma Chronic airway obstruction Chronic airway obstruction Chronic respiratory failure Chronic respiratory failure Cor Cor pulmonale pulmonale TB relapse TB relapse Pyogenic Pyogenic abscess abscess Tubercular Tubercular endobronchitis endobronchitis & & tracheitis tracheitis Extrapulmonary Extrapulmonary Pleural fibrosis Pleural fibrosis Pneumothorax Pneumothorax Amyloidosis Amyloidosis Cardiac Cardiac Abdominal Abdominal Skeletal Skeletal Neurological/TBM Neurological/TBM Genitourinary Genitourinary Hemoptysis Hemoptysis Common, potentially fatal Common, potentially fatal More common in young More common in young Incidence 30 Incidence 30 - - 35% 35% Causes : Causes : Rasmussens Rasmussens aneurysm, scar aneurysm, scar carcinoma, carcinoma, bronchiectasis bronchiectasis , , broncholith broncholith , , aspergilloma aspergilloma Hemoptysis Hemoptysis : Rx : Rx Bed rest Bed rest Diseased side be dependent Diseased side be dependent Sedation Sedation Rule out bleed from UR tract Rule out bleed from UR tract Restoration of fluid balance Restoration of fluid balance Antifibrinolytics Antifibrinolytics Bronchoscopy Bronchoscopy : : diagnostic and therapeutic : (i)localizes diagnostic and therapeutic : (i)localizes lesion, (ii)can place balloon catheter/CO2 laser, (iii) lesion, (ii)can place balloon catheter/CO2 laser, (iii) arterial arterial embolotherapy embolotherapy : : successful in 98% successful in 98% Surgery : last but definite Rx Surgery : last but definite Rx Bronchiectasis Bronchiectasis Increases with increase in severity of Increases with increase in severity of parenchymal parenchymal involvement involvement No relation to age,sex or presence of cavity No relation to age,sex or presence of cavity Causes : fibrosis, Causes : fibrosis, atelectasis atelectasis , , bronchostenosis bronchostenosis , rupture , rupture of calcified node into bronchus of calcified node into bronchus Bronchiectasis Bronchiectasis sicca sicca Diagnosis : Diagnosis : CxR CxR , , bronchography bronchography , CECT , CECT Management : Management : postural drainage, infection control, postural drainage, infection control, complications management complications management Bronchostenosis Bronchostenosis Most serious complication of Most serious complication of endobronchial endobronchial TB TB 60 60 - - 95 % of 95 % of endobronchial endobronchial TB TB Occurs in spite of chemotherapy : as late as 3 Occurs in spite of chemotherapy : as late as 3 years after treatment years after treatment Tracheal involvement : respiratory failure, Tracheal involvement : respiratory failure, retention of secretions, failure of retention of secretions, failure of endotracheal endotracheal intubation intubation Treatment : Treatment : cortiocosteroids cortiocosteroids have no role : have no role : repeated dilatation, end to end repeated dilatation, end to end anastomosis anastomosis Destroyed lung Destroyed lung Massive destruction of one lung Massive destruction of one lung Left bronchus syndrome : Left bronchus syndrome : Ieft Ieft bronchus bronchus longer, 15% narrower, decreased longer, 15% narrower, decreased peribonchial peribonchial space : review of 172 cases space : review of 172 cases showed 109 (63%) cases on the left : showed 109 (63%) cases on the left : perfusion to the affected side absent perfusion to the affected side absent Management : of complications Management : of complications [...]... (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)... 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 . Post tubercular Post tubercular sequelae sequelae Complications/ Complications/ sequelae sequelae Pulmonary. pulmonale pulmonale TB relapse TB relapse Pyogenic Pyogenic abscess abscess Tubercular Tubercular endobronchitis endobronchitis & & tracheitis tracheitis Extrapulmonary Extrapulmonary Pleural