Tuberculous pleurisy

An overview of the body in a state of high sensitivity of TB and its metabolites in the pleural inflammatory response, is the primary or secondary tuberculosis involvement of the pleura, the body due to different reaction, Clinical be dry and pleurisy two conditions. A diagnosis. History, symptoms : rapid onset may flu, with fever, cough, chest pain, effusion have more difficulty in breathing and shortness of breath, some are night sweating, weakness, anorexia and other symptoms. 2. Medical examination found : dry pleurisy ipsilateral respiratory movement is restricted, with local tenderness, touching pleural friction flu, auscultation pleural friction sound. Exudative pleural effusion more pleurisy, the ipsilateral thorax satiated and intercostal space widened, respiratory movement, weakened language chatter, trachea and heart to the contralateral displacement, liquid level is attending voiced deduction, breath sounds weakened or disappeared, on the plane before it bronchoalveolar lavage breath sounds, the occasional sound of small blisters. Right pleural effusion liver voiced sector disappeared. For pleurodesis hypertrophy local thoracic subsidence, the respiratory movement restricted deduction attendance voiced, breath sounds weakened. 3. Supplementary examination : (1) X-ray : dry pleurisy ipsilateral only costophrenic angle changes Kingston, pleurisy moderate effusion can be seen over large dense shadow, the upper edge is outside inwards from the arc, costophrenic angle disappeared, diaphragm and cardiac impact unclear. Effusion large mediastinal shift to the contralateral, intercostal space broadens, the diaphragm down. (2) Ultrasonic Inspection : pleural effusion can understand quantity and pleural puncture site, and identification of pleural effusion pleural thickening. (3) Other inspections : white blood cell counts and neutrophils can be increased erythrocyte sedimentation rate, increasing fast. Pleural effusion check for more grass yellow exudate, for a few bloody effusion. 4. Differential Diagnosis : dry pleurisy with intercostal neuralgia, epidemic muscle pain as well. Pleurisy with rheumatic disease and malignant pleural effusion caused by the differential phase. Malignant pleural effusion and tuberculous pleural effusion in differentiating malignant pleural effusion tuberculosis old age was mostly young people was mostly effusion cell types a large number of mesothelial cells lymphocyte predominance, mesothelial cells "5% pathological examination of tumor cells can be found in tumor cells without PH 7.30" 7.40 "(" 7.3 suppurative) hyaluronidase "0.8 g / L (mesothelial cell carcinoma)" 0.8 g / L of lactate dehydrogenase (L DH) bands increased, pleural effusion LDH / serum LDH "2.0 el anterior, five increased, pleural effusion LDH / serum LDH "lysozyme 2.0 pleural fluid dynamic (LIM)" 65ug / L, pleural effusion LIM / serum LIM "a" 65UG / L, pleural effusion LIM / serum LIM "a carcinoembryonic antigen (CEA)" ug / L, pleural effusion CEA / serum CEA "a" ug / L, pleural effusion CEA / serum CEA "a PPD skin test negative over a more positive treatment. Principle is the treatment and prevention of tuberculosis after the fat and eliminate the symptoms prevent pleurodesis Anti-tuberculosis treatment can be the beginning of the program with tuberculosis as INH 0.3 / d, 0.45 RFP / d, EMB 0.25 3 times / d or 0.5 pyrazinamide 3 times / d. 2. More than moderate pleural effusion weekly thoracic fluid pumping 2 ~ 3 times. each 600-1000ml extract speed but not too fast to prevent reexpansion pulmonary edema. 3. Serious symptoms of poisoning, exudative pleural effusion may increase too rapidly with strong pine 20 ~ 30 mg / d, pleural effusion reduce symptoms relieved after a week reduced 2.5-5.0mg.