系统病理学 (31)vv系统病理学.pdf

Pulmonary Tuberculosis n Review Ø Etiology: My cobacterium tuberculosis (aerobic) Ø Transmission: Inhale - lungs Ø Pathogenesis: Type IV hypersentivity Ø Morphology: Epithelioid granuloma Ø Consequences: Healing and depravation n Clinical case n Types Ø Primary pulmonary tuberculosis in the first infected or non-immunized individual Ø Secondary pulmonary tuberculosis in the previously sensitized host n Morphology ØGhon focus ØInflammatory lymphatic vesslels ØEnlarged regional lymph nodes n Consequences n Reservoir of mycobacteria Ø Primary complex Ø Reactivation of dormant primary lesions Ø Reinfection n Morphology Compared with primary type Ø Initial lesion: The apex of one or both upper lobes Initial lesion vs the lower part of the upper lobe Ø Cavitation: important reservoir of the bacilli Dissemination along airway vs spread by blood stream Cavitation n Spread by airways 1. Focal TB 2. Infiltrative TB 3. Chronic cavitary fibrocaseous TB 4. Tuberculoma 5. Caseous pneumonia 6. Tuberculosis pleurisy n Systemic miliary tuberculosis n Extrapulmonary tuberculosis 1. Tuberculous meningitis 2. Tuberculosis of intestine with mesenteric lymph nodes 3. Intestinal tuberculosis 4. Epididymis tuberculosis 5. Renal tuberculosis 6. Pott disease n Clinical features Ø Systemic features malaise, weight loss, night sweats, low-grade fever Ø Pulmonary manifestations Hemoptysis and pleuritic pain, chest X-ray Ø Extrapulmonary manifestations n Clinical features Ø Diarrhea, palpable mass -intestine Ø Infer