Guard against the merger of tumor tuberculous empyema
Case I: Liu, M, 62 years old, 40 years ago, suffering from the left side of tuberculous pleurisy, the non-formal anti-TB treatment, his condition improved, there is no obvious discomfort, not the regular review. The last two months, chest pain, cough, expectoration and fever a week. Chest X-ray and CT scan found that the original side pleural thickening obviously, calcification, the emergence of a soft side of the lung tissue, with each successive transitional empyema wall, to break into the lungs, uniform density, smooth edge. More than hospital diagnosis of chronic tuberculous empyema recurrence, to be anti-TB treatment, and no effect after surgery, pathological diagnosis: malignant pleural mesothelioma. When the body has been transferred.

Case II: Lee, F, 65 years old, 50 years ago, suffering from tuberculosis pleurisy on the left side, after the anti-tuberculosis "cure", side thorax collapse, and no other symptoms, very few medical review. Before July persistent fever for several days. Chest X-ray and CT scan also showed that the pleural thickening and calcification, which appeared under the rear of a soft tissue mass, with each successive transitional empyema wall, low-density centers, where calcification shadow line shift, disperse, absorb and break. By chronic tuberculous empyema be anti-TB relapse, his condition had improved, but instability in February after the CT review, see little change, after the May re-fever, CT examination revealed that the original tumor growing number of hospital again Consultation, diagnosis of TB is still also believe that some tumors may be very tuberculosis combined, the proposed operation. Pathological diagnosis: malignant lymphoma.

2 above cases I see in clinical practice, they have seen many doctors, many of them highly specialized technical experts, but why early diagnosis is still not able to do? After looking for, I found that on the domestic "chronic tuberculous empyema merger malignant" There are reports of fresh, so they continue to look abroad to read the relevant information, feel quite harvest. After translation, the name of "health" was published, forward, with the majority of the peer mutual encouragement and hope our due attention and vigilance.

Documented, acute tuberculous pleurisy by the regular and thorough anti-TB cured after more than can absorb, especially since the implementation of intensive therapy, the better effect. However, some patients especially in the early years of anti-TB treatment is not completely irregular, or TB resistance, and more able to develop into a chronic tuberculous empyema, pleural affected significantly hypertrophy, adhesion, and calcification, the empyema cavity are still crowded Thick pus and no vitality of the TB patients generally asymptomatic or mild symptoms. In many suffering from tuberculous empyema 20 to 50 years, as age increased, decreased immunity, empyema reburning can be merged or malignant, can occur at this time chest pain, cough, hemoptysis, chest pain, Fever. Liu, Li This is the case in two.

We are, however, chronic tuberculous empyema merger cancer awareness of tuberculosis as well as familiar with the merger of lung cancer. Mind the lack of adequate vigilance, and even some professional doctors often misdiagnosed as such a situation simply tuberculosis, long-term anti-TB treatment until the seizure sputum, biopsy, surgery or autopsy when the truth. Liu and Li received the two anti-TB treatment 2 months and 7 months. This is a sad and regrettable.

  A variety of malignant tumors may be chronic tuberculous empyema of the late complications, of which the most common malignant lymphoma, followed by vascular sarcoma, squamous cell carcinoma and malignant mesothelioma, rhabdomyosarcoma, liposarcoma, and malignant fibrous histiocytoma, etc. . It's not determine the cause, but there are several theories that chronic inflammation is the most important factor. So that the chronic stimulation of empyema intramural cholesterol into a strong carcinogen, which is complicated by chronic osteomyelitis and sinus fistula skin cancer quite similar. Animal experiments have proved that the calcium Chronic stimulation can be induced mesothelioma. Malignant lymphoma and auto-immune mechanisms, like Sjogren's syndrome, rheumatoid arthritis, chronic lymphocytic thyroiditis merger as lymphoma.

Chronic tuberculous empyema merger malignant tumor found in males, clinical performance of the non-specific. Once a clinically early TB patients, the recent chest, shoulder pain, breathing difficulties, cough, hemoptysis, fever, and chest wall pain, we must think of "the sick may be a new issue" and not always easy to consider Tuberculosis is a relapse. First of all, patients should be allowed to do imaging, including chest X-ray, CT, MRI, so as to strive for early diagnosis and treatment.

Is the patient's chest X-ray screening checks for the future treatment is the key to the merger of malignant tumors in patients with tuberculous empyema of the chest are usually the following special performance. Side increased the density of the chest, even though tuberculous empyema itself will also be increased density, but the merger of the tumor, the tumor tissue as a result of superposition, the density will be higher. Bulging soft tissue, when the tumor to the development of the chest wall, in the chest can be seen on the bulging tumor shadow. Chest wall fat interface clear, simple tuberculous empyema will not affect the chest outside the imaging performance, and the tumor after the merger, due to the infiltration of the tumor, chest wall fat interface blurred. Rib damage or swelling, caused by tuberculosis occasionally periosteal proliferation, but the tumor after the merger, the enlargement of the ribs will be more evident in the literature that was even spindle. Pleural calcification shadow displacement, disruption of the past, patients with chest X-ray contrast, the tumor because of the pressure, absorption, calcification of the new film will be displaced, suspended for the final diagnosis of great significance. Empyema cavity fluid appears flat, chronic tuberculous empyema patients with chest re-emergence of flat liquid, usually prompted by the merger of acute infection, such as necrosis, of course, should also take into account the possibility of malignancy.