What are the sequelae of tuberculous pleurisy?

If tuberculous pleurisy is not treated thoroughly, it will cause a series of sequelae, such as encapsulated effusion, pleural adhesion and thickening, or empyema, which will have a great impact on physical health.

Sequelae of tuberculous pleurisy--encapsulated effusion

1. Encapsulated effusion secondary to pleural exudative effusion. Pleural exudative effusion often occurs within the first six months of primary infection. The onset can be acute or slow. High fever may occur initially, with body temperature reaching 38-40℃, which subsides to low fever after 1-2 weeks, accompanied by symptoms such as chest pain, cough, shortness of breath, fatigue and weakness.

2. Once the amount of fluid accumulates, the patient's chest pain will gradually disappear. Examination showed limited respiratory movement on the affected side, displacement of the trachea and heart to the opposite side, solid sounds on percussion, and decreased breath sounds on auscultation. If a thoracocentesis is performed, the pleural effusion extracted is mostly straw-yellow exudate; Mycobacterium tuberculosis can be found in the pleural effusion, but the positive rate is not high.

3. On the tangential X-ray film, encapsulated effusion often appears as a semicircular or flat-hilled shadow protruding from the chest wall to the lung field, with an obtuse angle between the upper and lower edges and the chest wall, uniform density and clear edges.

Sequelae of tuberculous pleurisy--pleural adhesion and thickening

1. Pleural adhesion and thickening caused by tuberculous pleurisy is often a sequelae of improper treatment of pleural effusion.

2. When the pleural effusion in the patient's chest is not treated promptly and effectively, the fibrin in the effusion will slowly settle on the pleura, causing the pleura to gradually thicken. As fibrin continues to deposit, the thickness of the two layers of pleura will continue to increase, gradually compressing the gap between the two layers of mucosa until they adhere together.

3. If there is proliferation of granulation tissue in the pleural cavity, it will also lead to continuous thickening of the pleura, development in opposite directions, and finally adhesion.

Sequelae of tuberculous pleurisy--empyema

1. Empyema caused by tuberculous pleurisy includes two different manifestations: acute empyema and chronic empyema.

2. Patients with acute empyema have chills and high fever, with a pattern of fluctuating fever and chills, as well as symptoms of severe chest pain, chest tightness, shortness of breath, and cough. There are signs of pleural effusion in the affected chest, and the local chest wall skin may be red, swollen, hot, and tender. Clubbing symptoms may also appear within 2-3 weeks.

3. Routine blood examination may show an increase in white blood cell count, often above 15×109/L, with neutrophils as the main component; chest X-ray examination may show the presence of pleural effusion, and puncture may show that the effusion is purulent.

4. Patients with chronic empyema have chronic illness appearance, weight loss, pallor, anemia, persistent fever, clubbing of fingers (toes), as well as local manifestations such as cough, sputum, shortness of breath, chest tightness, chest pain, chest wall depression, and limited movement.

5. Chest X-ray examination shows pleural thickening on the affected side, collapsed chest cage, squeezed ribs, and elevated diaphragm.