By Edward W. Humphrey M.D., Ph.D., Deanne Lawrence McKeown (auth.)
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Extra info for Manual of Pulmonary Surgery
Sample text
If widespread pleural involvement producing a tuberculous pleural effusion occurs, it is soon after the primary infection, at a time when radiologic evidence of pulmonary parenchymal involvement is usually absent. For this reason, tuberculosis must be suspected in all unexplained exudative pleural effusions. Life-threatening hemorrhage occurs occasionally in patients with extensive cavitary disease and seems to happen soon after the onset of therapy. Because life-threatening complications may occur following a pulmonary resection, it is as important for a surgeon to refrain from operating on an untreated patient with active tuberculosis as it is to operate on a patient with a carcinoma that mimics tuberculosis.
Its principal interest to the thoracic surgeon is its ability to mimic carcinoma. In the lung it causes a chronic inflammation with dense fibrosis and may extend through the chest wall, destroying ribs and producing chronically draining sinus tracts. Surgery is infrequently required for an empyema or for chest wall disease, the treatment of choice is high-dose penicillin therapy continued for one to three months. Bacterial Pneumonias Antibiotic therapy is the primary treatment for bacterial pneumonias, but occasionally certain organisms, such as a Klebsiella, that are characterized by the production of numerous small cavities, will not respond well to antibiotic therapy and will spread to the opposite lung by transbronchial aspiration.
0 cm distal to the carina. 0 cm distal to the carina; or any tumor associated with atelectasis or obstructive pneumonitis of an entire lung or pleural effusion Nodal involvement (N) No No demonstrable metastasis to regional lymph nodes Nl Metastasis to lymph nodes in the peribronchial or the ipsilateral hilar region, or both, including direct extension. N2 Metastasis to lymph nodes in the mediastinum Distant metastasis (M) Mx Not assessed Mo No (known) distant metastasis Ml Distant metastasis present risk of malignancy in the nodule.