Cavitating pulmonary tuberculosis: gross pathology
Died in hospital of unrelated cause
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Postmortem examination of lungs
There is prominent scarring and cavitation, predominantly affecting the apical aspect of the right lung, along with background mild pneumonic consolidation.
These macroscopic changes are related to ongoing tissue damage at a microscopic level (caseous necrosis) with resulting parenchymal scarring and cyst formation.
The apical aspects of the lung are more commonly affected; this may be related to higher oxygen tensions or impaired tissue clearance mechanisms (1)
Cavitating pulmonary TB: Extensive necrosis with cavitation, usually occurring in the upper lung or apex, is a characteristic feature of "secondary" or "adult type" tuberculosis. This is probably related to persistence of M. tuberculosis from a prior primary infection. Cavities form when necrosis involves the wall of an airway and the semi-liquid necrotic material is discharged into the bronchial tree from where it is usually coughed up and may infect others. This infected material may seed other parts of the lung via the airways to produce a tuberculous bronchopneumonia. If swallowed, infection of the G.I. tract may result. Communication of the centers of the tuberculous lesions with the airway exposes the bacteria to a high concentration of oxygen and promotes their proliferation. The risk of spread of infection to non-infected persons from individuals with cavitary tuberculosis is very high.
Author: Yale Rosen, M.D.
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- 1. Goodwin RA, Des Prez RM. Apical localization of pulmonary tuberculosis, chronic pulmonary histoplasmosis, and progressive massive fibrosis of the lung. Chest. 1983 May;83(5):801-5.