Pseudotubercular nodules

Introduction Pseudotubercle : A disease caused by eggs in schistosomiasis. Acute egg nodule is an acute necrotic and exudative lesion caused by mature eggs. After 10 days of acute egg nodules, the trichomes die, the eggs and necrotic substances are cleared, absorbed or calcified. The macrophages in the lesions are transformed into epithelioid cells and foreign body multinucleated giant cells, forming granules similar to tuberculous nodules. Swollen, known as pseudotuberculous nodules, that is, chronic egg nodules. Due to repeated infections, the females continue to lay eggs, and the eggs are deposited in the intestinal wall in batches, and the lesions are old and new. There is a possibility of canceration on the basis of fiber thickening, chronic ulcers, and polyp formation.

Cause

It is a lesion caused by eggs in schistosomiasis. In addition to deposits in the rectum, sigmoid colon, ascending colon, appendix, ileum and liver, the eggs can be found in the mesenteric and retroperitoneal lymph nodes, lungs and brain. The pathological changes caused by the eggs deposited everywhere are basically similar, and the latter have acute and chronic points.

Intestinal lesions caused by schistosomiasis are generally within the range of the distribution of the inferior mesenteric vein. The colon, especially the rectum, descending colon and sigmoid colon, is prominent, and small intestinal lesions are rare, only in severe patients. In the acute phase, the intestinal mucosa is red and swollen, with acute catarrhal inflammation, scattered punctate hemorrhage and superficial small ulcer. Microscopic observation of mucosal and submucosal egg granuloma (acute phase).

The mucosa is necrotic and shedding, forming a superficial ulcer, and the eggs fall into the intestinal lumen. Clinical symptoms such as abdominal pain, diarrhea, blood in the stool, and eggs can be detected in the feces. In the chronic phase, mild infection, the intestinal connective tissue is slightly hyperplasia, clinically usually asymptomatic. In severe cases, the lesions are more extensive, the affected colon is thickened, the intestinal mucosa proliferates in granular form, and even forms polyps; or mucosal atrophy and mucosal folds disappear. Between the hyperplasia and the atrophic intestinal mucosa, there is a shallow gray ulcer with dirt gray. In addition, a small amount of gray-yellow acute egg nodules can be seen. In severe chronic schistosomiasis, the colon wall is extensively thickened by diffuse fibrosis, and the mesentery of the lesion is also thickened with fibers, and the two form a mass together.

Due to repeated infections, the females continue to lay eggs, and the eggs are deposited in the intestinal wall in batches, and the lesions are old and new. There is a possibility of canceration on the basis of fiber thickening, chronic ulcers, and polyp formation.

an examination

Related inspection

Plasma cell membranous effusion protein plasma cytoplasmic effusion pathogen serosal effusion glucose

Liver lesions caused by schistosomiasis are early hepatomegaly, and miliary yellow particles (worm nodules) are visible on the surface. In the late stage, due to the proliferation of a large number of fibrous tissues around the branch of the portal vein, the liver becomes hard and shrinks, and there are nodules of different sizes on the surface, forming schistosomiasis cirrhosis. The establishment of portal collateral circulation makes the lower esophageal vein and gastric fundus varices, spleen Portal hypertension and congestion and swelling can cause hypersplenism. The ectopic damage caused by schistosomiasis is most common in the lungs and brain. Miliary nodules and exudative inflammation around the nodules can be seen in the lungs, and egg nodules and glial cell hyperplasia can occur in different stages of the brain.

Differential diagnosis

The clinical symptoms of pseudotuberculosis were mainly cough, shortness of breath and low fever. The images showed nodular shadows on both lungs, and a small amount of effusion in the right thoracic cavity. The PPD skin test was positive, and the pleural fluid tuberculosis antibody was strongly positive.

Patients with pseudotuberculosis sarcoidosis originated from schistosomiasis-affected areas and contact with infected water: The miliary shadows of disseminated pulmonary tuberculosis are evenly distributed, uniform in size, uniform in density, and different from the characteristics of schistosomiasis; blood counts and white blood cell counts The percentage of eosinophils increased significantly, and positive stool incubation was the key point for identification. When the disease is suspected, you should consult a specialist in the parasitic control department or take a diagnostic treatment.

Liver lesions caused by schistosomiasis are early hepatomegaly, and miliary yellow particles (worm nodules) are visible on the surface. In the late stage, due to the proliferation of a large number of fibrous tissues around the branch of the portal vein, the liver becomes hard and shrinks, and there are nodules of different sizes on the surface, forming schistosomiasis cirrhosis. The establishment of portal collateral circulation makes the lower esophageal vein and gastric fundus varices, spleen Portal hypertension and congestion and swelling can cause hypersplenism. The ectopic damage caused by schistosomiasis is most common in the lungs and brain. Miliary nodules and exudative inflammation around the nodules can be seen in the lungs, and egg nodules and glial cell hyperplasia can occur in different stages of the brain.

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