Tracheal mediastinum and heart displacement to the unaffected side

Introduction The tracheal mediastinum and the shift of the heart to the healthy side are clinically diagnosed symptoms of tuberculous pleurisy. Tuberculous pleurisy is an exudative inflammation caused by tuberculosis directly invading the pleura from the primary lesion of the proximal pleura, or spreading to the pleura via lymphatic blood. Most of the tuberculous pleurisy in children in China is caused by human tuberculosis. Mycobacterium tuberculosis has strong resistance. In addition to acid, alkali and alcohol resistance, it has strong tolerance to cold, heat, dryness, light and chemicals.

Cause

Tuberculous pleurisy is a disease caused by Mycobacterium tuberculosis invading the body for the first time. There are 4 types of Mycobacterium tuberculosis: human, bovine, bird and mouse. Those who are pathogenic to the human body are human tuberculosis and tuberculosis. Most of the tuberculous pleurisy in children in China is caused by human tuberculosis. Mycobacterium tuberculosis has strong resistance. In addition to acid, alkali and alcohol resistance, it has strong tolerance to cold, heat, dryness, light and chemicals.

The pathways leading to tuberculous pleurisy are:

1 The lymphatic tuberculosis bacteria flow back to the pleura through the lymphatic vessels.

2 Tuberculosis lesions adjacent to the pleura rupture, so that the products of tuberculosis or tuberculosis infection directly into the pleural cavity.

3 acute or subacute hematogenous disseminated tuberculosis caused by pleurisy.

4 The body's allergicity is high, and the pleura is highly responsive to tuberculosis toxins.

5 thoracic tuberculosis and rib tuberculosis collapsed into the pleural cavity. Because needle pleural biopsy or thoracoscopic biopsy has confirmed that 80% of tuberculous pleurisy has a typical TB pathological change in the parietal pleura. Therefore, the direct involvement of Mycobacterium tuberculosis in the pleura is the main pathogenesis of tuberculous pleurisy.

an examination

Related inspection

Bronchoscopy tracheal shift examination

Most tuberculous pleurisy is an acute disease. The symptoms are mainly manifested by systemic symptoms of tuberculosis and local symptoms caused by pleural effusion. Symptoms of tuberculosis are mainly fever, chills, sweating, fatigue, loss of appetite, and night sweats. Local symptoms include chest pain, dry cough, and difficulty breathing. Chest pain is mostly located in the anterior or posterior tibial line of the thoracic respiratory movement, which is sharp pain, which is aggravated by deep breathing or coughing. As the pleural effusion gradually increases, the chest pain gradually decreases or disappears after a few days. Stimulation of the pleural effusion can cause a reflective dry cough, which is more pronounced when the position is rotated. When the amount of fluid is small, only chest tightness, shortness of breath, and a large amount of hydraulic pressure on the lungs, heart and mediastinum may cause difficulty in breathing. The faster and more effusions are produced and accumulated, the more obvious the difficulty in breathing, and even the sitting breathing and cyanosis.

Signs are related to the amount of fluid accumulated and the location of accumulation. Chest signs of less effusion or interpleural pleural effusion are not obvious, or pleural friction can be heard early. In the middle of the effusion, the affected side has a slightly convex thorax, the intercostal space is full, and the breathing movement is limited. The trachea, mediastinum, and heart are displaced to the healthy side. The vocal tremor of the affected side is weakened or disappeared, and the voiced sound or the actual sound is diagnosed. Auscultation breath sounds weakened or disappeared, and speech conduction was weakened. As the lungs close to the upper boundary of the pleural effusion are compressed, it can be found that the breath sounds are not weakened but increased during auscultation. If there is pleural adhesion and pleural thickening, it can be seen that the affected side is depressed, the intercostal space is narrowed, respiratory movement is limited, speech tremor is enhanced, percussion is dull, and respiratory sound is weakened.

1, pleural biopsy: acupuncture pleural biopsy is an important means of diagnosis of tuberculous pleurisy. In addition to the feasible pathological examination, the biopsy pleural tissue can also be cultured with tuberculosis. Such as wall pleural granuloma changes suggest the diagnosis of tuberculous pleurisy, although other diseases such as fungal diseases, sarcoidosis, tuaremia and rheumatic pleurisy can have granulomatous lesions, but more than 95% Pleural granulomatous lesions are tuberculous pleurisy. If the pleural biopsy fails to detect granulomatous lesions, the biopsy specimen should be stained with acid, because tubercle bacilli can be found in the specimen by chance. The first pleural biopsy revealed 60% of tuberculous granuloma changes, and biopsy 3 times was about 80%. For example, biopsy specimen culture plus microscopy, the positive rate of tuberculosis diagnosis is 90%. Thoracoscopy can also be used for direct pleural biopsy with a higher positive rate.

2, X-ray examination: When the pleural effusion is below 300ml, there may be no positive findings in the posterior anterior X-ray. When a small amount of fluid is accumulated, the rib angle becomes dull, and the amount of fluid is more than 500ml. In the supine position, the liquid is scattered in the supine cavity, and the sharp rib angle is seen. Can also be affected by lateral recumbent film, showing a strip of shadow on the outer side of the lung. The moderate amount of effusion showed a uniform density increase in the lower part of the chest cavity, and the shadow was covered. The effusion showed a high shadow on the outer side of the upper edge and a curved shadow on the inner side. When a large amount of pleural effusion occurs, most of the lung field is evenly densely shadowed, the shadow is covered, and the mediastinum is displaced to the healthy side.

3, ultrasound examination: ultrasound detection of pleural effusion with high sensitivity, accurate positioning, and can estimate the depth of pleural effusion and fluid accumulation, suggesting the puncture site. It can also be differentiated from pleural thickening.

Differential diagnosis

Let the patient head in the middle position, use the right middle finger to touch the trachea along the sternal notch. The index finger and the ring finger are on the left and right sides of the sterno-lock joint respectively. See if the middle finger is equidistant from the other two fingers, or touch the trachea with the middle finger. The size of the gap between the middle finger and the thoracic mammary muscles on both sides to determine whether the trachea is displaced. Tracheal displacement is important for the diagnosis of chest diseases. When one side of the pleural effusion, gas accumulation or space-occupying new organisms, the trachea is pushed to the healthy side due to increased intrathoracic pressure; when one side of the atelectasis, pleural thickening and adhesion, the trachea is pulled Pull to the affected side.

Mediastinal widening: mediastinal inflammation, hematoma, abscess, paratracheal lymph node, mediastinal tumor and cyst, superior vena cava and azygotic vein dilatation, aneurysm, mediastinal pleural effusion, etc. can widen the mediastinum, combined with clinical and Medical history, if necessary, tomography, angiography and other inspection methods to determine the reasons for the widening.

CT slices of patients with mediastinal nerve sheath tumors can show that the tumor fills the entire thoracic cavity, the mediastinum shifts to the healthy side, the trachea shifts, is compressed or narrowed. Neurogenic tumors are the most common mediastinal tumors in adults and children. The tumors are classified into benign tumors such as schwannomas, melanoma, Schwannoma, granulosa cell tumors and neurofibroma. Malignant tumors have malignant Schwannoma and neurogenic sources. Sarcoma.

Most tuberculous pleurisy is an acute disease. The symptoms are mainly manifested by systemic symptoms of tuberculosis and local symptoms caused by pleural effusion. Symptoms of tuberculosis are mainly fever, chills, sweating, fatigue, loss of appetite, and night sweats. Local symptoms include chest pain, dry cough, and difficulty breathing. Chest pain is mostly located in the anterior or posterior tibial line of the thoracic respiratory movement, which is sharp pain, which is aggravated by deep breathing or coughing. As the pleural effusion gradually increases, the chest pain gradually decreases or disappears after a few days. Stimulation of the pleural effusion can cause a reflective dry cough, which is more pronounced when the position is rotated. When the amount of fluid is small, only chest tightness, shortness of breath, and a large amount of hydraulic pressure on the lungs, heart and mediastinum may cause difficulty in breathing. The faster and more effusions are produced and accumulated, the more obvious the difficulty in breathing, and even the sitting breathing and cyanosis.

Signs are related to the amount of fluid accumulated and the location of accumulation. Chest signs of less effusion or interpleural pleural effusion are not obvious, or pleural friction can be heard early. In the middle of the effusion, the affected side has a slightly convex thorax, the intercostal space is full, and the breathing movement is limited. The trachea, mediastinum, and heart are displaced to the healthy side. The vocal tremor of the affected side is weakened or disappeared, and the voiced sound or the actual sound is diagnosed. Auscultation breath sounds weakened or disappeared, and speech conduction was weakened. As the lungs close to the upper boundary of the pleural effusion are compressed, it can be found that the breath sounds are not weakened but increased during auscultation. If there is pleural adhesion and pleural thickening, it can be seen that the affected side is depressed, the intercostal space is narrowed, respiratory movement is limited, speech tremor is enhanced, percussion is dull, and respiratory sound is weakened.

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