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• W2075750813 abstract "Tuberculous cavities probably represent the most important feature of pulmonary tuberculosis. Without cavitation, tuberculosis can be a benign disease; with cavitation it must be regarded as a serious and progressive malady. Closure of cavities is the primary aim of all forms of medical and surgical therapy. An understanding of the mechanisms whereby tuberculous cavities heal promotes a better grasp of the roentgen manifestations of such healing. This in turn facilitates the handling of the individual patient. The following cases, culled from a large material at the Eagleville Sanatorium, Eagleville, Penna., and from private practice, serve to illustrate the important mechanisms in cavity closure. Tuberculous cavities heal by two general processes, open and closed, the particular designation depending upon the status of the draining bronchus (4). In the open form of healing the lumen of the draining bronchus remains patent, the walls of the cavity become free of tubercle bacilli, usually in response to some form of therapy, and the cavity wall undergoes fibrosis with subsequent epithelialization with squamous or columnar epithelium. This leads to a residual saccule opening into a bronchus, a type of saccular bronchiectasis. Case I serves to illustrate open healing. Case I (Fig. 1): W. A., a 55-year-old white male, had a history of tuberculosis dating back to 1936. In 1947 he was classified as having chronic far advanced disease with strongly positive sputum. X-ray examination on Feb. 10, 1949, revealed a cavity 4 cm. in diameter in the apex of the right lower lobe with disseminated fibronodular infiltrations in the upper lobes. Tubercle bacilli were present in the sputum. The patient was maintained on bed rest and a regimen of streptomycin and PAS, with excellent response. He became afebrile, and tubercle bacilli disappeared from the sputum. X-ray examination on May 2, 1950, showed considerable shrinkage in the size of the cavity and marked thinning of the walls. The pericavitary infiltration had resolved. Repeated sputum examination and cultures were negative, and comparative roentgenograms remained essentially unchanged in appearance. Recognition of the openly healed cavity is not difficult if one has the advantage of clinical data and serial films. Systemic symptoms subside, the sputum becomes negative, the cavity becomes thin-walled because of regression of the pericavitary inflammatory reaction, and finally the fibrous walls contract. From the roentgen appearance alone, these healed cavities can not be distinguished from active cavities or even from other disease associated with cavitation. In the closed type of healing, the draining bronchus becomes firmly occluded and the cavity either undergoes atelectasis and scar formation, so called atelectatic closed healing, or the cavity becomes inspissated." @default.
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• W2075750813 date "1954-10-01" @default.
• W2075750813 modified "2023-09-24" @default.
• W2075750813 title "Healing Mechanisms of Tuberculous Cavities" @default.
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• W2075750813 doi "https://doi.org/10.1148/63.4.544" @default.
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