A young man with tuberculosis presents with massive recurrent hemoptysis. For angiographic treatment which
vascular structure should be evaluated first. (AIIMS May 2009 & LQ)
|D||Superior vena cava|
Sources of Bleeding in Hemoptysis
1). Bronchial Arteries: Most common source of Bleeding in Hemoptysis (>90% cases)
2). Pulmonary Arteries: Uncommon source of bleeding in hemoptysis (<10% cases)
Causes of hemoptysis in TB
1). Rupture of dilated vessel in a cavity (Rasmussen’s aneurysm) (AIIMS May 2008) It is of pulmonary artery in origin. (Ref. Hari-18thed., Pg 1345)
2). Erosion of vessel
3). Aspergilloma formation in an old cavity
Extra Edge: Commonest source of hemoptysis in TB is from rupture of bronchial artery.
Extra Edge - Treatment of TB in special situation:
1). Pregnancy with TB = H, R, E (S and Z are contraindicated)
2). Jaundice with TB = S, E (H, R, Z are contraindicated)
3). CRF with TB = R full dose, H half dose daily, E half dose twice a week only.
(S and Z are contra indicated in end stage renal failure).
Note:In mild to moderate renal failure, H, R, Z may be given in the usual doses (Ref. Hari 18th ed., pg. 1356)
Extra Edge - Indications of Corticosteroids in TB –
2). Addison’s crisis
3). Seriously ill pt. before chemotherapy is effective
4). Pericardial, pleural effusions
5). Genitourinary TB
6). Choroid retinitis
Extra Edge – Indication of Higher dose of Pyridoxine in TB
3). Pregnant /lactating mother
6). HIV, AIDS
Extra Edge - Indications of Surgery in TB
1). Massive hemoptysis
2). Empyema → chest tube.
3). MDR TB with localised disease