From January 1990 through June 1995, we operated on 121 patients who were suspected for pulmonary tuberculosis without definite final diagnosis.
After operation the final pathologic diagnoses were as follows:68 pulmonary tuberculosis in which 29 were tuberculoma, 23 lung cancer, 16 bronchiectasis, 6 aspergilloma, 2 lung abscess, 2 benign cyst and 4 others.
In 121 cases, 81 were male and 40 were female and the peak age incidence was 4th decade in tuberculosis(39.7%)and 6th and 7th decade in lung cancer(69.6%).
The diagnoses in 44 cases presented roentgenographically as pulmonary nodules were pulmonary tuberculosis(29 cases) and lung cancer(15 cases). Tuberculous nodules tended to be smaller in size with calcification and satellite lesions compared to
carcinomas.
Indications for operation were solitary nodules 44 cases (36.4%); destroyed lobe 31(25.6%); hemoptysis 25 (20.7%);cavitary lesion ll(9.1%); bronchostenosis 3 (2.5%); destroyed lung 5(4.1%) and destroyed lung with empyema 2(1.7%).
We conclude that preoperatively suspected pulmonary tuberculosis should be distinguished from various pulmonary lesions such as carcinoma, bronchiectasis, aspergilloma, lung abscess and benign cyst, For the possibility of carcinoma, pulmonary
nodules of
size greater than 3cm, non-calcified, non satellite lesion, newly developed nodule even under the anti-tuberculous medication, negative PPD skin test with elevated CEA level are recommended for an early resectional surgery and follow-up and
delayed
surgery is recommended in cases such as pulmonary nodules less than 3 cm in size with calcification, satellite lesion, positive PPD skin reaction and elevated ESR, CRP, ALP levels.
|