| CLINICAL OBSERVATION ON TUHEUCULOMA OF THE LUNG |
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Hyo Keun Lee |
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Chest Clinic, Yonsei University College of Medicine, Seoul, Korea |
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| Abstract |
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There is still a difference of opinion of what type and what size of tuberculous lesion should be termed a tuberculoma. In this paper the criteria for selection of tuberculoma were (1) a circumscribed solitary intra- pulmonary lesion 1.0 to 5.0 centimeters in diameter, (2) spheroid of ovoid shape, (3) contour smooth or slightly irregular with definite borders, (4) not cavitated, (5) no intrapulmonary lesions other than the solitary lesion or lesser amount, if any. Efforts are made to rule out the resembling diseases such as tumors, cysts and other granulomas. Among 1879 cases of pulmonary tuberculosis observed at Severance Hospital and Seoul City Hospitals there were 69 cases, or 3.7 percent, of tuberculoma fitting the above criteria. The ages ranged from 16 to 56 years with average age 24.7 years. All cases were treated with INH alone or combined with other major drugs for more than 6 months. They were observed for 1 to 5 years with average 2 years and 4 months. The size of tuberculomas varied from 1 to 5 centimeters in diameter, with 1~2 cm. in 60.9 percent, 2~3 cm. in 29.0 percent. Tuberculomas were mainly situated in the upper part of the lungs (Upper third 72.5% : Lower third 2.9%), and more in the right lung than in the left (Right lung 58.0% : Left lung 42.0%). Fourty-seven cases, or 68.1 percent, had no contributory symptoms and the remaining 22 cases had pulmonary symptoms which were thought related to the solitary pulmonary nodules. In four cases the tuberculomas were formed as an inspissated cavity and in another 4 cases by an absorption of perifocal infiltration. In the remaining cases it was unable to observe how the tuberculomas were formed. In 13 cases, or 18.9 percent, the sputum was positive for tubercle bacilli by microscopy of culture. Most of the tuverculomas remained unchanged during the period of observation. Only in 5 cases, or 7.2 percent, the lesions disappeared; in 5 cases reduced in sizes; in 7 cases, or 10.1 percent, the lesions reactivated forming cavities. Changeability of the lesions was closely related to the size of lesions, the larger the more frequent changes either progressive or retrogressive. It is noted that break down of the lesion forming cavity is also one of healing step. It is suggested that tuberculoma cases should have chest X-ray examination every 6 months to detect change of the leison in an early stage and resection is safer measure when the lesion is larger than 2~3 cm. in diameter. |
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