Complications of the tuberculous process
The complications of the tuberculous process are chronicity
and dissemination. These are, of course, interconnected, and the chronicity of
an effusion and the serial involvement of the opposite pleural space often go
hand in hand. Dissemination may be on a limited scale, or it may be
widespread, resulting in miliary tuberculosis, with the picture dominated by
meningitis. Other sites to which dissemination commonly takes place are the
pericardium, the peritoneum and the genito-urinary system. In the unstable and
febrile phase of an effusion, dissemination and acute miliary spread are
ever-present dangers.
Concato's disease—polyorrhomenitis or polyserositis—in which there is
effusion in both pleurae, the peritoneum and the pericardium, is nearly always
of tuberculous character. Rare cases are met with in which the condition
remains quite unexplained.
Complications
of the effusion
The fact of the presence of fluid carries with it the
risk of secondary infection, either endogenous in intercurrent disease, or
exogenous. Pleural thickening and adhesions are not uncommon sequels of
uncomplicated effusion, and sometimes marked pleural calcification develops in
the course of time. Mechanical hydrostatic disturbances may result from the
fact of the presence of fluid. As is mentioned elsewhere, redistribution of the
fluid, by adjustment due to movement within the thorax, may take place in the
natural course of events, or during aspiration. If the redistribution is rapid,
changes may ensue in the aeration of large districts of the sound lung, or in
the pulmonary circulation with resulting oedema of the lungs. The gravity of
either of these events or of a combination of them cannot be over-emphasized.
