Diverse Cavity Types and Evidence that Mechanical Action on the Necrotic Granuloma Drives Tuberculous Cavitation

The American Journal of Pathology
Elizabeth A IhmsWilliam R Bishai

Abstract

Effacement of normal lung parenchyma by cavities is an important sequela of pulmonary tuberculosis. Despite its clinical significance, the pathogenesis of tuberculous cavitation is poorly understood, with controversy as to whether the fundamental mechanism involves matrix depletion, lipid pneumonia, or mechanical factors. In this study, a repetitive aerosol infection model using Mycobacterium tuberculosis was used to generate cavities in 20 New Zealand white rabbits. Serial computed tomography was performed to monitor cavity progression over 14 weeks. Three-dimensional reconstructions were compiled for each time point, allowing comprehensive four-dimensional cavity mapping. Terminally, cavities were processed for histopathology. Cavities progressed rapidly from areas of consolidation, and often showed a pattern of explosive growth followed by gradual contraction. Cavities formed preferentially in the caudodorsal lung fields, and frequently were subpleural. Cavitation was associated invariably with necrosis. Histomorphology showed four distinct cavity types that provide mechanistic clues and insight on early cavity development. Our study shows that cavitation is a highly dynamic process with preferential formation at sites of hi...Continue Reading

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Citations

Dec 11, 2020·The Journal of Clinical Investigation·Bidisha BhattacharyaIgor Kramnik
Dec 10, 2020·Respiratory Medicine Case Reports·Hitomi NogawaShigeharu Ueki
Jun 3, 2020·The Lancet Infectious Diseases·Michael E UrbanowskiWilliam R Bishai
May 1, 2021·International Journal of Molecular Sciences·Radha Gopalaswamy, Selvakumar Subbian
May 25, 2021·Biofouling·Esmeralda Ivonne Niño-PadillaAdriana Garibay-Escobar

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