Daily Archive 19.11.2019

Tuberculosis of the intrathoracic lymph nodes (Bronchoadenitis)

Tuberculous bronchoadenitis can occur as without pronounced symptoms, i hk and with obvious symptoms of tuberculous intoxication. In modern conditions, “small forms” of tuberculosis of the intrathoracic lymph nodes are increasingly observed. They are determined by the main OSROM during tomographic examination. Their clinical symptoms are scarce. Bronchoadenitis can be infiltrative and tumor-like. Infiltrative forms of bronchoadenitis usually occur with severe signs of intoxication, with a prolonged increase in temperature from 37.5 to 38 ° and higher, complaints of dry cough, which is sometimes bitonal (pertussis-like) due to compression of large bronchi. Tuberculous bronchoadenitis can be accompanied by pleurisy, often interlobar. In the presence of enlarged tumor-like lymph nodes, a violation of bronchial obstruction may occur as a result of compression of the bronchus from the outside or as a result of a breakthrough of the caseous contents of the lymph node into the lumen of the bronchus (bronchofistulosis syndrome) with the formation of atelectasis and bronchogenic seeding.

Diagnosis of bronchoadenitis

Recognition of bronchoadenitis requires a comprehensive clinical and radiological examination, taking into account anamnestic data, the nature of tuberculous intoxication, the presence of severe tuberculin reactions. Often, an incorrect assessment of radiological data entails overdiagnosis of these forms of tuberculosis.
The most convincing for the radiological diagnosis of bronchoadenitis are data from a tomographic study of the roots of the lungs. Changes in the roots of the lungs have to be differentiated mainly from lymphogranulomatosis, malignant neoplasms in the mediastinum, Beck sarcoidosis. In typical cases with bronchoadenitis, dullness of percussion sound in the interscapular space at the level of IV-V thoracic vertebrae (Korani symptom) and in the parasternal region can be determined.
During auscultation, altered breathing, scanty rales in the interscapular space and at the angle of the scapula are established.
Blood changes are expressed in accelerated ESR, a neutrophilic shift to the left. The white blood cell count is usually either normal or slightly increased. Accelerated ESR in combination with a pronounced tuberculin breakdown indicates the continued activity of the process. When bronchoadenitis has lost activity, changes in the blood, like tuberculin tests, are normalized. An X-ray examination in these cases reveals compaction of the lymph nodes and their petrification.
Tuberculous mycobacteria are usually detected with infiltrative bronchoadenitis, a breakthrough of the caseous lymph node in the bronchus – bronchofistulous forms (often in old age), and specific damage to the bronchial pathways. Mycobacterium tuberculosis is more often found in the study of bronchial lavage by sowing or flotation.
Patients with active tuberculosis of the intrathoracic lymph nodes need long-term treatment in a sanatorium using antibacterial drugs, and in some cases, surgical removal of caseous degenerated large lymph nodes. They need constant monitoring of the dispensary and treatment until a lasting clinical cure is established.