Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Tuberculous Mediastinal Lymphadenitis
- Radiologic Findings
- On chest radiograph (Figuew 1), Bulging opacity at right hilar area is noted.
On pre contrast (Figure 2) and post contrast CT images (Figure 3), an irregular shaped necrotic mass is noted in the anterior mediastinum. Adjacent lung collapse and centrilobular nodules at right upper lobe are also noted (not shown). Multiple necrotic lymph nodes are noted at both neck areas (Figure 4).
- Brief Review
- The patient didn’t have systemic symptoms. But, Tbc PCR and PPD skin test were positive. Lymph node biopsy was done at left supraclavicular lymph node. The pathologic diagnosis was chronic granulomatous inflammation with caseous necrosis, which was consistent with tuberculosis findings. After 6 months’ medication for Tbc, the anterior mediastinal necrotic mass considerably decreased in size. Mediastinal or hilar tuberculous lymphadenitis is a frequent manifestation of primary tuberculosis both in children and in adults. In mediastinal tuberculous lymphadenitis, those patients with large nodes and with symptoms generally have positive disease whereas those patients with small nodes and no symptoms have negative disease. However, in pediatric, geriatric and immunocompromised populations, patients can have no systemic symptoms despite active disease and patients with inactive disease may have large calcified nodes and symptoms due to illness other than tuberculosis. Biopsy and culture of the diseased nodes are considered the gold standard for determination of disease activity in patients with mediastinal tuberculous lymphadenitis.
Patients proven to have active disease had CT findings of nodes with central low attenuation and peripheral rim enhancement that corresponded pathologically to caseation or liquefaction necrosis and granulation tissue
with inflammatory hypervascularity, respectively. With treatment, nodes changed in appearance on follow-up studies, first becoming homogeneous and finally disappearing or resuIting in a residual mass composed of fibrotic tissue and calcifications. Calcifications within the nodes, however, because they were seen in both active and inactive disease, were not so reliable a CT finding for diagnosis of disease activity as were low-attenuation areas within the nodes.
- References
- Moon WK, Im JG, Yeon KM, Han MC. Mediastinal Tuberculous Lymphadenitis: CT Findings of Active and Inactive Disease AJR Am J Roentgenol. 1998 Mar;170(3):715-8.
- Keywords
- mediastinum, infection, Bacterial infection, Tuberculosis,