대한흉부영상의학회 Korean Society of Thoracic Radiology GuerBet

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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 77 Date 1999-04-17

  • Courtesy of Jae-Woo Song, MD / Seoul City Boramae Hospital, Seoul, Korea
  • Age/Sex 62 / M
  • Chief Complaintweight loss (10kg during last 6 months) and poor oral intake, mild cough, known alcoholic
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 5

Chest PA

Diagnosis With Brief Discussion

Diagnosis
Pulmonary Tuberculosis with Tuberculous Mediastinal Lymphadenitis
Radiologic Findings
Chest PA radiograph shows a large mass-like opacity with peripheral tubular and nodular lesions in the right upper lobe. We can also see the right paratracheal opacity. CT scans show multiple enlarged mediastinal lymph nodes with central necrotic low attenuation and enhancing peripheral rim. CT scans also show diffuse thickning of the wall of the right main and right upper lobar bronchi, tapered narrowing and total occlusion of the anterior segmental bronchus of RUL and distal dilated bronchi filled with secretion, nodules with or without cavitation in the posterior segment of RUL, and right pleural effusion.
Brief Review
Tuberculous mediastinal lymphadenopathy is an infrequent occurrence (about 4.4%) in adults, because aquired resistance enhances the ability of subjects to confine organisms to the site of infection. There is some female preponderance of 2~3:1. Right sided mediastinal lymph nodes are more commonly involved because the preferential lymph flow of entire right lung and left upper lung to right tracheobronchial and paratracheal nodes as well as the higher frequency of right lung pulmonary tuberculosis involvement. The involved lymph nodes show necrotic central low attenuation area and enhanced peripheral portion due to inflammatory hypervasculaity on enhanced CT scan.
References
1. JG Im, KS Song, HS Kang, et al. Mediastinal tuberculous lymphadenitis: CT manefestations. Radiology 1987;164:115-119
Keywords
Lung, Mediastinum, Infection, Bacterial infection, tuberculosis, Pulmonary Tuberculosis with Tuberculous Mediastinal Lymphadenitis

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  • - Northwestern Memorial Hospital, Chicago, IL. USA Mitchell J. Kline
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