CT features of lymphobronchial tuberculosis in children, including complications and associated abnormalities

Lucas, Susan; Andronikou, Savvas; Goussard, Pierre; Gie, Robert P.

doi:10.1007/s00247-012-2399-x

Cited by 41 publications

(60 citation statements)

References 28 publications

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“…It is due to an excessive lymph node response with inadequate innate or adaptive immunity, or both. The most frequent clinical manifestations usually associated with a substantial deterioration in general health are wheezing and/or reduced ventilation and radiological changes include hyperinflation, atelectasis, lung collapse, and the expanding consolidation of a segment or entire lobe [22-24]. Tracheoesophageal or bronchoesophageal fistula are very rare presentations.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous emphysema as the first relevant clinical sign of complicated tubercular lymph node disease in a child

et al. 2013

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BackgroundChildren make up a significant proportion of the global tuberculosis (TB) caseload, and experience considerable TB-related morbidity and mortality. Unfortunately, it is not easy to diagnose TB in the first years of life because of the diversity of its clinical presentation and the non-specific nature of most of its symptoms.Case presentationA 26-month-old male child was admitted to hospital because of the sudden onset of rapidly increasing swelling of the neck, face and upper trunk a few hours before. Upon admission, his temperature was 36.5°C, pulse rate 120/min, respiratory rate 36/min, and O2 saturation 97% in air. Palpation revealed subcutaneous emphysema (SE) over the swollen skin areas, and an examination of the respiratory system revealed crepitations in the left part of the chest without any significant suggestion of mediastinal shift. Chest radiography showed enlargement of the left lung hilum with pneumomediastinum and diffuse SE. Bronchoscopy was carried out because of the suspicion that the SE may have been due to the inhalation of a peanut. This excluded the presence of a foreign body but showed that the left main bronchus was partially obstructed with caseous material and showed significant signs of granulomatous inflammation on the wall. Contrast-enhanced computed tomography of the lungs confirmed the SE and pneumomediastinum, and revealed bilateral hilum lymph node disease with infiltration of the adjacent anatomical structure and a considerable breach in the left primary bronchus wall conditioning the passage of air in the mediastinum and subcutaneous tissue. As a tuberculin skin test and polymerase chain reaction for Mycobacterium tuberculosis on bronchial material and gastric aspirate were positive, a diagnosis of TB was made and oral anti-TB therapy was started, which led to the elimination of M. tuberculosis and a positive clinical outcome.ConclusionsThis is the first case in which SE was the first relevant clinical manifestation of TB and arose from infiltration of the bronchial wall secondary to caseous necrosis of the hilum lymph nodes. Physicians should be aware of the fact that SE is one of the possible initial signs and symptoms of early TB infection, and act accordingly.

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Section: Discussionmentioning

confidence: 99%

Subcutaneous emphysema as the first relevant clinical sign of complicated tubercular lymph node disease in a child

et al. 2013

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“…Right lung volume loss in primary TB may occur as a result of bronchial compression by lymphadenopathy in children and is termed “lymphobronchial TB” . This is found in about a third of patients suspected of having TB when imaged with CT and almost all patients who have airway symptoms and TB . Complications of lymph node compression include hyperinflation (partial obstruction), collapse (total obstruction), perforation into a bronchus with obstructive pneumonia/atelectasis (epituberculosis) and caseation with parenchymal destruction, cavitation and resultant fibrosis .…”

Section: Discussionmentioning

confidence: 99%

“…This is found in about a third of patients suspected of having TB when imaged with CT and almost all patients who have airway symptoms and TB . Complications of lymph node compression include hyperinflation (partial obstruction), collapse (total obstruction), perforation into a bronchus with obstructive pneumonia/atelectasis (epituberculosis) and caseation with parenchymal destruction, cavitation and resultant fibrosis . Lymphobronchial TB usually affects the right main bronchus or bronchus intermedius …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Lymphobronchial TB (LBTB) occurs in children due to the presence of lymphadenopathy impressing on compressible airways . This is found in over a third of children with suspected TB using CT and is found in up to 100% of children with TB who present and airway symptoms, (almost a third of the latter affecting the bronchus intermedius) . This condition may mimic pneumonectomy when there is compression of the bronchus intermedius, between large matted lymphnode groups causing volume loss in the right lung and displacement of the mediastinum to the right.…”

Section: Introductionmentioning

confidence: 99%

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Left main bronchus compression as a result of tuberculous lymphnode compression of the right‐sided airways with right lung volume loss in children

Andronikou

Wyk

Goussard

et al. 2012

Pediatric Pulmonology

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Bronchoscopic assessment of airway involvement in children presenting with clinically significant airway obstruction due to tuberculosis

Goussard

Gie

Kling

et al. 2012

Pediatric Pulmonology

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CT features of lymphobronchial tuberculosis in children, including complications and associated abnormalities

Abstract: Airway compression was more severe in infants and most commonly involved the bronchus intermedius. Numerous parenchymal complications were documented, all showing right-side predominance.

Cited by 41 publications

References 28 publications

Subcutaneous emphysema as the first relevant clinical sign of complicated tubercular lymph node disease in a child

Subcutaneous emphysema as the first relevant clinical sign of complicated tubercular lymph node disease in a child

Left main bronchus compression as a result of tuberculous lymphnode compression of the right‐sided airways with right lung volume loss in children

Bronchoscopic assessment of airway involvement in children presenting with clinically significant airway obstruction due to tuberculosis

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