Surgical treatment of childhood mediastinal tuberculous lymphadenitis

Freixinet, J.; Varela, A.; Rivero, Luis López; Caminero, José A.; Castro, Felipè Rodríguez de; Serrano, Ana Aparicio

doi:10.1016/0003-4975(94)00993-7

Cited by 19 publications

(18 citation statements)

References 8 publications

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“…One of the forms of PTB that has been described as requiring surgical treatment is the primary massive mediastinal adenopathy that causes acute or chronic compression in the bronchotracheal tree with obstructive symptoms [39,40]. This complication is seen in the context of the bronchial effects of tuberculosis, whose incidence is about 9% in our studies [39].…”

Section: Mediastinal Gangliobronchial Lymphadenitis Tuberculosismentioning

confidence: 73%

“…This complication is seen in the context of the bronchial effects of tuberculosis, whose incidence is about 9% in our studies [39]. The complications of this varied clinical picture are pulmonary atelectasis, the formation of bronchial ulcerations, and gangliobronchial perforation with the passage of caseous material into the airways, which can provoke acute episodes [40].…”

Section: Mediastinal Gangliobronchial Lymphadenitis Tuberculosismentioning

confidence: 99%

“…Dissection and excision of ganglia should be avoided so as not to provoke vascular accidents. Pulmonary resection is not indicated if irreversible pulmonary damage is not believed to exist [39,40].…”

Section: Mediastinal Gangliobronchial Lymphadenitis Tuberculosismentioning

confidence: 99%

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Surgical Indications for Treatment of Pulmonary Tuberculosis

Freixinet

1997

World j. surg.

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Surgery for pulmonary tuberculosis (PTB) has passed through various stages throughout history, having been the treatment of choice in the past. It has now been relegated to second place for treatment of this disease. One of the most strongly debated surgical indications has been clinical picture of multidrug resistance with the focus of pulmonary tuberculous activity located in a segment, lobe, or lung. In these cases some authors have described good results with surgical excision. Another important indication is the complications of PTB, among which bronchiectases (provoking pictures of suppuration, superinfections, or hemoptysis) are found, along with known destructive pulmonary sequelae such as destroyed lung, massive hemoptysis, and the presence of a bronchopleural fistula that cannot be resolved with pleural drainage. The presence of a neoplasm in a patient affected by PTB is a surgical indication if the lesion is resectable. The existence of an unidentifiable pulmonary mass or node is a surgical criterion because it might signal bronchogenic carcinoma. A frequent indication for surgery is pulmonary aspergilloma, which in a large percentage of cases is a destructive PTB sequela and generates serious complications, hemoptysis being the most frequent. Mediastinal tuberculous lymphadenitis that produces compressive symptoms and pulmonary complications, especially in children, is another surgical indication for decompressing the bronchial tree. The surgery in these cases consists in excision and curettage of adenopathies. Surgery therefore now constitutes a valid option for the treatment of certain clinical pictures of PTB that do not respond to medical treatment, are serious, and are potentially fatal.

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Section: Mediastinal Gangliobronchial Lymphadenitis Tuberculosismentioning

confidence: 73%

Section: Mediastinal Gangliobronchial Lymphadenitis Tuberculosismentioning

confidence: 99%

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Surgical Indications for Treatment of Pulmonary Tuberculosis

Freixinet

1997

World j. surg.

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“…The involved lymph nodes are typically firm, non-tender, and painless, with non-erythematous overlying skin. They are initially non-fluctuant: lymph node suppuration and spontaneous drainage may occur after caseation and necrosis development [7,8]. Fever, weight loss, fatigue, and malaise are usually absent or minimal.…”

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confidence: 99%

Head and neck mycobacterial infections in pediatric patients

Caruso

Passali

Salerni

et al. 2009

International Journal of Pediatric Otorhinolaryngology

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Objective: Lymph nodal disease is one of the most common manifestations of head and neck tuberculosis and is particularly frequent in paediatric patients with an increasing incidence in the last decade. It may represent the manifestation of a systemic tuberculous disease or a clinical entity specific of the neck. Aim of this paper is to retrospectively analyse mycobacterial cervical adenopathies observed in two Paediatric European Centers between 1986 and 2004 and the outcomes of medical or surgical treatment. Methods: 353 children were examined for mycobacterial cervical lymphadenopaties since January 1986 to December 2004. Demografic data about the sample are showed. The retrospective evaluation of the sample underlined distribution according to etiologic patterns, head and neck adenopathies localization. Previous or simultaneous medical or surgical treatment were analyzed. Statistical analysis with Chi Square test was performed. Results: 281 (79.60%) cases showed a higher localization and 72 (20.40%) a lower localization. In relation to the etiological agent, 8 (2.27%) Mycobacterium tuberculosis (MTB) and 222 (62.89%) mycobacteria other than tuberculosis (MOTT) lymphadenopaties were observed in the upper localization as opposed to 21 (5.95%) MTB and 39 (11.05%) MOTT in the lower plane. Two (0.56%) were detected as upper lymph nodal tumefaction in the median line. In 86 (24.36%) cases at the MRI the so-called "iceberg effect" was noted. 163 (62.45%) patients underwent primary excisional biopsy whereas 74 (28.35%) underwent exeresis after other unsuccessfull therapies, 9 underwent only drainage, and 15 drainage with subsequent antibiotic therapy. Number of relapses after surgery was 16 (6.13%). Conclusions:A not homogeneous therapeutic approach to the mycobacterial cervical adenitis arises from literature and WHO guidelines does not give indications for the treatment of the cervical pattern.A therapeutic strategy based on the etiology is mandatory. In case of MBT adenopathy the therapy of choice includes the association, in variable way, of different chemotherapic drugs; surgery is reserved to advanced cases. Conversely, in cases of MOTT adenopathy, surgery is the treatment of choice.

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“…This practice is hazardous. In our experience, the danger is not so much to vessels [5,6,15] as to the airway wall. Evacuation of nodal contents only is effective and safer.…”

Section: Discussionmentioning

confidence: 93%

Role of Thoracic Surgery for Childhood Tuberculosis

1997

World j. surg.

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Lymphadenopathy is the hallmark of intrathoracic tuberculosis in children. The role of the thoracic surgeon in treating childhood tuberculosis is to relieve the more severe symptoms of lymphadenopathy, prevent the more long-term secondary damage that lymphadenopathy may cause to the lung, and treat the sequelae of thoracic tuberculosis. We reviewed the role of surgery in childhood tuberculosis at Red Cross Children Hospital from January 1981 to January 1996 in 161 children under 13 who were admitted for 168 therapeutic surgical interventions for proved intrathoracic tuberculosis and its related complications. We classified patients according to the pathophysiology of their disease to clarify the role of surgery in their management. Successful decompression of lymph nodes that were acutely compromising major airways was done in 25 children, and decompression for chronic airway compression was successful in 8 of 11 children. Therapeutic bronchoscopy successfully opened an airway obstructed by intraluminal tissue in 68% of 28 patients, with long-term pulmonary reexpansion in 50%. Pulmonary resections for postprimary tuberculous damage were done in 72 patients with a mortality of 2.7% and morbidity of 16.7%. Another 17 patients were operated on for pleural disease and 15 for other tuberculosis-related problems. The mortality for all patients undergoing surgery for complications of tuberculosis during childhood was 1.9% (3/161), suggesting that when indicated, an aggressive surgical approach is relatively safe.

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Surgical treatment of childhood mediastinal tuberculous lymphadenitis

Cited by 19 publications

References 8 publications

Surgical Indications for Treatment of Pulmonary Tuberculosis

Surgical Indications for Treatment of Pulmonary Tuberculosis

Head and neck mycobacterial infections in pediatric patients

Role of Thoracic Surgery for Childhood Tuberculosis

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