Tuberculosis of intrathoracic lymph nodes - The primary lesion of tuberculosis infection hilar lymph node localization, occurs without the formation of primary lung infiltration and development of lymphangitis. The disease is manifested by weakness, fever, loss of appetite and weight, sweating, paraspetsificheskimi reactions, sometimes coughing and asphyxia. The diagnosis is established according to the inspection, X-ray and CT scan of the chest, tuberculin tests, biopsy of lymph nodes. Treatment of tuberculosis VGLU long; tuberculostatic includes a combination of drugs, immunomodulators, diet, plasmapheresis, lymphadenectomy.
Tuberculosis of intrathoracic lymph nodes
tuberculosis. Tuberculosis of intrathoracic lymph nodes (VGLU) - the main kind of clinical primary tuberculosis in children, adolescents and young people aged 18-24 years (up to 80-90% of cases). In connection with the mass BCG vaccination and chemoprophylaxis are currently more likely to occur on their own; at least - as the involutive form of primary tuberculosis complex (in pulmonary lesions). For tuberculosis of intrathoracic lymph nodes is characterized by a chronic course with a long preservation of the activity of a specific process in the host tissue and slow regression. Most complications (70%) is observed in the age of 3 years.
HIV-positive), smokers with chronic pathology, poor living conditions, experiencing excessive stress, nutritional deficiencies.
Tuberculosis may be affected by one or more groups of intrathoracic lymph nodes - paratracheal, tracheobronchial, bifurcation, bronchopulmonary. Intrathoracic lymph nodes, as the basic structure of the lung immune system, responsive to the primary tubinfitsirovanie. This marked hyperplasia of lymphoid tissue with an increase in unit volume and the development of specific inflammation with the gradual formation of foci of necrosis (caseation). In the future, the centers may be sealed and replaced by lime in the form petrifikatov and capsule hyalinized or melt with breakthrough infection and spread to the surrounding tissues.
Tuberculosis of intrathoracic lymph nodes can hronizirovatsya with the development of clinical signs of hypersensitivity - so called paraspetsificheskih reactions (erythema annular, blepharitis, conjunctivitis, vasculitis, poliserozita, polyarthritis). Small forms of the disease occur hidden. In BCG-vaccinated children or receiving chemoprophylaxis symptoms bronhoadenita erased with a wave-like increase in temperature, non-permanent cough or cough, moderate sweating without paraspetsificheskih reactions.
Bronhoadenit TB often occurs with complications: a breakthrough with the formation of caseous node limfobronhialnyh and limfotrahealnyh fistula, tuberculosis bronchi, segmental atelectasis lung development. A frequent complication can be nonspecific catarrh endobronchitis, pleural effusion, tuberculous dissemination to the lungs. Remotely may appear radical bronchiectasis, hemoptysis and pulmonary hemorrhage, bronholitiaz.
phthisiatrician holding a tuberculin test, X-ray lung, bronchoscopy, according to testimony - lymph node biopsy. Typical visual symptoms bronhoadenita are dilation of small superficial venous vascular network in the chest and back (symptoms Vidergoffera and Frank). With significant lesions is determined by palpation positive symptom Parsley (pain with pressure on the thoracic vertebrae). Auscultated dullness, may sometimes appear bronhofoniya and tracheal breathing below I vertebra.
Tuberculosis of intrathoracic lymph nodes is often found after the X-ray light child having a bend or hyperergic reaction tuberculin tests. Infiltrative forms distinguish the outer contours blur, a small extension and blur the shadow of the lung root. Calcinates defined as irregular round or oval shadow. In the form of visible tumor expansion, extension and strengthening of the shadow of the lungs of the roots of intensity, with clearly defined bumpy circuit. In the diagnosis of "minor" forms on the stage of infiltration are indirect radiological signs. To clarify the size and lymph node structure is used MSCT chest.
The possible small blood leukocytosis, eosinophilia, lymphocytosis, increased erythrocyte sedimentation rate. Bronchoscopy is indicated for suspected tuberculosis bronchi, nonspecific endobronchitis, limfobronhialny fistula and for the differential diagnosis. Tuberculosis VGLU have to differentiate with nonspecific lymphadenopathy with pneumonia, influenza, measles, whooping cough; Hodgkin's disease, lymphosarcoma, and pulmonary sarcoidosis, lymphocytic leukemia, tumors and cysts of the mediastinum, metastasis of cancer.
plasmapheresis. In the absence of positive dynamics of treatment for 1.5-2 years, complications, and the formation of tuberculoma mediastinal chemotherapy combined with surgery - lymphadenectomy degenerative intrathoracic lymph nodes.
An important factor is the observance of high-protein, vitamin and diet. Further treatment proceeds in the sanatorium, then outpatient advisable to stay recover children and adolescents in special kindergartens, boarding schools.
The prognosis of tuberculosis of intrathoracic lymph nodes, especially small form - favorable, with complete resorption of specific inflammation of the lymphoid tissue and recovery. Relatively favorable outcome is considered lymph node calcification, sclerosis of the root of the lung, the formation of bronchiectasis. Progression of tubercular process indicates poor course.