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Tuberculosis of intrathoracic lymph nodes in children
Last reviewed: 18.10.2021
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The first place among the clinical forms of the primary period of tuberculosis in children and adolescents is currently occupied by tuberculosis of the intrathoracic lymph nodes - a specific lesion of the lymph nodes of the root of the lung and mediastinum. The leading role in the pathogenesis of primary tuberculosis is given to the pulmonary focus, bronchoadenitis is considered as the second component that developed after the formation of the pulmonary focus. As a result of the widespread introduction of BCG vaccination, an increase in body resistance and many other factors in modern conditions, pulmonary affect, located subpleurally, is delimited by pulmonary tissue and is not further developed. The tubercular process is characterized by the spread of the lesion to the regional lymph nodes of the mediastinum.
On the basis of the pathoanatomical picture, tuberculosis of the intrathoracic lymph nodes is divided into infiltrative and tumor-like. However, the subdivision of bronchoadenitis into an infiltrative and tumorous form is to a certain extent conditional, since they can pass into each other.
- In the first case, perinodular inflammation predominates, the tuberculous focus in the lymph node is small.
- With tumor-like tubercular bronchoadenitis, the process does not go beyond the capsule of the lymph nodes, which grow to a considerable extent.
The defeat of the intrathoracic lymph nodes is not an isolated specific process. With tubercular bronchoadenitis, pathological changes occur in all organs of the mediastinum, located around the lymph nodes infected with tuberculosis. In a specific process, large bronchi, vessels, mediastinal tissue, nervous ganglia and trunks, pleura (often mediastinal and interlobar) are often involved. With tuberculosis, one or more different groups of lymph nodes with a wide range of pathomorphological transformations may be involved in the process. In severe and unfavorably current forms, a bilateral spread of the process takes place, which is caused by a network of lymphatic tract anastomoses. In lymph nodes, a specific process lasts for a long time, the healing is slow. With the passage of time, the capsule is hyalinosed, the deposits of calcium salts occur. The size of the arisen petrification depends on the degree of expression of caseous disease.
Symptoms of tuberculosis of the intrathoracic lymph nodes
The clinical picture of uncomplicated bronchoadenitis is primarily due to symptoms of intoxication, as well as the extent to which intrathoracic lymph nodes and surrounding organs are involved in a specific process. The study of an anamnesis often reveals contact with a patient with active tuberculosis. An analysis of the sensitivity of the child to tuberculin indicates an infective turn or a later infection. Tuberculosis of the intrathoracic lymph nodes is characterized by a normal sensitiveness to tuberculin. Only in some patients tuberculin reactions may be hyperergic.
The onset of tuberculosis of the intrathoracic lymph nodes is usually gradual. The child has increased fatigue, poor appetite, irritability, body temperature rises, usually to subfebrile digits. Significantly less often, mainly in young children, bronchoadenitis can begin more sharply, with the rise in body temperature to febrile numbers and pronounced common disorders. Paraspecific reactions in primary tuberculosis in children are rare in modern conditions, but blepharitis is sometimes possible. Keratoconjunctivitis, nodal erythema.
Diagnostics of intrathoracic lymph nodes
Tuberculosis of the intrathoracic lymph nodes must be differentiated from pathological changes in the mediastinum and root of the lungs of non-tubercular etiology. More than 30 radiological diagnoses of this area are described. In general, they can be divided into three main groups:
- tumor-like lesions of mediastinal organs;
- nonspecific adenopathy;
- abnormalities of vessels of the chest.
When conducting differential diagnosis, the X-ray anatomical structure of the mediastinum should be taken into account. Being a part of the thoracic cavity, the mediastinum in front is limited by the back wall of the sternum and the marginal cartilages, behind - by the vertebral column, from the sides - by medial pleura sheets, at the bottom by the diaphragm, and on the top by the aperture of the thorax.
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