Tuberculosis of intrathoracic lymph nodes is a primary lesion of intrathoracic lymph nodes with tuberculosis infection, without the formation of a primary infiltrate in the lungs and the development of lymphangitis. The disease is manifested by weakness, fever, decreased appetite and weight, sweating, paraspecific reactions (ring-shaped erythema, blepharitis, conjunctivitis, vasculitis, polyserositis, polyarthritis), sometimes cough and asphyxia. Diagnosis is established by examination, chest X-ray and CT, tuberculin tests, lymph node biopsy. Treatment of HLU tuberculosis is long-term; it includes a combination of antituberculosis drugs, immunomodulators, diet, plasmapheresis.

Intrathoracic lymph node tuberculosis (tuberculous bronchoadenitis) is a specific inflammation of the lymph nodes of the mediastinal zone and lung root caused by Mycobacterium tuberculosis. Intrathoracic lymph node tuberculosis (ILNT) is the main clinical presentation of primary tuberculosis in children, adolescents and young adults aged 18-24 years (up to 80-90% of cases).

Due to mass BCG vaccination and chemoprophylaxis, it now more often occurs independently; less often as an involutional form of primary tuberculosis complex (with pulmonary involvement). Tuberculosis of intrathoracic lymph nodes is characterized by a chronic course with long preservation of the activity of the specific process in the node tissue and slow regression. Most complications (up to 70%) are observed before the age of 3 years.

Causes

Tuberculosis (including intrathoracic lymph nodes) is caused by bacteria of the genus Mycobacterium, most often M.tuberculosis and M.bovis. Bronchoadenitis develops with primary hematogenous or lymphogenous penetration of Mycobacterium tuberculosis into the lymph nodes of the mediastinum and lung root. Less commonly, it may be the result of endogenous reactivation of a pre-existing tuberculous infection in a group of intrathoracic lymph nodes.

Infection usually occurs by airborne droplet transmission from a bacillus-secreting patient, rarely by food, household and transplacental routes. The risk group for tuberculous bronchoadenitis includes:

- unvaccinated and improperly immunized children and adults

- People with immunodeficiency (including HIV-infected persons)

- smokers

- having chronic pathology, poor living conditions

- experiencing excessive stress, nutritional deficiencies.

Symptoms of intrathoracic lymph node tuberculosis

The clinic of tuberculosis of intrathoracic lymph nodes is mediated by the nature, topography, volume of the specific lesion and the degree of involvement of surrounding structures. The disease is characterized by the predominance of symptoms of intoxication, respiratory manifestations and frequent complications. Usually bronchoadenitis begins gradually. In children there is increased fatigue, deterioration of appetite, poor sleep, sweating at night, subfebrile fever, nervousness, weight loss.

In tumor-like and infiltrative forms the symptoms are more pronounced; their course is accompanied by general weakness, pallor, febrile (up to 38-39°C) and prolonged subfebrile temperature. At an early age, bronchoadenitis may be acute, with high fever and sharp general disorders. A whooping or bitonal nocturnal cough is possible, caused by bronchial compression by hyperplastic lymph nodes. Rapid enlargement of the bifurcation group of nodes may cause asphyxia.

Tuberculosis of intrathoracic lymph nodes may become chronic with the development of clinical signs of hypersensitization - so-called paraspecific reactions (ring-shaped erythema, blepharitis, conjunctivitis, vasculitis, polyserositis, polyarthritis). Minor forms of the disease are latent. In BCG-vaccinated or chemoprophylactic children, the symptomatology of bronchoadenitis is vague, with wavelike increase in temperature, occasional cough or coughing, moderate sweating without paraspecific reactions.

Complications

Tuberculous bronchoadenitis often proceeds with complications: breakthrough of the caseous node with the formation of lymphobronchial and lymphotracheal fistulas, bronchial tuberculosis, the development of segmental atelectasis of the lung. A frequent complication may be nonspecific catarrhal endobronchitis, exudative pleuritis, tuberculous dissemination into the lungs. Distant root bronchiectasis, hemoptysis and pulmonary hemorrhage, bronchiolithiasis may appear.

Diagnosis

In case of suspicion of tuberculosis of intrathoracic lymph nodes, a careful collection of anamnesis, consultation with a phthisiatrist, tuberculin tests, lung radiography, bacteriologic diagnosis, bronchoscopy, bronchoscopy, if indicated - biopsy of the lymph node. Of primary importance in the diagnosis are:

- Physical findings. Typical visual signs of bronchoadenitis are dilation of small superficial vessels of the venous network on the chest and back (Wiederhoffer and Frank symptoms). With significant lesions palpatorially determined positive Petrushka's symptom (pain when pressing on the upper thoracic vertebrae). A dulling of the percussion sound is heard, sometimes bronchophony and tracheal breathing below the I vertebrae may appear.

An important factor is the observance of a high-protein, vitaminized diet. Further treatment is continued on an outpatient basis expedient stay overdosed children and adolescents in specialized kindergartens, boarding schools.

Prediction

Prediction in tuberculosis of intrathoracic lymph nodes, especially the small form - favorable, with complete resorption of specific inflammation of lymphoid tissue and recovery. Relatively favorable outcome is considered calcification of lymph nodes, sclerosis of the lung root. Progression of the tuberculous process indicates an unfavorable course.

Ukumatshoeva L- lecturer of the department of phthisiopulmonology

translated Ismoilov R.