Symptoms of intrathoracic lymph node tuberculosis

Symptoms of uncomplicated bronchoadenitis are primarily due to symptoms of intoxication, as well as the degree of involvement of the intrathoracic lymph nodes and surrounding organs in the specific process. Anamnesis study often reveals contact with a patient with active tuberculosis. Analysis of the child's sensitivity to tuberculin indicates an infectious turn or a later period of infection. Normergic sensitivity to tuberculin is characteristic of tuberculosis of the intrathoracic lymph nodes. Only in some patients can tuberculin reactions be hyperergic.

The onset of tuberculosis of the intrathoracic lymph nodes is usually gradual. The child develops increased fatigue, poor appetite, irritability, and an increase in body temperature, usually to subfebrile levels. Much less frequently, mainly in young children, bronchoadenitis can begin more acutely, with an increase in body temperature to febrile levels and pronounced general disorders. Paraspecific reactions in primary tuberculosis in children are rare in modern conditions, but blepharitis, keratoconjunctivitis, and nodular erythema are sometimes possible.

When examining the intrathoracic lymph nodes of a patient with tuberculosis, attention is usually drawn to the pallor of the skin and mucous membranes, weight loss, and blueness under the eyes. On the anterior chest wall, one can sometimes see an expansion of the peripheral venous network in the first or second intercostal space on one or both sides (Wiedergoffer's symptom). This is caused by compression of the azygos vein. In the upper third of the interscapular space, one can sometimes see an expansion of small superficial vessels (Frank's symptom). Laboratory data for tuberculous bronchoadenitis provide scant information, as with other forms of tuberculosis of the respiratory organs. In the hemogram at the onset of the disease, slight leukocytosis is often noted. In the first period of the disease, lymphopenia is possible. ESR is moderately increased. When examining sputum, bronchial and gastric lavage, MVT is usually not detected.

The course depends on the extent of specific inflammation, on the one hand, and the state of the body's immunological reactivity, on the other. The nature of the process and its outcome are also determined by timely detection of the disease and the adequacy of tuberculostatic therapy. In young children who are not vaccinated or ineffectively vaccinated with BCG and who have come into close bacillary contact, tuberculosis of the intrathoracic lymph nodes, even with a limited nature of the initial process, can proceed rapidly and turn into a generalized form. Timely detected processes with limited damage to the intrathoracic lymph nodes with adequate tuberculostatic therapy usually give positive dynamics with a gradual transition from the infiltration phase to the resorption phase. Tumor-like or tumorous form of tuberculosis of the intrathoracic lymph nodes, as a rule, has a more severe clinical course. This form often occurs in young children, it is accompanied by a more vivid clinical picture, it is often accompanied by the development of complications. This form is characterized by hyperergic sensitivity to tuberculin against the background of a turn.

A small proportion of patients experience cough, sometimes it takes on a whooping cough-like character, less often - a bitonal character. Bitonal cough occurs at an early age with a significant increase in the intrathoracic lymph nodes and compression of the bronchial lumen.

These percussion and auscultatory signs are quite rare in modern conditions, they are typical only for tumor forms of bronchoadenitis in young children. Massive caseous bronchoadenitis can acquire a protracted course. Currently, torpid bronchoadenitis is rare. The causes of chronic bronchoadenitis can be considered close contact with a bacilli excretor, the onset of the disease in early childhood, late initiation and inadequate tuberculostatic therapy. The development of paraspecific changes in internal organs, as well as adhesions and adhesions in serous cavities, diffuse sclerosis in parenchymatous organs and blood vessel walls determines a peculiar clinical picture. Such patients develop atypical manifestations of primary tuberculosis, occurring under the guise of other pathological conditions.

Currently, the most common form of bronchoadenitis is minor. Minor forms of tuberculosis of the intrathoracic lymph nodes in the infiltration phase are understood to mean processes of mild hyperplasia of one or two groups of lymph nodes (size from 0.5 to 1.5 cm). Minor forms are diagnosed only by a combination of clinical and radiological signs of the disease. Early diagnosis of minor forms is of great importance, since in some cases, especially in young children, they can have a progressive course and be accompanied by complications, and also be the basis for the generalization of tuberculosis. Minor forms of tuberculosis of the intrathoracic lymph nodes are characterized by insignificant expression of clinical and radiological manifestations. The onset of the disease is usually gradual, imperceptible. Intoxication syndrome may be unexpressed or determined by individual symptoms: loss of appetite, subfebrile body temperature, etc. An increase in five or more groups of peripheral lymph nodes can be detected.

Percussion and auscultatory symptoms are usually uninformative. When examining the hemogram and proteinogram, pathological changes are usually not determined. In bronchial and gastric lavage waters, MBT is detected in 8-10% of cases by both bacterioscopic and bacteriological methods. During a bronchological examination, pathological changes in the bronchi can be detected: various phases of bronchial tuberculosis, limited catarrhal endobronchitis, as well as damage to regional and intrathoracic lymph nodes, detected in more than 35% of children with minor forms of tuberculosis of the intrathoracic lymph nodes. In the diagnosis of minor forms, the decisive role belongs to the radiological method. Difficulties in identifying and diagnosing minor forms lead to the need to take into account all indirect signs of local pathological changes in the root and mediastinum zone.

The forms of tuberculosis of the intrathoracic lymph nodes in X-ray semiotics have a characteristic picture. When the lymph nodes are affected by a tumor type, an increase in various (one or more) groups with clear polycyclic outlines is documented, which is represented by a wavy border of the root of the lung in the form of semi-oval or semi-rounded protrusions. The degree of their increase can be different - from small to significant.

In the infiltrative type of tuberculosis of the intrathoracic lymph nodes, the X-ray picture of the roots of the lungs shows a blurring of their outlines - the result of perinodular inflammation. The infiltrative form of tuberculosis of the intrathoracic lymph nodes is detected mainly when the bronchopulmonary groups located in the area of the roots of the lungs are affected. Hyperplastic intrathoracic lymph nodes of the upper mediastinum (paratracheal and tracheobronchial) are delimited by the mediastinal pleura. Their inflammatory hyperplasia, even when the process passes to the surrounding tissue, often creates a picture of a tumor-like type of changes in the lymph nodes in the X-ray image.

Minor forms of tuberculosis of the intrathoracic lymph nodes. One of the signs that allows one to suspect a minor form of tuberculosis with the corresponding clinical syndrome in children and adolescents is a change in the shape and size of the median shadow.

In modern conditions, new diagnostic methods have appeared that allow to reliably establish the localization of the process despite the small size (up to 1 cm) of the intrathoracic lymph nodes. Such diagnostic methods include CT of the mediastinal organs, which allows to establish the diagnosis of a small form of tuberculosis of the intrathoracic lymph nodes with up to 90% reliability.