Symptoms of tuberculosis of the intrathoracic lymph nodes

Symptoms of uncomplicated bronchoadenitis are 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, keratoconjunctivitis, nodal erythema are sometimes possible.

When examining a patient with tuberculosis of the intrathoracic lymph nodes, attention is usually drawn to the pallor of the skin and mucous membranes, weight loss, blueness under the eyes. On the anterior chest wall, one can sometimes see an expansion of the peripheral venous network in the first-second intercostal space from one or both sides (the Wiederffer symptom). The cause of this is the compression of an unpaired vein. In the upper third of the interlobular space, it is sometimes possible to see the enlargement of small superficial vessels (Frank's symptom). The data of laboratory studies for tubercular bronchoadenitis give scarce information, as with other forms of tuberculosis of the respiratory system. In the hemogram, at the onset of the disease, minor leukocytosis is more often noted. In the first period of the disease, lymphopenia is possible. ESR moderately increased. In the study of sputum, washing water of the bronchi and stomach, MW is usually not detected.

The course depends on the extent of the specific inflammation, on the one hand, and the state of the organism's immunological reactivity, on the other. The nature of the course of the process and its outcome are also due to the timely detection of the disease and the usefulness of tuberculostatic therapy. In infants who are not vaccinated or ineffectively vaccinated with BCG in close bacillary contact, tuberculosis of the hilar lymph nodes, even with a limited nature of the initial process, can proceed violently and become generalized. Timely identified processes with limited lesion of the intrathoracic lymph nodes with full tuberculostatic therapy usually give a positive dynamics with a gradual transition from the phase of infiltration to the phase of resorption. 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 on the background of a bend.

In a small part of patients, cough is noted, sometimes it becomes pertussis-like, more rarely - bitonal. Bitonal cough occurs at an early age with a significant increase in the intrathoracic lymph nodes and compression of bronchial lumens.

The data of percussion and auscultative symptoms are rare in modern conditions, they are characteristic only of tumorous forms of bronchoadenitis in children of early age. Massive caseous bronchoadenitis can acquire a prolonged course. Currently, the torpid current bronchoadenitis is rare. The causes of chronic bronchoadenitis can be considered close contact with bacilli, the onset of the disease in early childhood, late and incompletely conducted tuberculostatic therapy. The development of paraspecific changes in the internal organs, as well as adhesions and adhesions in the serous cavities, diffuse sclerosis in the parenchymal organs and the walls of the blood vessels causes a peculiar clinical picture. Such patients develop atypical manifestations of primary tuberculosis, which occurs under the mask of other pathological conditions.

At present, the most common form of bronchoadenitis is small. Small forms of tuberculosis of the intrathoracic lymph nodes in the infiltration phase are understood as processes of blurred hyperplasia of one or two groups of lymph nodes (sizes from 0.5 to 1.5 cm). Small forms are diagnosed only by a combination of clinical and radiological signs of the disease. Early diagnosis of small forms is of great importance, since in some cases, especially in young children, they can have a progressive course and are accompanied by complications, and may also be the basis for the generalization of tuberculosis. Small forms of tuberculosis of the intrathoracic lymph nodes differ slightly in their clinical and radiological manifestations. The onset of the disease is usually gradual, inconspicuous. Intoxication syndrome may be not expressed or determine individual symptoms: decreased appetite, subfebrile body temperature, etc. You can detect an increase in five or more groups of peripheral lymph nodes.

Percutaneous and auscultatory symptoms are usually not informative. When studying the hemogram and proteinogram pathological changes, as a rule, do not determine. In washing waters of the bronchi, the stomach, in 8-10% of cases, MBT is detected both bacteriologically and bacteriologically. When carrying out a bronchological examination, pathological changes in the bronchi can be detected: various phases of bronchial tuberculosis, limited catarrhal endobronchitis, as well as regional and intrathoracic lymph nodes, detected in more than 35% of children with small forms of tuberculosis of the intrathoracic lymph nodes. In the diagnosis of small forms the crucial role belongs to the x-ray method. Difficulties in identifying and diagnosing small forms lead to the need to take into account all the 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 pattern. When the lymph nodes are damaged by the tumor type, an increase in various (one or several) groups with polycyclic distinct outlines is documented, which seems to be a wavy border of the lung root in the form of semi-oval or semicircular bulges. The degree of their increase can be different - from small to significant.

With the infiltrative type of tuberculosis of the intrathoracic lymph nodes in the radiographic picture of the roots of the lungs, the blurriness of their outlines is determined - the result of perinodular inflammation. The infiltrative form of tuberculosis of the intrathoracic lymph nodes is found mainly in the defeat of bronchopulmonary groups located in the region of the roots of the lungs. Hyperplasic hilar lymph nodes of the superior mediastinum (paratracheal and tracheobronchial) are delimited by the mediastinal pleura. Their inflammatory hyperplasia, even with the transition of the process to the surrounding tissue in the X-ray image, often creates a picture of a tumor-like type of changes in the lymph nodes.

Small forms of tuberculosis of the intrathoracic lymph nodes. One of the signs that allow one to suspect a small form of tuberculosis with the appropriate clinical syndrome in children and adolescents is the change in the shape and magnitude of the median shadow.

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