Tuberculosis of intrathoracic lymph nodes in children

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, increased resistance of the body and many other factors in modern conditions, the pulmonary affect, located subpleurally, is limited by the lung tissue and does not develop further. The tuberculous process is characterized by the spread of the lesion to the regional lymph nodes of the mediastinum.

Based on the pathological picture, tuberculosis of the intrathoracic lymph nodes is divided into infiltrative and tumor-like. However, the division of bronchoadenitis into infiltrative and tumor-like forms is to some extent arbitrary, since they can transform into one another.

• In the first case, perinodular inflammation predominates, the tuberculous focus in the lymph node is small.
• In tumor-like tuberculous bronchoadenitis, the process does not extend beyond the capsule of the lymph nodes, which increase to significant sizes.

The defeat of the intrathoracic lymph nodes is not an isolated specific process. In tuberculous bronchoadenitis, pathological changes occur in all organs of the mediastinum located around the lymph nodes affected by tuberculosis. Large bronchi, vessels, mediastinal tissue, nerve ganglia and trunks, pleura (usually mediastinal and interlobar) are often involved in the specific process. In tuberculosis, one or more different groups of lymph nodes with a wide range of their pathomorphological transformations can be involved in the process. In severe and unfavorably progressing forms, the process spreads bilaterally, which is due to the network of anastomoses of the lymphatic pathways. In the lymph nodes, the specific process remains active for a long time, healing is slow. Over time, hyalinosis of the capsule and deposition of calcium salts occur. The size of the resulting petrifications depends on the degree of caseation.

Symptoms of tuberculosis of the intrathoracic lymph nodes

The clinical picture of uncomplicated bronchoadenitis is primarily determined by the 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 still sometimes possible.

Symptoms of intrathoracic lymph nodes

Diagnostics of intrathoracic lymph nodes

Tuberculosis of the intrathoracic lymph nodes must be differentiated from pathological changes in the mediastinum and lung root of non-tuberculous etiology. More than 30 diseases of this area detected by X-ray examination have been described. In general, they can be divided into three main groups:

• tumor-like lesions of the mediastinal organs;
• non-specific adenopathy;
• anomalies in the development of blood vessels of the chest organs.

When conducting differential diagnostics, the X-ray anatomical structure of the mediastinum should be taken into account. Being part of the thoracic cavity, the mediastinum is limited in front by the posterior wall of the sternum and costal cartilages, behind by the spinal column, on the sides by the medial pleural layers, below by the diaphragm, and above by the thoracic aperture.

Diagnostics of intrathoracic lymph nodes

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