Transcript Tuberculous adenopathies

Tuberculous adenopathies
Anatomic recall
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Most frequent localisations of TB
adenopathies
Hilar adenopathies:
 -Opacities with convexe external
edge
 - opacities overlapping normal
vascular opacities
Bilateral adenopathies
Hilar adenopathy
Normal hilus
The tuberculous adenopathies are:
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Sometimes unilateral (latero-tracheal )
Most often bilateral and asymetric
Sometimes compressive, especially in children
Some lesions are possible inside the bronchi:
compression or fistula
• Adenopathies are frequent in cases of AIDS: they are
often bulky and associated with other pulmonary
lesions or extra-pulmonary TB
• AFB are most often negative in sputum, except in
cases of pulmonary lesions (pneumonia, cavern..)
associated with adenopathies
The most important differential
diagnosis are:
• Metastatic adenopathies of bronchial
cancer
• Lymphoma and hodgkin disease
• Sarcoïdosis (incidence in developping
countries ?)
Do not forget 2 radiological differential diagnosis:
- overlap sign of the hilus (anterior or posterior)
- vascular hypertrophy (convergence sign of
the hilus)
Don’t forget:
For a good analysis of the mediastinum, it is
necessary to have a good quality chest x-ray:
• Strictly front view
• Complete inspiration
• Patient standing up, postero-anterior
incidence
Bilateral tb adenopathies
Normal CXR
Right latero-tracheal opacity: Tuberculous adenopathies
Man, 20 years old ,
Asymptomatic,
Good condition, HIV systematic chest radio.
AFB negative in sputum
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Right latero-tracheal and precarena space adenopathies. AFB-,
Diagnosis made by mediastinoscopy: epithelioid and gigantocellular
granuloma. Culture +
Young woman, 22 years old. Weight loss and cough.
Contact with a tuberculous case 6 monthes ago. Positive
skin test with phlyctena
Normal chest x-ray
African woman, 27 years old. Left cervical
adenopathy
Left latero-aortic adenopathies in superior mediastinum
Puncture of the cervical adenopathy:
Pus with AFB+
Tuberculous right hilar adenopathy
Widening of the mediastinum:
adenopathies of superior and middle
mediastinum
Normal chest x-ray
/
In subcarena and inter tracheo bronchial areas (red arrows) , lateral view
is usefull for diagnosis of adenopaties
Rx normale
Lateral view is very usefull for diagnosis of mediastnum adenopathies
in sub carena and inter tracheo bronchial areas
Right hilar adenopathy. Is there mediastinum associated adenopathies?
Notice mediastinum enlargment
Normal lateral view
Left side, previous case : hilar and mediastinum adenopathies.. On the right side
normal lateral view.
Lateral view is useful to confirm hilar and mediastinum adenopathies (red arrow)
in the carena area. Notice partial atelectasis of the middle lobe (yellow arrow).
Bulky left hilar adenopathy.
Associated mediastinum adenopathies are well visible on the lateral view
Normal
lateral view
Young child, one year old: TB primary-infection
Notice the bilateral adenopathies with inferior lobe atelectasis
(left inferior bronchus compressed by adenopathy )
Tuberculous bulky adenopathies. AIDS context.
Infiltration into the surrounding lung tissu
Tuberculous adenopathies with endo-bronchial fistula
(endoscopic view)
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Fistula in the right para-cardiac bronchus
Fistulas coming from TB adenopathies
Tuberculosis / HIV +
Tuberculosis with mediastinal adenopathies and
pneumonia in a patient with AIDS. AFB++ in sputum
The association of unilateral or bilateral pneumonia
with mediastinal adenopathies
is very indicative of Tuberculosis, and often, HIV
context.
Adenopathy in left aorto-pulmonary space( and widening of superior
mediatinum due to TB adenopathies)
Normal chest radiography
Node calcifications: sequela of primary infection
Left hilar calcification: sequela of a TB primary infection
However, the mediastinal
adenopathies are not always
tuberculous…
Male, poor health condition, smoker, dyspnea
Right inferior lobe cancer and metastatic adenopathies
(laterotracheal space). Notice the associated emphysema.
Small cell carcinoma with bulky mediastinal adenopathies
Evolution after 6 cycles of chemotherapy
Bronchial cancer with superior vena cava syndrome
(No superior vena cava syndrome in tubercular
adenopathies)
Bronchial cancer with right hilar metastatic adenopathy
Man, 60 years old, weight loss and asthenia, cough
with hemoptoic sputum. AFB-
Bronchial cancer!
Right superior bronchus
Spur infiltrated
by the cancer
normal bronchus
Lymphoma (hodgkin disease)
Sarcoidosis
Trap: mediastinum enlargement in an older
woman with cyphoscoliosis
Differential diagnosis: vascular bulky
hilus: Convergence sign of the hilus
Differential diagnosis: posterior overlap sign
Differential diagnosis: Posterior overlap sign (2)
Differential diagnosis: anterior overlap
Differential diagnosis: Anterior overlap sign
(courtesy of Dr. Bellamy)
anterior overlap