1. Tuberculosis of intrathoracic lymph nodes
Lecture № 4
The Department of Tuberculosis of KSMA
Doc. Fydorova S.V.

2. Tuberculosis of intrathoracic lymph nodes tuberculosis
is specific affection of hilar lymph nodes or/and mediastinal lymph nodes
It is the most frequent of all clinical forms of primary TB

3. Pathogenesis of intrathoracic lymph nodes tuberculosis
TB-infection of person
Lymphohematogenous spreading of MBT
MBT penetrates into different organs and tissues, especially lymphatic system. The involvement of intrathoracic lymph nodes in children is most typical

4. Pathomorphological and clinical forms of intrathoracic lymph nodes tuberculosis
infiltrative form
tumorous form
small form
Tuberculous inflammation of lymphatic nodes with caseous necrosis and nonspecific inflammation around affected lymph nodes develops.

5. Intrathoracic lymph nodes topographical classification of Sukennikov
paratracheal lymph nodes
tracheobronchial lymph nodes
bifurcational lymph nodes
bronchopulmonary lymph nodes

6. Small form of intrathoracic lymph nodes tuberculosis
Tuberculosis of intrathoracic lymph nodes, especially small form, may be asymptomatic

7. Infiltrative form of intrathoracic lymph nodes tuberculosis
the onset of infiltrative form is usually subacute or sometimes acute, symptoms of intoxication and physical findings are expressed. But usually treatment has fast effect, complications develop rarely

8. Tumorous form of intrathoracic lymph nodes tuberculosis
The beginning of tumorous form is usually gradual, symptoms of intoxication develop slowly, but they reach the high level. It is the most severe form, complications are often observed. Children with tumorous form may have cough, sometimes – brassy paroxismal cough, expiratory stridor

9. X-ray picture of intrathoracic lymph nodes tuberculosis
The wideness of lung roof with the shadows of enlarged lymph nodes is observed in patients with tumorous form of TILN. Mediastinal lymph nodes are enlarged, their form is oval or round, their borders are usually clear, because area of perifocal inflammation around lymph nodes is absent. Unilateral enlargement is more typical than bilateral.

10. X-ray picture of intrathoracic lymph nodes tuberculosis
Enlarged tumorous lymph nodes may compress vessels, bronchi. In these cases atelectasis of one or several lobes (or other portions of lung tissue) develop

11. X-ray picture of intrathoracic lymph nodes tuberculosis
In patients with infiltrative form affected lung roof is wide, it’s borders are unclear. Shadows of enlarged lymph nodes are not detected very clear, because perifocal inflammation is located around them.

12. X-ray picture of intrathoracic lymph nodes tuberculosis
in patients with small form enlarged lymph nodes often aren’t detected. There are only indirect signs of there involvement:
enlargement of lung roof and/or mediastinum
deformation of lung roof shadow and/or mediastinum
deformation and constriction of bronchi
pleural adhesions
etc.

13. Diagnosis of intrathoracic lymph nodes tuberculosis
complaints
contact with infectious patient in previous history
micropolyadenopathy and other paraspecific reactions
conversion of tuberculin skin test, hyperergic Mantoux reaction
typical physical findings

14. Diagnosis of intrathoracic lymph nodes tuberculosis
typical changes in common blood count and urine analysis
detection of MBT by sputum microscopy in patients with severe and complicated forms of TB
X-ray syndrome of lung roof pathology and enlargement of intrathoracic lymph nodes

15. Differential diagnosis of intrathoracic lymph nodes tuberculosis
lymphogranulomatosis
sarcoidosis
viral lymphadenopathy
lymphoma
metastases to mediastinal lymph nodes
etc.

16. Complications of primary TB
caused by mediastinal lymph node
atelectasis
bronchonodular fistula
TB bronchitis
lymphohematogenous dissemination, generalized tuberculosis
mediastinal or interlobar pleuritis
etc.
caused by pulmonary component
costal or diafragmatical pleuritis
primary cavity
primary tuberculoma
primary caseous pneumonia

17. Thank you
for your attention!