1. Tuberculous adenopathies

2. Anatomic recall

5. Most frequent localisations of TB adenopathies

6. Hilar adenopathies: -Opacities with convexe external edge
- opacities overlapping normal vascular opacities

7. Bilateral adenopathies

8. Hilar adenopathy
Normal hilus

9. The tuberculous adenopathies are:
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

10. 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)

11. 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

12. Bilateral tb adenopathies

13. Right latero-tracheal opacity: Tuberculous adenopathies
Normal CXR
Right latero-tracheal opacity: Tuberculous adenopathies

14. Man, 20 years old ,
Asymptomatic,
Good condition, HIV -
systematic chest radio.
AFB negative in sputum

15. Right latero-tracheal and precarena space adenopathies. AFB-,
Diagnosis made by mediastinoscopy: epithelioid and gigantocellular granuloma. Culture +

16. Young woman, 22 years old. Weight loss and cough
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

18. African woman, 27 years old. Left cervical adenopathy
Left latero-aortic adenopathies in superior mediastinum

19. Puncture of the cervical adenopathy:
Pus with AFB+

20. Tuberculous right hilar adenopathy

21. Widening of the mediastinum: adenopathies of superior and middle mediastinum
Normal chest x-ray

22. is usefull for diagnosis of adenopaties/
In subcarena and inter tracheo bronchial areas (red arrows) , lateral view
is usefull for diagnosis of adenopaties

23. Rx normale
Lateral view is very usefull for diagnosis of mediastnum adenopathies
in sub carena and inter tracheo bronchial areas

24. Notice mediastinum enlargment
Chest x ray: bilateral adenpathies, nearly symetric. It could be TB adenopathies. In this case it is sarcoïdosis
Right hilar adenopathy. Is there mediastinum associated adenopathies?
Notice mediastinum enlargment

25. 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).

26. Bulky left hilar adenopathy.
Associated mediastinum adenopathies are well visible on the lateral view

27. Normal lateral view

28. Young child, one year old: TB primary-infection
Notice the bilateral adenopathies with inferior lobe atelectasis
(left inferior bronchus compressed by adenopathy )

29. Tuberculous bulky adenopathies. AIDS context
Tuberculous bulky adenopathies. AIDS context. Infiltration into the surrounding lung tissu

30. Tuberculous adenopathies with endo-bronchial fistula (endoscopic view)

31. Fistula in the right para-cardiac bronchus
Fistulas coming from TB adenopathies

32. Tuberculosis / HIV +

33. Tuberculosis with mediastinal adenopathies and pneumonia in a patient with AIDS. AFB++ in sputum

34. is very indicative of Tuberculosis, and often, HIV context.
The association of unilateral or bilateral pneumonia with mediastinal adenopathies
is very indicative of Tuberculosis, and often, HIV context.

35. Normal chest radiography
Adenopathy in left aorto-pulmonary space( and widening of superior mediatinum due to TB adenopathies)
Normal chest radiography

36. Node calcifications: sequela of primary infection

37. Left hilar calcification: sequela of a TB primary infection

38. However, the mediastinal adenopathies are not always tuberculous…

39. Male, poor health condition, smoker, dyspnea Right inferior lobe cancer and metastatic adenopathies (laterotracheal space). Notice the associated emphysema.

41. Small cell carcinoma with bulky mediastinal adenopathies

42. Evolution after 6 cycles of chemotherapy

43. Bronchial cancer with superior vena cava syndrome (No superior vena cava syndrome in tubercular adenopathies)

44. Bronchial cancer with right hilar metastatic adenopathy

45. Man, 60 years old, weight loss and asthenia, cough with hemoptoic sputum. AFB-

46. Right superior bronchus
Bronchial cancer!
Right superior bronchus
Spur infiltrated
by the cancer
normal bronchus

47. Lymphoma (hodgkin disease)

48. Sarcoidosis

49. Trap: mediastinum enlargement in an older woman with cyphoscoliosis

50. Differential diagnosis: vascular bulky hilus: Convergence sign of the hilus

51. Differential diagnosis: posterior overlap sign

52. Differential diagnosis: Posterior overlap sign (2)

53. Differential diagnosis: anterior overlap

54. Differential diagnosis: Anterior overlap sign (courtesy of Dr. Bellamy)

55. anterior overlap