[The lymph node perforation in tuberculosis and its consequences for the course of pulmonary tuberculosis]

After a historic review of the ever changing views concerning the pathogenesis of tuberculosis, a special possibility of extension is closely examined, that is the lymph node perforation into the bronchial system. In the past decades, the importance of this has been commensurately over -- as well as under -- evaluated. Our own examinations are based upon the experience gained by over 20.000 bronchoscopies in the past 25 years. According to the formulations of these examinations, carried out in 3 different groups, the following correlations were determined: The first series, registered during the years 1949-1952, included tuberculosis patients alone. In these series, 5.5% of the bronchoscopically proven changes were of tubercular lymph node perforation. The second series, published in 1961, included the compiling of 350 bronchoscopies performed on 350 cases of tuberculosis in the old age. In these series 11.4% of apparent lymph node perforations were observed. The third series contained 6021 bronchoscopies which were performed during 1970-1975. In this series, the tuberculosis presents only a small percentage of pulmonary diseases. In these cases, 2,9% were revealed as florid or healed lymph node invasions. This percentage would indicate that in cases of tuberculosis, lymph node invasion into the bronchial system means a minimal incidence. However, these figures, which are only based upon bronchoscopically determined findings must be considered, from an anatomical point of view, as the lowest occurrence border. Upon the basis of individual cases, different clinical pictures have been described, whereby these lymph node perforations can be clinically manifested. Consequently, it is this obturation with symptomatic foreign bodies, the atelectasis, which can falsely be diagnosed as a malignant bronchial closure, and also spread and aspiration even as is observed in the pneumonias. Additionally, because of interlobular lymphogenic propagation a similar symptom may be produced. Finally, as a last significant clinical manifestation, bleeding must be mentioned. Such bleeding is caused primarily when a caseous lymph node simultaneously perforates into the bronchial system and into a neighboring blood vessel. Over the past 25 years the clear up of the findings, due to constant improvements in bronchoscopy, have culminated in a method, the importance of which must be necessarily emphasized. This method should be universally utilized as routine examination in pulmonary departments and its neglecting should only be justified in specifically indicated cases.