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Mediastinal tuberculosis in a 10-month-old child
A Ahmed1, S Mirza, M P Rothera
1Department of Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK. aftabahmed1@hotmail.com
Insights
Mediastinal tuberculosis is a rare condition that can mimic an inhaled foreign body in children. This case highlights the importance of considering tuberculosis in the differential diagnosis of pediatric airway obstruction.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Thoracic Surgery
Background:
- Mediastinal tuberculosis is an uncommon presentation of Mycobacterium tuberculosis infection.
- Symptoms of upper airway obstruction in children can be misdiagnosed.
- Tuberculosis incidence is increasing globally, necessitating awareness of its diverse clinical manifestations.
Observation:
- A 10-month-old girl presented with chronic cough, wheeze, and feeding difficulties, initially suspected as asthma.
- Clinical deterioration and imaging suggested an inhaled foreign body, but bronchoscopy was negative.
- Subcarinal mediastinal mass was discovered, later confirmed as tuberculous.
Findings:
- Histological analysis of the excised mediastinal mass confirmed tuberculous origin.
- The case underscores the need to consider mediastinal tuberculosis in pediatric airway obstruction when foreign bodies are not identified.
- Otolaryngologists must be vigilant for varied presentations of tuberculosis and ensure proper specimen analysis.
Implications:
- This case expands the differential diagnosis for pediatric upper airway obstruction.
- Increased awareness of mediastinal tuberculosis is crucial for timely diagnosis and treatment.
- Prompt identification and management of pediatric tuberculosis can prevent severe complications.
Abstract:
We report a rare case of mediastinal tuberculosis in a child who presented as a possible inhaled foreign body. A 10-month-old girl was admitted with a five-month history of cough, wheeze and problematic feeding, thought initially to be due to asthma. A clinical deterioration and subsequent X-rays suggested an inhaled foreign body. However, at direct laryngotracheobronchoscopy no foreign body was found and subsequent investigations revealed a subcarinal mediastinal mass. She underwent a thoracotomy and excision of the mass, the histological analysis of which revealed it to be of tuberculous origin. When a patient presents with symptoms of upper airway obstruction which are highly suggestive of a foreign body, other causes such as mediastinal tuberculosis must be borne in mind when no foreign body can be found. Although rare, cases of tuberculosis are apparently increasing and the otolaryngologist must be aware of its various manifestations and submit specimens for appropriate analysis. We also briefly review mediastinal lymphadenopathy due to tuberculosis.