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Related Experiment Videos

Pseudoazygos lobe caused by lymph node pneumatocele.

Samson Munn1

  • 1Department of Radiology, Lemuel Shattuck Hospital, Boston, MA 02130-3735, USA.

Journal of Thoracic Imaging
|October 4, 2002
PubMed
Summary

Tuberculosis in AIDS patients can cause severe esophageal issues, including rare fistulas. A unique case revealed a lymph node completely filled with air, mimicking an azygos fissure on chest X-rays.

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Area of Science:

  • Medical Imaging
  • Infectious Diseases
  • Pulmonology

Background:

  • Patients with Acquired Immunodeficiency Syndrome (AIDS) have a high incidence of pulmonary tuberculosis, increasing their risk for severe esophageal tuberculosis.
  • Tuberculous esophagitis and esophageal fistulae are known complications, but their frequency in AIDS patients may be underestimated.

Observation:

  • A rare case of tuberculous mediastinal lymphadenopathy in an AIDS patient is presented.
  • CT scans revealed a fistula between a large lymph node and the esophagus.
  • The lymph node's necrotic content was entirely replaced by air, forming a 'lymph nodal pneumatocele', a previously undescribed entity.

Findings:

  • Complete air filling of a large mediastinal lymph node (lymph nodal pneumatocele) secondary to tuberculous fistula in an AIDS patient.
  • This pneumatocele mimicked an azygos fissure on frontal chest radiography, representing a novel cause of false azygos lobe appearance.

Implications:

  • Highlights the importance of considering tuberculosis in AIDS patients presenting with esophageal fistulae.
  • Emphasizes that large lymph nodes can completely "shell out" with air in this context.
  • Warns against mistaking this appearance for a normal variant, crucial for accurate diagnosis and management.

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