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Decompression of enlarged mediastinal lymph nodes due to mycobacterium tuberculosis causing severe airway obstruction

Pierre Goussard1, Robert P Gie1, Jacques T Janson2

  • 1Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town.

The Annals of Thoracic Surgery
|March 2, 2015
PubMed

Insights

Tuberculosis lymph node decompression is a safe and effective procedure for children with severe airway obstruction. This intervention offers low rates of complications, failure, and death.

Area of Science:

  • Pediatric Pulmonology
  • Thoracic Surgery
  • Infectious Diseases

Background:

  • Enlarged tuberculosis (TB) lymph nodes can cause life-threatening airway obstruction in children.
  • Indications, safety, and efficacy of TB lymph node decompression are not well-documented.
  • This study addresses the need for data on TB lymph node decompression in pediatric airway compression.

Purpose of the Study:

  • To describe indications for TB lymph node decompression in children with severe airway compression.
  • To evaluate the efficacy of TB lymph node decompression.
  • To identify factors influencing outcomes of the procedure.

Main Methods:

  • Prospective cohort study of children (3 months–13 years) with airway obstruction from TB lymph nodes.
  • Airway obstruction assessed via bronchoscopy and chest CT scans.
  • Transthoracic lymph node decompression performed when indicated.

Main Results:

  • 34% of 250 children required lymph node decompression, often after failed medical treatment.
  • Compression of the bronchus intermedius and left main bronchus predicted need for decompression.
  • Decompression had low complication (8%), failure (2%), and zero fatality rates.

Conclusions:

  • Approximately one-third of pediatric TB cases with severe airway obstruction necessitate lymph node decompression.
  • Transthoracic decompression is a safe procedure with minimal adverse events.
  • The study confirms the safety and efficacy of this intervention for pediatric airway obstruction due to TB lymph nodes.
Abstract

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