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Surgical treatment of childhood mediastinal tuberculous lymphadenitis
J Freixinet1, A Varela, L Lopez Rivero
1Thoracic Surgery Service, Nuestra Señora Del Pino Universitary Hospital, Las Palmas de Gran Canaria, Canary Islands, Spain.
Insights
Tuberculosis-related enlarged mediastinal lymph nodes can cause severe airway obstruction in children. Surgical intervention, alongside drug therapy, effectively resolves these tracheobronchial complications with no reported complications.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Surgical Oncology
Background:
- Enlarged mediastinal lymph nodes secondary to tuberculosis (TB) can cause significant complications in children.
- These complications include bronchial obstruction and severe tracheal/esophageal stenosis.
- Diagnosis often requires radiologic, endoscopic, and pathologic evaluation.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical intervention as an adjunct to medical management for tracheobronchial complications of pediatric mediastinal tuberculous lymphadenitis.
- To assess the outcomes in children requiring invasive procedures for TB-related lymph node complications.
Main Methods:
- Retrospective review of 6 children (2 months to 3 years) treated between 1985-1991.
- Patients received a standard 6-month anti-TB drug regimen (isoniazid, rifampicin, pyrazinamide).
- Surgical procedures included thoracotomy (curettage/excision), lobectomy with bronchoplasty, or endoscopic resection.
Main Results:
- All 6 children showed radiologic and endoscopic resolution of lesions.
- Four patients had bronchial involvement with obstruction; 2 had tracheal/esophageal stenosis.
- No postoperative morbidity was observed.
- Pathology confirmed granulomas with caseous necrosis and Langhans' giant cells.
Conclusions:
- Surgical treatment, as a coadjuvant therapy for tracheobronchial complications from mediastinal tuberculous lymphadenitis, leads to lesion resolution.
- This combined approach is safe and effective in pediatric patients, with no related morbidity.
- Early and aggressive management, including surgery, is crucial for complex pediatric TB cases.
Abstract:
Between 1985 and 1991, we treated 6 children, aged 2 months to 3 years, who required an invasive procedure for the management of complications caused by enlarged mediastinal lymph nodes secondary to tuberculosis. Radiologic and endoscopic studies revealed bronchial involvement by lymph nodes, with endobronchial granulomas and lobar or pulmonary obstruction in 4 patients and marked tracheal and esophageal stenosis produced by extrinsic compression in the remaining 2. Pathologic study of the lymph node or bronchial samples from the 6 patients disclosed granulomas with caseous necrosis and Langhans' giant cells. All the children were treated with a standard 6-month drug regimen consisting of isoniazid, rifampicin, and pyrazinamide. Five of the patients underwent thoracotomy for the purpose of nodal curettage or excision. In 1, upper right lobectomy and bronchoplasty were necessary. The sixth patient was treated by endoscopic resection of the granulomas. There was no postoperative morbidity, and radiologic and endoscopic evidence of resolution of the lesions was observed in all the patients. In our experience, surgical treatment, when performed as a coadjuvant treatment for tracheobronchial complications stemming from mediastinal tuberculous lymphadenitis, results in the resolution of the lesions and has no related morbidity.