Differential diagnosis of tuberculosis of the intrathoracic lymph nodes in children and adolescents

Case histories and clinico-roentgenologic symptoms of 103 children with intrathoracic lymphatic tuberculosis and 66 with non specific intrathoracic adenopathies were analysed. As a result, considerable differences were revealed both in the natural history of intrathoracic adenopathies of tuberculous and nonspecific etiology and in the clinical symptoms and X-ray picture, making it possible to ascertain a nosologic diagnosis of the disease. A diagnosis-rating table for the most common diseases with underlying hyperplasia of the intrathoracic lymph nodes has been developed.     

Computed tomography in the diagnosis of intrathoracic lymph nodes tuberculosis in children

Computed tomography (CT) was used to examine 48 children aged 3 to 14 years; among them 15 patients were studied for small tuberculosis of intrathoracic lymph nodes (ITLN), 33 for infiltrative and tumorous forms, 19 infected with Mycobacterium tuberculosis with progressive positive hyperergic tuberculin reactions or with its variations. Chest CT study of children with ITLN tuberculosis established the precise site of lymph nodal involvement, evaluated the lymph nodes based on their density, homogeneity, the presence of liquid and solid caseous portions, cavities, calcifications, and the affection of the adjacent mediastinal organs. CT data were used to make a differential diagnosis of bulky mediastinal formations regarded as ITLN tuberculosis. It is recommended to consider CT as the method of choice in the complex X-ray examination of children with ITLN tuberculosis.     

儿童胸内淋巴结结核CT诊断分析

目的分析胸内淋巴结结核CT表现。方法对我院诊治120例胸内淋巴结结核进行分析。结果胸CT表现：肺门区淋巴结肿大共76例,右侧52例,左侧6例,双侧18例,炎症型37例,结节型39例,可发生在肺门上、中、下部。右肺门上部淋巴结肿多在上叶支气管分叉附近,中部淋巴结多在右肺动脉分叉附近,下部淋巴结在右肺下动脉干周围,伴有肺内播散8例。气管旁淋巴结肿大共44例,右侧40例,左侧3例,双侧1例,炎症型16例,结节型28例。结论儿童胸内淋巴结结核CT表现复杂,需认真分析,密切结合临床及实验室检查,可做出正确诊断。     

Tuberculin sensitivity in children at the time of diagnosis of tuberculosis of intrathoracic lymph nodes

Trends in RM with 2 TU PPD-L were analysed in 71 children at the time of detection of tuberculosis of intrathoracic lymph nodes (TITLN). The disease is often diagnosed in children getting infected with tuberculosis infection. Monotonous tuberculin tests represent the most frequent variant of tuberculin allergy at the time of TITLN diagnosis in children. Careful follow-up of children with monotonous RM (2 TU) may improve TITLN outcomes.     

Diagnosis and treatment of tuberculosis of peripheral lymph nodes in children and adolescents

Among lymphadenopathies of different etiology, tuberculosis of peripheral lymph nodes was detected in 28% of cases in children and adolescents, as shown by our data. In its diagnosis in the children, the most informative methods include a morphological study of lymph node biopsy specimens and the results of experimental treatment. History data, clinical findings, and tuberculin diagnosis were also of great importance in verifying the disease. Lymphotropic administration of antituberculosis agents in patients with tuberculosis of peripheral lymph nodes enhances the efficiency of chemotherapy.     

Strategy of the management of children with lesions of intrathoracic lymph nodes during the calcinosis phase

To verify the diagnosis of tuberculosis of the intrathoracic lymph nodes (paraaortal group) in calcination phase in hospital setting using tuberculin diagnosis, tomography, immunological and serological tests, clinical examination, epidemiological history, 70 children aged 3-15 years were examined. It was found that 58.6% of the children had 2-3 signs of tuberculosis activity. Therefore, they need 6-month antituberculous treatment in the sanatorium. 35.7% had no signs of active tuberculosis and can be followed up outpatiently. 5.7% exhibited more than 5 signs of tuberculosis activity and must be treated basically for 8-10 months in hospital.