Kanaji N, Junichiro H, Naokatsu H, Yutaro S, Shigeo I
Department of Internal Medicine, Kure Kyosai Hospital, 2-3-28 Nishichuo Kure, Hiroshima, 737-8505, Japan.
Nihon Kokyuki Gakkai Zasshi. 2001 Nov;39(11):857-61.
A 40-year-old woman was admitted to the hospital with general fatigue and cough. Chest CT films revealed mediastinal lymphadenopathy with multiple low density areas, but no pulmonary lesions. There were no abnormal findings on neck, abdominal or pelvic CT. A PPD skin test was strongly positive, but M. tuberculosis bacilli were not found in the sputum. Mediastinal tuberculous lymphadenitis was diagnosed histologically and bacteriologically from specimens obtained by mediastinoscopy. Fiberoptic bronchoscopy did not reveal tracheobronchial tuberculosis. Follow-up chest CT three months after the start of antituberculosis chemotherapy with isoniazid, rifampicin and ethambutol hydrochloride showed that the mediastinal lymph nodes were decreased in size. Mediastinal tuberculous lymphadenitis in adults is rare, but the number of reports has increased. Mediastinal tuberculous lymphadenitis in adults must be distinguished from other causes of mediastinal masses. In this case, mediastinoscopy was very useful for differential diagnosis.
一名40岁女性因全身乏力和咳嗽入院。胸部CT片显示纵隔淋巴结肿大，有多个低密度区，但无肺部病变。颈部、腹部或盆腔CT未发现异常。结核菌素皮肤试验呈强阳性，但痰中未发现结核杆菌。通过纵隔镜检查获取的标本经组织学和细菌学诊断为纵隔结核性淋巴结炎。纤维支气管镜检查未发现气管支气管结核。开始使用异烟肼、利福平及盐酸乙胺丁醇进行抗结核化疗三个月后的胸部CT随访显示，纵隔淋巴结大小缩小。成人纵隔结核性淋巴结炎较为罕见，但报告数量有所增加。成人纵隔结核性淋巴结炎必须与纵隔肿块的其他病因相鉴别。在本病例中，纵隔镜检查对鉴别诊断非常有用。
