Bircan H Ahmet, Bircan Sema, Oztürk Onder, Ozyurt Songül, Sahin Unal, Akkaya Ahmet
Department of Chest Diseases, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
Tuberk Toraks. 2007;55(4):409-13.
Anthracotic pigmentation in the bronchial mucosa has been regarded as a bronchoscopic finding of pneumoconiosis or evidence of heavy atmospheric soot. Anthracotic pigmentation with bronchial narrowing or obliteration, surrounded by calcified or noncalcified lymph nodes is typical finding of anthracofibrosis. There is a potential relationship between bronchial anthracofibrosis and tuberculosis. Tuberculous lymphadenopathy of superior mediastinum presentation with hoarseness is very rare. The paper reports a case of tuberculous mediastinal lymphadenitis with anthracosis causing vocal cord paralysis. A 66-year-old woman was admitted to our clinic with the symptoms of dry cough, hoarseness, malaise, anorexia, night sweats and with the multiple mediastinal lymphadenopathy. Fiberoptic bronchoscopy revealed left vocal cord paralysis, bronchial mucosal inflammation and multiple anthracotic plaques. Bronchial lavage and mucosal biopsy were negative for malignancy and tuberculosis. The thoracotomy was performed and a mediastinal lymph node showing caseating granulomatous inflammation with anthracosis and parenchymal anthracosis were detected. The diagnosis of anthracosis and mediastinal tuberculous lymphadenitis was made and the patients put on antituberculous treatment. But she unfortunately died in the second month of the treatment because of the abdominal complication of gastric adenocarcinoma operation.
支气管黏膜的炭末沉着症被视为尘肺病的支气管镜检查表现或大气中煤烟严重的证据。伴有支气管狭窄或闭塞、周围有钙化或未钙化淋巴结的炭末沉着症是炭末纤维化的典型表现。支气管炭末纤维化与结核病之间存在潜在关系。上纵隔结核性淋巴结病伴声音嘶哑的情况非常罕见。本文报告一例结核性纵隔淋巴结炎合并炭末沉着症导致声带麻痹的病例。一名66岁女性因干咳、声音嘶哑、乏力、厌食、盗汗以及多发纵隔淋巴结病入住我院。纤维支气管镜检查显示左侧声带麻痹、支气管黏膜炎症和多发炭末沉着斑。支气管灌洗和黏膜活检未发现恶性肿瘤和结核。进行了开胸手术，发现一个纵隔淋巴结呈现干酪样肉芽肿性炎症合并炭末沉着症以及实质炭末沉着症。诊断为炭末沉着症和纵隔结核性淋巴结炎，并对患者进行抗结核治疗。但不幸的是，她在治疗的第二个月因胃腺癌手术的腹部并发症死亡。
