Abstract:

Objective To investigate the CT features and prognosis of tuberculous lymphatic ruptures in mediastinum and lung in adults. We retrospectively analyzed 52 adult patients with tuberculous lymphatic ruptures in mediastinum and lung in Guangzhou Chest Hospital from January 2009 to December 2017. According to the location of ruptures, the patients were divided into 3 groups:tracheobronchial group with lymph nodes only ruptured to tracheobronchial airway, lung group with lymph nodes only ruptured to the lung, and tracheobronchial-lung group with lymph nodes ruptured into both tracheobronchial airways and lungs. Each group’s CT manifestations and all lymphatic ruptures’ prognosis were summarized and analyzed. There were 84 ruptured lymph nodes in 52 patients. Among them, 19 patients with 23 ruptured lymph nodes were in the tracheobronchial group, 14 of these 23 lymph nodes were with thickened mucous membrane and granulation of the corresponding bronchoedema made nodular protrusion in the airway cavity at the side of the rupture. In the CT enhancement, extension of the necrotic region to the airway could be seen in 13 of them, and 1 was homogeneous enhanced, and among the other 9 lymph nodes in this group, the airway wall close to the fistula was not smooth but with no nodular sign. There were 13 patients with 13 ruptured lymph nodes in the lung group, swollen lymph nodes crossed mediastinum or hilum to pulmonary tissue and formed nodules or masses, with halo sign or patchy shadows surrounding. and with necrotic region extended to the lung tissue in 12 of those lymph nodes after enhanced, and homogeneous enhancement was seen in the other 1. There were 20 patients with 48 lymph nodes ruptured in the tracheobronchial-lung group, which had multiple lymph nodes obviously enlarged in multiple regions in mediastinum and pulmonary hilum, 11 of which ruptured into airway, and 20 ruptured into lung. Under CT enhancement, these lymph nodes had the extension of the necrotic region to the side of fistulas except one homogeneous enhanced, and the airway walls corresponding to the fistula of the other 16 lymph nodes were not smooth but with no nodular sign in this group. After anti-tuberculosis treatment, and treatment under bronchoscope towards the lymph nodes ruptured into airway including taking out the granuloma with forceps, and suction of the necrosis, 33 patients had bronchostenosis at the fistula related remained, and 18 patients had some pulmonary fibrosis at the fistula related in the lung field remained after treatment. TB tuberculous lymphatic ruptures of adults in mediastinum and lung are mostly ruptured to trachea, bronchus and lung. CT plain scan and enhancement is helpful for their early diagnosis. Some therapeutic effect could be found after tuberculosis treatment on most of the ruptured lymph nodes, but some cases will leave bronchial cicatricial stenosis behind.

Key words: Tuberculosis, lymph node, Mediastinum, Lung, Tomography, spiral computed, Diagnostic imaging, Treatment outcome