Tuberculosis of intrathoracic lymph nodes: diagnosis, forms of disease

Tuberculosis of the intrathoracic lymph nodes is a form of a disease that has not yet been fully classified. Some believe that it can be attributed to independent diseases, others believe that it should be left as part of the primary tuberculosis complex. We will talk about this ailment in our article. Let us examine in detail the causes of the disease, its forms, diagnostic methods and methods of treatment, as well as possible complications and preventive measures.

What it is?

Tuberculosis of the intrathoracic lymph nodes (VGLU) is a disease characterized by the onset of inflammatory processes of the lymph nodes located in the region of the lung root. Cause pathology of microbacterium tuberculosis. The causative agent can be transmitted through infected animals.

Tuberculosis of VGLU most often affects children, adolescents and young people under 25 years old. Thanks to mass vaccinations, there are practically no epidemics, cases of infection are rare and occur only with a decrease in immunity. This pathology is characterized by a chronic course with prolonged persistence of degenerative processes. 70% of complications of the disease occur in children under three years old.

Method of infection

All forms of tuberculosis of the intrathoracic lymph nodes in humans are caused by the bacterium Mycobacterium tuberculosis.

Infection occurs in the following ways:

• Because of the consumption of food obtained from a sick animal (for example, cow's milk).
• Airborne droplets from an infected person or animal.
• Through household items and foods contaminated with bacteria.
• Through wounds on the skin.
• Can be transmitted from mother to child during pregnancy (through the placenta) or lactation (with milk).

Most likely is infection through the respiratory tract. A person with tuberculosis, constantly during a cough and conversation, exhales into the air phlegm, which contains hostile microorganisms. They are able to spread to a distance of up to two meters and remain in the air for an hour. Then they settle on the floor and mix with dust, while their viability remains for up to a month and a half.

What increases the likelihood of infection?

The respiratory organs of a healthy person are protected from tuberculosis, but smoking and bronchopulmonary diseases can reduce this immunity. In 95% of cases with the first contact with a tuberculosis bacterium, there is no infection.

Factors that increase the likelihood of infection:

• Inadequate and unbalanced nutrition.
• Prolonged exposure to infected tuberculosis.
• Poor living conditions.
• Presence of chronic diseases.
• Great physical and mental stress.

Usually, the infected one of these items, or even several, includes a medical history. Tuberculosis of the intrathoracic lymph nodes therefore affects people with bad habits that suffer from chronic fatigue, as well as children from dysfunctional families. Infection is almost impossible to notice, besides a healthy organism immediately begins to form a natural immunity. Where there was a patient, several people can pass a day, but only one will become infected, whose body will not be ready to defend. At risk are children and adults who have not been vaccinated, as well as people with HIV infection and people with weak immunity.

Forms of the disease

There are following forms of tuberculosis of intrathoracic lymph nodes:

• Tumor-like.
• Infiltrative.
• Small.

Tumor is a severe form of bronchoadenitis. It often occurs in young children with a strong increase in lymph nodes (their diameter can reach up to 5 cm) and massive tubinfication. Often, the affected nodes are soldered, forming a single conglomerate.

Infiltrative form causes a slight increase in lymph nodes, with perinodular inflammation predominant.

Small form

The small form of tuberculosis of the intrathoracic lymph nodes is difficult to detect, and it affects mostly children. Late diagnosis or unrecognized leads to cicatricial changes in the mediastinum, which affects the normal functioning of the capillary pulmonary blood flow. Also, pathology can cause more serious and dangerous forms of tuberculosis.

To conduct the correct diagnosis and to identify the disease, it is necessary to take into account the whole complex of radiographic and endoscopic data, and it is also necessary to perform a mediastinal tomography.

Problems of diagnostics of small form

Even in the active phase, a small form of tuberculosis of the intrathoracic lymph nodes is characterized by the defeat of 1-2 lymph nodes with a small increase (up to 1.5 cm). These signs can be seen on an x-ray.

Clinical symptoms are very poorly expressed. Presented usually only by subfebrile and intoxication syndrome. In adolescence, the main complaint is vegetovascular dystonia. Therefore, patients are often sent for examination to doctors of a different profile. In this case, the small form of tuberculosis is dangerous because the disease can lead to the defeat of other internal organs.

Symptoms

Tuberculosis of the intrathoracic lymph nodes has the following symptoms:

• The body temperature rises to 39 degrees.
• At night, there is an incomprehensible sweating, that is, caused not by heat.
• Appetite worsens.
• A cough begins, similar to the one that appears with whooping cough.
• Strong pale skin, up to a bluish hue.

However, these signs may be mild, then it will be extremely difficult to make an accurate diagnosis of them. But in the process of inspection, other signs can be revealed:

• Visual. Peripheral venous mesh considerably widens in the first and second intercostal spaces. Between the scapula small vessels expand in the upper sections.
• Palpatory. Appearance of painful sensations under pressure on the spinous processes of the thoracic vertebrae (from the 3rd to the 7th).

Important in the diagnosis of tuberculosis is an x-ray study. It is carried out in this case in the lateral and anteroposterior projections, since the shadow of the lymph nodes may be hidden by the organs of the mediastinum and the heart muscle. It is also important to carry out tomography of the tracheobronchial tree. But we'll talk about this in more detail later.

Diagnostics

It is very difficult to distinguish tuberculosis of the intrathoracic lymph nodes from other similar pathologies. Differential diagnosis is needed here as with no other disease.

So, where does the diagnosis begin?

The first step is to identify the presence of mycobacterium tuberculosis in the body. Tuberculosis bacilli can easily be found in the gastric lavage. Most often they are found in the washing waters of bronchi, sputum.

Next is the mandatory conduct of an X-ray study. Using it, you can not only determine if a person is infected, but also to understand how long it has been infected. Also a good method of tomography, which allows you to analyze the structure of lymph nodes, which seriously makes it easier for doctors to make a diagnosis.

An important diagnostic method is the Mantoux test. With a positive result, it is also called a "turn". In this case, the reaction of the infected to the injection made will be the next - the site of the injection will increase by more than 5 mm. "Virage" is diagnosed in the following cases:

• The papule (the place of compaction) becomes larger than 0.5 cm.
• There is much more in comparison with the previous results.
• Exceeds the norm by 17 mm without considering the prescription of the previous vaccination.
• After 3 years, its size remains more than 12 mm.

However, not always a positive result Mantoux says about the infection. There is a possibility that the cause of such a reaction may be an allergy or a previous illness. Also, not always a negative test indicates the absence of infection. False negative result can be caused by immunodeficiency or by the fact that 10 weeks have not passed since the moment of infection.

However, the "turn" is a sufficient basis for continuing further investigation.

Also in the diagnostic activities make a blood test. When MTB is infected, the number of leukocytes, lymphocytes, neutrophils, eosinophils will be slightly increased.

Differential diagnosis of tuberculosis of intrathoracic lymph nodes

When making a diagnosis, tuberculosis of VGL often has to be differentiated from other tuberculous pathologies. To do this, the doctor should carefully study the history, identify the likelihood of contacts with bacillary patients, analyze tuberculin samples, consider all previous illnesses that could be associated with infection.

In addition to the possibility of confusing tuberculosis VGLU with another type of tuberculosis, there is still a chance not to distinguish it from diseases of the intrathoracic lymph nodes.

There is also the possibility of confusing pathology with metastases that have arisen due to lung cancer and lymphosarcoma. However, this probability appears only in older patients.

Methods of treatment

Tuberculosis of the intrathoracic lymph nodes in children and adults is almost the same, therefore, therapy is appointed with minimal differences.

Treatment of this type of tuberculosis is quite long. On average, therapy can take anywhere from 10 months to a year and a half. At the same time, the patient should be in the TB hospital for the first 2-3 months. First, not to infect others. Secondly, for more effective treatment.

All this time complex therapy is being carried out, which includes drugs against tuberculosis, hepatoprotectors, vitamins, immunomodulators.

Also in the first weeks with advanced stages of the disease, chemotherapy can be performed. Together with her, various procedures for cleansing the body are usually prescribed. For example, intravenous laser irradiation of blood or plasmapheresis.

Treatment of tuberculosis VGLU is divided into two stages. During the first intensive treatment is carried out, which is aimed at destroying the MBT, restoring the damaged pulmonary tissues during the period of illness and preventing complications. Therapy against tuberculosis includes the combination of several drugs that are capable of exterminating all varieties of MBT. The second stage is not so intense. Here the main thing is to prevent the repeated development of pathology, to promote the healing of tissues, to destroy the remaining harmful microbacteria and to strengthen immunity.

During the whole treatment it is recommended to follow a special diet that will help to reduce intoxication of the body and increase resistance to infections. The diet necessarily includes food with a high protein (eggs, meat, dairy), cream and olive oil, honey, cereals, vegetables and fruits with a lot of vitamin C.

Surgical intervention

Tuberculosis of the intrathoracic lymph nodes rarely leads to the need for surgical intervention, since the disease is extremely calm, almost asymptomatic.

There are basically two main reasons for surgery:

• The beginning of the formation of tuberculoma of the lymph nodes.
• Absence of any positive results of treatment, which was started more than six months ago.

Possible complications

Let's list possible complications of tuberculosis of intrathoracic lymph nodes:

• Formation of glandular bronchial fistula due to severe bronchial involvement.
• Because of the complete disruption of bronchial patency, which occurs when the bronchus is compressed by massive lymph nodes or by blocking them with caseous masses, there is often a collapse of the lobe, atelectasis of the part of the lung located above the center of compression or blockage.
• Total or focal atelectasis (collapse of a part or lobe of the lung).

Preventive measures

Tuberculosis of the intrathoracic lymph nodes, the diagnosis of which was examined in detail above, refers, like all other types of tuberculosis, to "social diseases". That is, its emergence directly depends on housing conditions and the level of prosperity. In Russia, the causes of epidemiological trouble in this pathology is a sharp deterioration in living standards, a decline in the quality of socio-economic conditions, a rapid increase in the number of citizens without a fixed residence, and the active resumption of migration processes.