Intrathoracic lymph node tuberculosis in pulmonological practice: clinical case

Intrathoracic lymph node tuberculosis (ITLNTB), or tuberculous bronchoadenitis, is increasingly diagnosed in middle aged patients in the era of spreading human immunodeficiency virus (HIV) infection. The difficulty of early diagnosis lies in the absence of specific symptoms at the initial stages of the disease. Often, the diagnosis can be verified only after complications develop.

The aim of the study was to analyze a clinical case of diagnosing ITLNTB in the practice of a pulmonologist.

Methods. The article presents the results of general clinical, laboratory, and instrumental research methods, and other materials of a patient with a long previous history of respiratory symptoms.

Results. According to the results of the diagnostic minimum at the initial examination, no data for tuberculosis were found, and the antibacterial therapy for 7 days had no effect. Intoxication syndrome persisted. Computed tomography (CT) of the chest organs detected fistulas from the paratracheal lymph nodes to the esophagus and bronchi. Mycobacterium tuberculosis was detected in the bronchoalveolar lavage fluid using the Ziehl – Neelson staining method.

Conclusion. Despite the modern extensive diagnostic capabilities, such as CT, fibrobronchoscopy (FBS), and fibrogastroduodenoscopy, the diagnosis of tuberculosis is still highly challenging due to the numerous “masks”, long-term latent development of symptoms, and clinical manifestations only with the development of a fistula. FBS is recognized as the primary method for diagnosing tuberculosis of the trachea and bronchi. It not only visualizes the mucosal lesion, but also allows obtaining material for microbiological and histological examination.

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