Radiological changes post-lymph node enucleation for airway obstruction in children with pulmonary tuberculosis

Maydell A. ; Goussard P. ; Andronikou S. ; Bezuidenhout F. ; Ackermann C. ; Gie R. (2010)


Background: Tuberculous lymphadenopathy causing airway obstruction in children may be life threatening and may require surgical enucleation of the lymph glands. There are no studies investigating the radiological picture post-enucleation. We attempt to explore this area in our study. Method: A retrospective study of the imaging in 21 paediatric cases having undergone tuberculosis (TB) lymph node enucleation. Results: Bronchus intermedius (BI) stenosis was present in 95% of patients undergoing enucleation, followed by left main bronchus (LMB) (81%) and right main bronchus (RMB) (67%) stenosis. Right lung collapse/consolidation occurred more frequently (48-62%) than left-lung collapse/consolidation (10-14%). Resolution of BI stenosis and right lower lobe (RLL) collapse/consolidation is the most consistent postoperative finding. Nine children resolved at an average time of 6.5 months postoperatively, while 10 children were still resolving at an average time of 4.5 months. Conclusion: The resolution of the complications of lymph node enlargement (airway stenosis and lung collapse/consolidation) was seen more frequently than the resolution of the offending lymphadenopathy itself. Right-sided disease was necessary to produce complications severe enough to require enucleation. Subcarinal lymph node enucleation is sufficient for resolution of LMB stenosis and associated left-lung sequelae. © 2010 European Association for Cardio-Thoracic Surgery.

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