Clinical Features in Primary Mediastinal Tuberculous Lymphadenitis

Ahn, Cheol Min; Kim, Hyung Joong; Yoo, Kwang Ha; Park, Kwang Ju; Kim, Sung Kyu; Lee, Won Young

Abstract

BACKGROUND: Tuberculous mediastinal lymphadenitis(TML) is a relatively commonly encountered in Korea. However, there were no datas available on TML without other combined tuberculous infections in Korea. We retrospectively analyzed clinical manifestations, radiologic findings, Chest CT scan findings, the duration of treatment, and follow up Chest CT scan findings of 23 cases who had only TML. METHOD: 23 cases from 1991 to 1997 with TML confirmed by biopsy and had no other combined tuberculous infections were studied retrospectively.
RESULTS
Of the 23 cases, 7 cases were male and 16 female. The male to female ratio was 1:2.4. Mean age was 31 years and the most prevalent age group was the 3rd decade(43%). The most common presenting symptoms were fever(39%) followed by no symptom, cough, swallowing difficulty, and chest discomfort. On simple chest X-ray, mediastinal enlargement were noted in 20 cases(90%). The most frequently involved site was the paratracheal node in 11 cases with the right to left side involvement ratio being 4.6:1. On chest CT scan, the most commonly enlarged node was the paratracheal node(33%) followed by the subcarinal(20%), hilar(13%), tracheobronchial(8%), subaortic(8%), supraclavicular(8%) and ant. mediastinal nodes. 6 cases were dropt out due to incomplete follow up. 13 cases were treated with HERZ regimen and the mean durations of treatment was 14 months. Three cases were treated with a 2nd line drug regimen(Tarivid, Pyrazinamide, Streptomycin plus Ethambutol or Para-aminosalicylic acid) for 18 months. In HERZ groups, one case was recurred after 10 months later and retreatment was done by same HERZ regimen during 12 months. Follow up chest CT scan after completion of treatment were done in 13 cases and that revealed more than a 50% decrease in size in 77% of the cases and no interval change in 23% of the cases.
CONCLUSION
In cases of TML without other combined tuberculous infection, the minimal duration of treatment was required 12 months by HERZ regimen and 18 months by a 2nd line regimen or more. Further studies will be needed to confirm the treatment duration for TML without other combined tuberculous infections.