RESUMO
OBJECTIVE: To evaluate patients with mediastinal tuberculosis (MT), their demographic profiles, symptoms, radiological features and the role of mediastinoscopy. METHODS: This retrospective study conducted at Bradford Teaching Hospitals, Bradford, United Kingdom, looked at the case notes of 160 (13%) patients with MT out of a cohort of 1252 notifications of tuberculosis (TB) cases from 1995 to 2004, analysing the demographic data, diagnostic findings, computed tomography (CT) scans and outcomes. Interventions included bronchoscopy, lymph node biopsy and mediastinoscopy. RESULTS: Patient age ranged from 1 to 75 years; the majority were females and from minority ethnic groups. Contact history was positive in 76% of cases. Cough was the most common symptom (50%); however, asymptomatic patients were also common (45%). Heaf test was positive in 99%. Right paratracheal lymphadenopathy was common on chest X-ray and chest CT scan. Mediastinoscopy was performed in only 37 patients with definitive diagnosis. CONCLUSION: MT should be suspected in adult asymptomatic immigrants presenting with mediastinal adenopathy and a strongly positive Heaf test. Trial of anti-tuberculosis treatment should be initiated and response should guide further management. Mediastinoscopy is required in only a minority of patients.
Assuntos
Doenças do Mediastino/diagnóstico , Mediastinoscopia , Tuberculose dos Linfonodos/diagnóstico , Adolescente , Adulto , Idoso , Antituberculosos/uso terapêutico , Biópsia , Criança , Pré-Escolar , Busca de Comunicante , Quimioterapia Combinada , Emigração e Imigração , Inglaterra/epidemiologia , Feminino , Hospitais de Ensino , Humanos , Lactente , Masculino , Doenças do Mediastino/tratamento farmacológico , Doenças do Mediastino/etnologia , Doenças do Mediastino/microbiologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Teste Tuberculínico , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose dos Linfonodos/etnologia , Tuberculose dos Linfonodos/microbiologia , Adulto JovemRESUMO
In this report, we describe a case of domestically acquired particulate lung disease (DAPLD) or "hut lung" in a 59-year-old woman of Moroccan descent who emigrated to the Netherlands, having lived in an rural area for most her life. She presented with obstructive lung disease and with signs of mediastinal fibrosis which were shown to be caused by massive enlargement of mediastinal lymph nodes. To the best of our knowledge, this is the first case of DAPLD from Morocco and the first report of a case of DAPLD mimicking mediastinal fibrosis.
