成人纵隔淋巴结结核16例临床分析

目的探讨纵隔淋巴结结核的临床表现。方法总结自1999年1月~2004年12月收治并确诊为成人纵隔淋巴结结核的16例患者的临床症状、体征、辅助检查及诊断要点。结果16例患者中,男10例,女6例,年龄22~63岁,平均41.25±21.2岁。诊断依据是16例患者有不同程度发热、咳嗽、消瘦、乏力等结核中毒症状。8例(50%)有浅表淋巴结肿大,活检或穿刺病理确诊。16例经胸部CT扫描,肿大淋巴结位于右纵隔8例,左纵隔4例,双侧纵隔4例,12例行增强CT扫描有环形强化表现,占75%,其中2例合并腹膜后淋巴结亦呈环形强化表现。13例行PPD试验(5u)的患者中有12例(92.3%)阳性(8例强阳性,2例中度阳性,2例弱阳性),仅1例阴性。血沉12例增快,4例正常。12例经病理确诊,其中7例淋巴结活检病理证实,1例经淋巴结穿刺病理证实,1例经胸腔镜活检病理证实,1例经支气管镜TBLT活检病理证实,1例经纵隔镜活检病理证实。1例误诊为食道平滑肌瘤而手术病理为肉芽肿改变,凝固性坏死,经验性抗结核治疗有效明确诊断。结论成人纵隔淋巴结结核少见,并易误诊为其它疾病,但结合临床仔细体检发现浅表肿大淋巴结并活检,胸部增强CT扫描有环形强化,结合结核毒血症状、PPD试验和血沉等指标诊断并不困难。疑难病人可行纵隔镜或胸腔镜病理活检明确诊断。

Adult's mediastinal tuberculous lymphadentis: a report of 16 cases

Objective To investigate the clinical characteristics of mediastinal tuberculous lymphadenitis.Methods WT6BZA total of 16 cases, treated between January 1999 and December 2004, were analyzed.Results There were 10 males and 6 females in this group, ranging between 23 and 63 years old (mean age=41.25). 16 cases had one or more tuberculous toxic syndrome. 8 cases (50%) were pathologically diagnozed by enlarged nodes. 16 cases were performed by CT scan. There were 8 cases of only right mediastinum, 4 of left side, and 4 were bilaterally involved. 12 cases were performed by enhanced CT scan, and all showed peripheral rim enhancement. PPD (5U) were performed in 13 cases. 12 cases were positive, only 1 was negative. ESR was quick with 12 cases, and 4 cases were normal. 12 cases pathologically diagnozed: 8 by enlarged nedes, 3 by bronchoscopy and mediastinoscopy. 1 by surgery.Conclusion Mediastinal lymphatic tuberculous is a rare disease and easily misdiagnosed in adults. But it is not difficult to diagnose the disease if physical examination were performed carefully to find enlarged nodes, and peripheral rim enhance can be seen by enhanced CT scan. PPD test and ESR or tuberculous toxic syndrome are also important. Mediastinoscopy is of great value to diagnose mediastinal tuberculous lymphadenitis in adults.