INTRATHORACIC TUBERCULOUS LYMPHADENOPATHY - CLINICAL AND BRONCHOSCOPIC FEATURES IN 17 ADULTS WITHOUT PARENCHYMAL LESIONS

Background - Whilst intrathoracic lymphadenitis is a characteristic si gn of primary tuberculosis in children, its presence without parenchym al lesions in adults is unusual and makes the diagnosis using noninvas ive techniques difficult. The diagnostic role of bronchoscopy in adult s with intrathoracic tuberculous lymphadenitis is reported. Methods - Seventeen patients with intrathoracic lymphadenopathy seen during 1993 who had all undergone bronchoscopy and had been found to have tubercu losis in the absence of any parenchymal lung lesions were evaluated re trospectively.Results - Right paratracheal lymphadenopathy was observe d on the plain chest radiograph in all the patients. Fifteen of the 17 patients had an endobronchial abnormality and samples taken at bronch oscopy gave a definitive diagnosis in nine (53%) of the 17. Four patie nts had ulcerating endobronchial granuloma and all had biopsy samples positive for tuberculosis. Transbronchial or transcarinal needle aspir ation samples were diagnostic in five of 11 patients (45%) subjected t o the procedure. Peripheral lymph node biopsy diagnosed tuberculosis i n two cases and in the remaining six patients the diagnosis was achiev ed by mediastinoscopy or thoracotomy. Conclusions - Bronchoscopy has a n important role in the diagnosis of intrathoracic tuberculous lymphad enopathy in adults and should be considered before other invasive proc edures.