SURGICAL-TREATMENT OF CHILDHOOD MEDIASTINAL TUBERCULOUS LYMPHADENITIS

Between 1985 and 1991, we treated 6 children, aged 2 months to 3 years , who required an invasive procedure for the management of complicatio ns caused by enlarged mediastinal lymph nodes secondary to tuberculosi s. Radiologic and endoscopic studies revealed bronchial involvement by lymph nodes, with endobronchial granulomas and lobar or pulmonary obs truction in 4 patients and marked tracheal and esophageal stenosis pro duced by extrinsic compression in the remaining 2. Pathologic study of the lymph node or bronchial samples from the 6 patients disclosed gra nulomas with caseous necrosis and Langhans' giant cells. All the child ren were treated with a standard 6-month drug regimen consisting of is oniazid, rifampicin, and pyrazinamide. Five of the patients underwent thoracotomy for the purpose of nodal curettage or excision. In 1, uppe r right lobectomy and bronchoplasty were necessary. The sixth patient was treated by endoscopic resection of the granulomas. There was no po stoperative morbidity, and radiologic and endoscopic evidence of resol ution of the lesions was observed in all the patients. In our experien ce, surgical treatment, when performed as a coadjuvant treatment for t racheobronchial complications stemming from mediastinal tuberculous ly mphadenitis, results in the resolution of the lesions and has no relat ed morbidity.