Thoracic "fantom opacity"

The etiology of the respiratory distress syndrome is dominated by tpulmoner ay edema and the septic shock. We report a rare etiology of a respiratory d istress secondary to a rupture of a well treated tuberculous latero-trachea l adenopathy. A 24-year-old woman was treated a year ago for a peripheral a nd mediastinal ganglial tuberculosis confirmed by the biospy of a left supr a clavicular adenopathy, by two months of isoniazid-rifampicin-pyrazinamid- ethambutol and seven months of isoniazid-rifampicin. The patient completed 9 month treatment with a goon clinical and radiology course. Two months aft er slopping the antibacilar treatment, the patient was admitted to an inten sive care unit with a respiratory distress syndrome requiring both intubati on and artificial ventilation. The bronchial aspiration brought back plain pus. The telethorax from admission was normal and the retrospective history suggested the diagnostic of a ganglio-bronchial fistula which was confirme d by bronchial fibroscopy demonstrating right latero-tracheal fistula. The course was goon with recovery of consciousness on the seventh day. Direct b acilloscopies and culture were negative. The digestive fibroscopy was norma l. Finally, fistulization of a tuberculous adenopathy must be considered am ong the etiologies of respiratory distress even in a patient appropriately treated for mediastinal ganglial tuberculosis.