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Superior Vena Cava Syndrome in a Primary Tuberculosis of Mediastinal Lymph Nodes FREE TO VIEW

Emilia Tabacu, PhD; Roxana Nemes*, PhD; Mihaela Mitrea, MD; Emilia Crisan, PhD; Nicolae Galie, PhD
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Institute of Pulmonology, Bucharest, Romania

Chest. 2012;142(4_MeetingAbstracts):251A. doi:10.1378/chest.1389215
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SESSION TYPE: Infectious Disease Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: The most common cause of superior vena cava syndrome is cancer. Primary or metastatic cancer in the upper lobe of the right lung can compress the superior vena cava. Recognition of a nonmalignant cause of the superior vena cava syndrome is typically straightforward and infectious causes became rare. (#1)

CASE PRESENTATION: Young man , 28 years old, without respiratory exposure to noxious, nonsmoker was admitted to our clinic with fever (38°C), chills - for a week ago, dry cough, irritation, effort dyspnea, night sweats, loss of appetite, weight loss (10 kg in the last 3 months) . He received one month ago antibiotics with unfavorable evolution. Physical examination: febrile patient, edema in the mantle, without peripheral adenopathy, right pleural effusion, moderate hepato-splenomegaly. Chest Xray: upper and middle mediastinum widening bilateral predominantly on the right. CT scan exam reveal: lymph nodes located in isolated and confluent thymic lodge, pretraheal, laterotracheal bilateral precarinal, and hilarious bilateral infracarinal, pleural effusion in little-medium right without adenopathy under diaphragmatic area, moderate hepato-splenomegaly. Our patient was HIV negative. Pleural effusion: serocitrin fluid, exudates, 90% lymphocitis, negative for Ziehl Nelsen stain. Bronchoscopic exam found: capillary circulation stasis in third distal trachea, infiltration of tronchus intermedius (external wall) , significant stenosis, extrinsic compression and infiltration of mucosa to right Nelson bronchus. In the left bronchus tree: normal issues.Smear sputum was negative for Ziehl Nelsen stain. At this moment the common possible diagnosis were: mediastinal lymphoma, sarcoidosis. Bronchial washing: moderate lymphocytic alveolitis (38% lymphocytes) without tumor cells, negative for Ziehl Neelsen stain. Bronchial biopsy reveals complete fragments necrosis, with infiltration granulomatous. Mediasthinoscopy with histopatological examination of a laterotracheal lymph node reveal: tuberculosis lymphadenitis with extensive areas of caseous necrosis. Under antituberculosis treatment evolution was favorable.

DISCUSSION: A case of primary tuberculosis of bilateral mediastinal lymph nodes, pleural and bronchial confirmed hystopathologic, in a young man without a TB contact, which has involved clinically superior vena cava syndrome is not a common condition

CONCLUSIONS: Primary tuberculosis, although relatively rare, should not be ignored in judging a case with mediastinal masses, even in the absence of parenchymal lesions, in a tuberculosis endemic area.

1) Lynn D. Wilson, M.D., M.P.H., Frank C. Detterbeck, M.D., and Joachim Yahalom, M.D. Superior Vena Cava Syndrome with Malignant Causes; N Engl J Med 2007; 356:1862-1869

DISCLOSURE: The following authors have nothing to disclose: Emilia Tabacu, Roxana Nemes, Mihaela Mitrea, Emilia Crisan, Nicolae Galie

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Institute of Pulmonology, Bucharest, Romania




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