Chest Infections |

A Primary Tuberculosis With Superior Vena Cava Syndrome FREE TO VIEW

Roxana Nemes, PhD; Emilia Tabacu, PhD; Paraschiva Postolache, PhD
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Institute of Pulmonology, Bucharest, Romania

Chest. 2014;145(3_MeetingAbstracts):90A. doi:10.1378/chest.1825333
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SESSION TITLE: Tuberculosis Case Report Posters

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To diagnose and treat a young patient with superior vena cava syndrome

METHODS: A 28 years old patient, without respiratory exposure to noxious, nonsmoker was admitted to our clinic with fever (38C), 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.

RESULTS: 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. 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.

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 high tuberculosis endemic area.

CLINICAL IMPLICATIONS: 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

DISCLOSURE: The following authors have nothing to disclose: Roxana Nemes, Emilia Tabacu, Paraschiva Postolache

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