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Surgical repair of tracheobronchial compression by tuberculous lymph nodes
Br.
J. Dis.
Chest
(1979)
73, 305
SURGICAL REPAIR OF TRACHEOBRONCHIAL COMPRESSION BY TUBERCULOUS LYMPH NODES YURDAKUL Hacettepe
YURDAKUL University
AND Hospitals,
AYDIN Ankara,
AYTAC Turkey
Summary We describe a patient with a tuberculous lymph node pressing on the trachea and right lobe of the bronchus who was managed with resection of the node and Dacron patch closure of a defect in the tracheobronchial tree.
INTRODUCTION
Tuberculosis may lead to enlargement of the paratracheal and parabronchial lymph nodes and compression of the adjacent structures (node compression syndrome) (Watkins 1952; Mair 1969; Malatinsky & Sashegyi 1970). Such a case treated surgically by extirpation of the enlarged lymph node and repair of the residual tracheal defect by a Dacron patch is the subject of this paper.
Case Report A three-year-old boy was referred to our hospital with fever, cough, and dyspnoea. Stridor and dyspnoea leading to cyanosis had been present for eight months. Lymph node biopsy of the neck had been carried out three months before, revealing tuberculosis. Antituberculosis drugs were not helpful. There was no family history of tuberculosis. Physical examination showed a breathless restless child with diffuse wheezing and stridor. Sedimentation rate was 32 mm/hour. The peripheral blood showed lymphocytosis (36%). The PPD test was 10 mm positive. The chest radiograph showed a mass in the right hemithorax compressing the trachea and right main bronchus (Fig. 1). Right thoracotomy was performed in August 1975. A mass 5 x 6 x 6 cm adherent to the trachea was found. The mass was punctured and pus was removed together with necrotic tissue material. It was thought that this was enlarged tuberculous lymph node. An air leak was observed from the trachea when the mass was removed. There was a defect on the tracheobronchial junction about 4 x 1.5 cm in size. The defect was closed with a Dacron patch with interrupted silk sutures. The patch was shaped to prevent airway obstruction (Fig. 2). Intact parietal pleura was sewn over the patch. The chest was closed in the usual manner. Pathological examination of the specimen confirmed tuberculosis. Antituberculosis treatment was started. A control bronchogram taken 40 days after the operation showed that there was no leak and the airways were patent (Fig. 3). The patient was readmitted to the paediatric unit in February 1976 with fever and tachycardia. On the seventeenth day of admission he died in a hepatic coma of unknown cause.
306
Yurdakul
Yurdakul and Aydin Aytac
Fig. 1. Preoperative
Fig. 2. The
radiograph
patch
DISCUSSION Tuberculous lymph nodes in children may cause pressure or traction on the adjacent organs (node compression syndrome) which can lead to bronchiectatic changes in the lungs (Watkins 1952; Grill0 1965; Mair 1969; Malatinsky & Sashegyi 1970). Compres-
307
Tracheobronchial Compression by Tuberculous Lymph Nodes
Fig. 3. Postoperative
bronchogram
showing
no
leak
sion of the trachea by these lymph nodes as observed in our case is very rare (Grill0 1965 ; Gerbeaux 1970; Linchtenaur et al. 1970; Malatinsky & Sashegy 1970). Caseous material from the lymph nodes may be spread in the tracheobronchial tree as the result of perforation and obstruct the airways, leading to sudden death. This complication is very rare, one case having been reported in 4041 patients with tuberculosis (Gerbeaux 1970). This complication might have developed in our patient if the operation had not been carried out. Pericardium, dura mater and skin grafts have been used in the closure of the defects on the tracheobronchial walls. Teflon and Dacron are now more commonly used (Paulson 1951; Burke 1962; Mair 1969; Linchtenaur et al. 1970).
REFERENCES BURKE,
J. F. (1962)
Early
diagnosis
of traumatic
rupture
of the
bronchus.
r.
Am.
med. Ass. 181,
682. GERBEAUX, J. (1970) Primary Tuberculosis in Childhood, pp. 294, Thomas. GRILLO, H. C. (1965) Circumferential resection and cerenstruction trachea. Ann. Surg. 162, 374.
312.
Springfield, of mediastinal
Ill. : Charles and
cervical
C.
308
Yurdakul
Yurdakul and Aydin Aytac
LICHTENAUER, F., NAHRSTEDT, J. & WINDHEIM, K. V. (1970) Gewebeersatz durch Lyophiliserte Dura in der Thorax-Chirurgie. Langenbecks Arch. Chip. 327, 1131. MAIR, H. C. (1969) Chest wall pleura, lung and mediastinum. In Principles of Surgery, ed. S. I. Schwartz, pp. 470-552. Tokyo : McGraw-Hill. MALATINSKY, I. & SASHEGYI, B. (1970) Broncho-pulmonary lesions associated with tuberculosis lymph node compression: ‘node compression syndrome’. Tube&e 51, 412. PAULSON, D. L. (1951) Traumatic bronchial rupture with plastic repair. J. thorac. Surg. 22, 636. WATKINS, A. G. (1952) Discussion the fate of tuberculous primary complex. Proc. R. Sot. Med. 45, 741.
J. Dis.
Chest
(1979)
73, 305
SURGICAL REPAIR OF TRACHEOBRONCHIAL COMPRESSION BY TUBERCULOUS LYMPH NODES YURDAKUL Hacettepe
YURDAKUL University
AND Hospitals,
AYDIN Ankara,
AYTAC Turkey
Summary We describe a patient with a tuberculous lymph node pressing on the trachea and right lobe of the bronchus who was managed with resection of the node and Dacron patch closure of a defect in the tracheobronchial tree.
INTRODUCTION
Tuberculosis may lead to enlargement of the paratracheal and parabronchial lymph nodes and compression of the adjacent structures (node compression syndrome) (Watkins 1952; Mair 1969; Malatinsky & Sashegyi 1970). Such a case treated surgically by extirpation of the enlarged lymph node and repair of the residual tracheal defect by a Dacron patch is the subject of this paper.
Case Report A three-year-old boy was referred to our hospital with fever, cough, and dyspnoea. Stridor and dyspnoea leading to cyanosis had been present for eight months. Lymph node biopsy of the neck had been carried out three months before, revealing tuberculosis. Antituberculosis drugs were not helpful. There was no family history of tuberculosis. Physical examination showed a breathless restless child with diffuse wheezing and stridor. Sedimentation rate was 32 mm/hour. The peripheral blood showed lymphocytosis (36%). The PPD test was 10 mm positive. The chest radiograph showed a mass in the right hemithorax compressing the trachea and right main bronchus (Fig. 1). Right thoracotomy was performed in August 1975. A mass 5 x 6 x 6 cm adherent to the trachea was found. The mass was punctured and pus was removed together with necrotic tissue material. It was thought that this was enlarged tuberculous lymph node. An air leak was observed from the trachea when the mass was removed. There was a defect on the tracheobronchial junction about 4 x 1.5 cm in size. The defect was closed with a Dacron patch with interrupted silk sutures. The patch was shaped to prevent airway obstruction (Fig. 2). Intact parietal pleura was sewn over the patch. The chest was closed in the usual manner. Pathological examination of the specimen confirmed tuberculosis. Antituberculosis treatment was started. A control bronchogram taken 40 days after the operation showed that there was no leak and the airways were patent (Fig. 3). The patient was readmitted to the paediatric unit in February 1976 with fever and tachycardia. On the seventeenth day of admission he died in a hepatic coma of unknown cause.
306
Yurdakul
Yurdakul and Aydin Aytac
Fig. 1. Preoperative
Fig. 2. The
radiograph
patch
DISCUSSION Tuberculous lymph nodes in children may cause pressure or traction on the adjacent organs (node compression syndrome) which can lead to bronchiectatic changes in the lungs (Watkins 1952; Grill0 1965; Mair 1969; Malatinsky & Sashegyi 1970). Compres-
307
Tracheobronchial Compression by Tuberculous Lymph Nodes
Fig. 3. Postoperative
bronchogram
showing
no
leak
sion of the trachea by these lymph nodes as observed in our case is very rare (Grill0 1965 ; Gerbeaux 1970; Linchtenaur et al. 1970; Malatinsky & Sashegy 1970). Caseous material from the lymph nodes may be spread in the tracheobronchial tree as the result of perforation and obstruct the airways, leading to sudden death. This complication is very rare, one case having been reported in 4041 patients with tuberculosis (Gerbeaux 1970). This complication might have developed in our patient if the operation had not been carried out. Pericardium, dura mater and skin grafts have been used in the closure of the defects on the tracheobronchial walls. Teflon and Dacron are now more commonly used (Paulson 1951; Burke 1962; Mair 1969; Linchtenaur et al. 1970).
REFERENCES BURKE,
J. F. (1962)
Early
diagnosis
of traumatic
rupture
of the
bronchus.
r.
Am.
med. Ass. 181,
682. GERBEAUX, J. (1970) Primary Tuberculosis in Childhood, pp. 294, Thomas. GRILLO, H. C. (1965) Circumferential resection and cerenstruction trachea. Ann. Surg. 162, 374.
312.
Springfield, of mediastinal
Ill. : Charles and
cervical
C.
308
Yurdakul
Yurdakul and Aydin Aytac
LICHTENAUER, F., NAHRSTEDT, J. & WINDHEIM, K. V. (1970) Gewebeersatz durch Lyophiliserte Dura in der Thorax-Chirurgie. Langenbecks Arch. Chip. 327, 1131. MAIR, H. C. (1969) Chest wall pleura, lung and mediastinum. In Principles of Surgery, ed. S. I. Schwartz, pp. 470-552. Tokyo : McGraw-Hill. MALATINSKY, I. & SASHEGYI, B. (1970) Broncho-pulmonary lesions associated with tuberculosis lymph node compression: ‘node compression syndrome’. Tube&e 51, 412. PAULSON, D. L. (1951) Traumatic bronchial rupture with plastic repair. J. thorac. Surg. 22, 636. WATKINS, A. G. (1952) Discussion the fate of tuberculous primary complex. Proc. R. Sot. Med. 45, 741.