Spontaneous Pneumothorax due to Obstructive Emphysema as Presentation of Tuberculous Mediastinal Lymphadenopathy

Abstract

Mediastinal lymph node involvement is usually seen in primary childhood tuberculosis (TB). When caseation and necrosis of the mediastinal lymph nodes progresses, the enlarged nodes may compress the regional bronchi and cause bronchial narrowing, obstruction, and emphysema. However, mediastinal adenopathy leading to emphysema and causing pneumothorax in children is not yet reported. A 6-month-old male patient presented with left-sided pneumothorax that required immediate treatment with thoracostomy. Computed tomography chest showed mediastinal necrotic nodes causing obstructive emphysematous changes in left lung. He was treated with antituberculous therapy along with steroids to which he responded well.

Keywords

tuberculosis - pneumothorax - mediastinal adenopathy

• References

• 1 Freixinet JL, Caminero JA, Marchena J, Rodríguez PM, Casimiro JA, Hussein M. Spontaneous pneumothorax and tuberculosis: long-term follow-up. Eur Respir J 2011; 38 (1) 126-131
• 2 Shamaei M, Tabarsi P, Pojhan S , et al. Tuberculosis-associated secondary pneumothorax: a retrospective study of 53 patients. Respir Care 2011; 56 (3) 298-302
• 3 Lincoln EM, Sewell EM. Tuberculosis in Children. New York, NY: McGraw-Hill; 1963: 111-132
• 4 Agrons GA, Markowitz RI, Kramer SS. Pulmonary tuberculosis in children. Semin Roentgenol 1993; 28 (2) 158-172
• 5 Kim WS, Choi JI, Cheon JE, Kim IO, Yeon KM, Lee HJ. Pulmonary tuberculosis in infants: radiographic and CT findings. AJR Am J Roentgenol 2006; 187 (4) 1024-1033
• 6 Effmann EL. Pulmonary infection. In: Kuhn JP, Slovis TL, Haller JO, , eds. Caffey's Pediatric Diagnostic Imaging. 10th ed. Philadelphia, PA: Mosby; 2004: 982-1039
• 7 McAdams HP, Erasmus J, Winter JA. Radiologic manifestations of pulmonary tuberculosis. Radiol Clin North Am 1995; 33 (4) 655-678
• 8 Schaaf HS, Gie RP, Beyers N, Smuts N, Donald PR. Tuberculosis in infants less than 3 months of age. Arch Dis Child 1993; 69 (3) 371-374
• 9 Choe KO, Jeong HJ, Sohn HY. Tuberculous bronchial stenosis: CT findings in 28 cases. AJR Am J Roentgenol 1990; 155 (5) 971-976