tuberculous adenopathies. anatomic recall most frequent localisations of tb adenopathies
TRANSCRIPT
![Page 1: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/1.jpg)
Tuberculous adenopathies
![Page 2: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/2.jpg)
Anatomic recall
![Page 3: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/3.jpg)
![Page 4: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/4.jpg)
© OFCP
![Page 5: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/5.jpg)
Most frequent localisations of TB adenopathies
![Page 6: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/6.jpg)
Hilar adenopathies:
-Opacities with convexe external edge
- opacities overlapping normal vascular opacities
![Page 7: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/7.jpg)
Bilateral adenopathies
![Page 8: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/8.jpg)
Hilar adenopathy Normal hilus
![Page 9: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/9.jpg)
The tuberculous adenopathies are:
• Sometimes unilateral (latero-tracheal )• Most often bilateral and asymetric • Sometimes compressive, especially in children• Some lesions are possible inside the bronchi:
compression or fistula • Adenopathies are frequent in cases of AIDS: they are
often bulky and associated with other pulmonary lesions or extra-pulmonary TB
• AFB are most often negative in sputum, except in cases of pulmonary lesions (pneumonia, cavern..) associated with adenopathies
![Page 10: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/10.jpg)
The most important differential diagnosis are:
• Metastatic adenopathies of bronchial cancer
• Lymphoma and hodgkin disease• Sarcoïdosis (incidence in developping
countries ?)
Do not forget 2 radiological differential diagnosis:
- overlap sign of the hilus (anterior or posterior)
- vascular hypertrophy (convergence sign of the hilus)
![Page 11: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/11.jpg)
Don’t forget:
For a good analysis of the mediastinum, it is necessary to have a good quality chest x-ray:
• Strictly front view• Complete inspiration • Patient standing up, postero-anterior
incidence
![Page 12: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/12.jpg)
Bilateral tb adenopathies
![Page 13: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/13.jpg)
Right latero-tracheal opacity: Tuberculous adenopathies
Normal CXR
![Page 14: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/14.jpg)
Man, 20 years old , Asymptomatic,Good condition, HIV - systematic chest radio.AFB negative in sputum
![Page 15: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/15.jpg)
Right latero-tracheal and precarena space adenopathies. AFB-, Diagnosis made by mediastinoscopy: epithelioid and gigantocellular
granuloma. Culture +
© OFCP © OFCP © OFCP
© OFCP© OFCP © OFCP
![Page 16: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/16.jpg)
Young woman, 22 years old. Weight loss and cough. Contact with a tuberculous case 6 monthes ago. Positive
skin test with phlyctena
Normal chest x-ray
![Page 17: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/17.jpg)
![Page 18: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/18.jpg)
African woman, 27 years old. Left cervical adenopathy
Left latero-aortic adenopathies in superior mediastinum
![Page 19: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/19.jpg)
Puncture of the cervical adenopathy:Pus with AFB+
![Page 20: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/20.jpg)
Tuberculous right hilar adenopathy
![Page 21: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/21.jpg)
Widening of the mediastinum: adenopathies of superior and middle
mediastinum
Normal chest x-ray
![Page 22: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/22.jpg)
/In subcarena and inter tracheo bronchial areas (red arrows) , lateral view
is usefull for diagnosis of adenopaties
![Page 23: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/23.jpg)
Lateral view is very usefull for diagnosis of mediastnum adenopathies in sub carena and inter tracheo bronchial areas
Rx normale
![Page 24: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/24.jpg)
Right hilar adenopathy. Is there mediastinum associated adenopathies? Notice mediastinum enlargment
![Page 25: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/25.jpg)
Left side, previous case : hilar and mediastinum adenopathies.. On the right side normal lateral view. Lateral view is useful to confirm hilar and mediastinum adenopathies (red arrow) in the carena area. Notice partial atelectasis of the middle lobe (yellow arrow).
Normal lateral view
![Page 26: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/26.jpg)
Bulky left hilar adenopathy. Associated mediastinum adenopathies are well visible on the lateral view
![Page 27: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/27.jpg)
Normal lateral view
![Page 28: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/28.jpg)
Young child, one year old: TB primary-infection
Notice the bilateral adenopathies with inferior lobe atelectasis (left inferior bronchus compressed by adenopathy )
![Page 29: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/29.jpg)
Tuberculous bulky adenopathies. AIDS context. Infiltration into the surrounding lung tissu
![Page 30: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/30.jpg)
Tuberculous adenopathies with endo-bronchial fistula(endoscopic view)
![Page 31: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/31.jpg)
© OFCP
© OFCP
© OFCP
© OFCP
Fistulas coming from TB adenopathiesFistula in the right para-cardiac bronchus
![Page 32: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/32.jpg)
Tuberculosis / HIV +
![Page 33: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/33.jpg)
Tuberculosis with mediastinal adenopathies and pneumonia in a patient with AIDS. AFB++ in sputum
![Page 34: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/34.jpg)
The association of unilateral or bilateral pneumonia with mediastinal adenopathies
is very indicative of Tuberculosis, and often, HIV context.
![Page 35: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/35.jpg)
Adenopathy in left aorto-pulmonary space( and widening of superior mediatinum due to TB adenopathies)
Normal chest radiography
![Page 36: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/36.jpg)
Node calcifications: sequela of primary infection
![Page 37: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/37.jpg)
Left hilar calcification: sequela of a TB primary infection
![Page 38: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/38.jpg)
However, the mediastinal adenopathies are not always
tuberculous…
![Page 39: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/39.jpg)
Male, poor health condition, smoker, dyspneaRight inferior lobe cancer and metastatic adenopathies
(laterotracheal space). Notice the associated emphysema.
![Page 40: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/40.jpg)
![Page 41: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/41.jpg)
Small cell carcinoma with bulky mediastinal adenopathies
![Page 42: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/42.jpg)
Evolution after 6 cycles of chemotherapy
![Page 43: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/43.jpg)
Bronchial cancer with superior vena cava syndrome(No superior vena cava syndrome in tubercular
adenopathies)
![Page 44: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/44.jpg)
Bronchial cancer with right hilar metastatic adenopathy
![Page 45: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/45.jpg)
Man, 60 years old, weight loss and asthenia, cough with hemoptoic sputum. AFB-
![Page 46: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/46.jpg)
Bronchial cancer!Right superior bronchus
Spur infiltrated by the cancer
normal bronchus
![Page 47: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/47.jpg)
Lymphoma (hodgkin disease)
![Page 48: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/48.jpg)
Sarcoidosis
![Page 49: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/49.jpg)
Trap: mediastinum enlargement in an older woman with cyphoscoliosis
![Page 50: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/50.jpg)
Differential diagnosis: vascular bulky hilus: Convergence sign of the hilus
![Page 51: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/51.jpg)
Differential diagnosis: posterior overlap sign
![Page 52: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/52.jpg)
Differential diagnosis: Posterior overlap sign (2)
![Page 53: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/53.jpg)
Differential diagnosis: anterior overlap
![Page 54: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/54.jpg)
Differential diagnosis: Anterior overlap sign (courtesy of Dr. Bellamy)
![Page 55: Tuberculous adenopathies. Anatomic recall Most frequent localisations of TB adenopathies](https://reader035.vdocuments.net/reader035/viewer/2022062303/551a9dbb5503466b3a8b555c/html5/thumbnails/55.jpg)
anterior overlap