Mediastinal tuberculous lymphadenitis presenting as a mediastinal mass with Dysphagia: a case report

Abstract

Mediastinal tuberculous lymphadenitis is a rare disease in adults. Dysphagia as the accompanying symptom is even a rarer manifestation. Cases with esophageal symptoms may present as esophageal ulceration, mucosal or submucosal mass, fistula or sinus formation, extrinsic compression or displacement of the esophagus. Extrinsic compression may radiologically or endoscopically present as a submucosal tumor. Our case is a 30-year-old woman with dysphagia for a month. Extrinsic compression was seen endoscopically on the mid-esophagus. On thoracic CT and MRI images, a multiloculated cystic/necrotic mass 5.5×4.8×3.1 cm in size consisting of multiple septa was located subcarinally in the middle mediastinum. In Wang needle aspiration, a mucopurulaent liquid was aspirated from the subcarinal localization by bronchoscopy. Diagnostic thoracotomy was carried out because histological and bacteriological examinations were not diagnostic. It was reported as tuberculous lymphadenitis pathologically. The control thoracic CT performed after antituberculous treatment showed complete regression of the mass. We herein report a rare form of tuberculous lymphadenitis.

Keywords: Mediastinal Lymph Node; Thoracotomy; Tuberculosis.

Fig. 1. A 30-year-old female patient with mediastinal tuberculous lymphadenitis presenting as a mediastinal mass with dysphagia.

A. Thoracic CT shows a 5.5×4.8×3.1 cm mass with subcarinal localization in the middle mediastinum with a multilocular cystic/necrotic appearance and multiple septa. B. MRI shows a subcarinally located 5.5×4,8×3.1 cm mass in the middle mediastinum with a multilocular cystic/necrotic appearance and multiple septa.

Fig. 2. The pathologic examination of the specimen demonstrates granulomatous inflammation (H-E´400).