Tuberculous lymphadenopathy is not only obstructive but also inflammatory - It can erode anything it touches. Reply to Marchiori, et al.

摘要

Sir, We thank Dr. Marchiori and colleagues for taking an interest in our publication on lymphobronchial tuberculosis and for contributing a case demonstrating the development of lymphobronchial fistula in a child with tuberculosis. Members of our research group have reported the consequences of lymph node erosion into adjacent structures through inflammation and necrosis. These include erosion into the oesophagus with subsequent need for oeso-phageal stenting; erosion into the pleural space with fibrin glue closure as a treatment option, erosion into the phrenic nerve with resulting palsy and erosion into the thoracic duct causing chylothorax. We have also performed a CT scan on a 5-month-old infant where the tuberculous lymphadenopathy eroded into the airway, leading to a significant amount of air detectable throughout the mediastinal structures and within the lymph nodes (Fig. 1). Bronchoscopy demonstrated a defect in the wall of the left lower lobe bronchus, allowing air to escape freely into the mediastinum (Fig. 2).