以发热为首发症状的纵隔淋巴结结核12例诊治分析

Analysis of Diagnosis and treatment of Mediastinal Tuberculous Lymphadenitis with Fever as Initial Symptom

目的探讨以发热为首发症状的无肺内结核病灶的纵隔淋巴结结核的诊治,分析其延误诊断原因。方法收集2005年10月至2009年12月沈阳市胸科医院内科门诊12例纵隔淋巴结结核患者,对其临床表现、实验室检查、诊断性抗结核治疗反应进行回顾性分析。结果 12例纵隔淋巴结结核患者结核菌素试验(PPD)均为强阳性,血沉均增快,抗结核治疗1周左右体温均有下降。8例增强CT检查6例不同程度强化,2例未强化。4例浅表淋巴结手术病理活组织检查3例为结核肉芽肿,1例为肉芽肿性病变,结核不除外。结论长期发热中青年患者抗感染治疗无效,应注意纵隔淋巴结结核。PPD、结核抗体检查、浅表淋巴结病理检查、诊断性抗结核治疗可明确诊断。

Objective To evaluate the reason of delaying diagnosis and treatment mediastinal tuberculous lymphadenitis in no chest involvement and with fever as initial symptom.Methods We investigated and analyzed retrospectively clinical features and assistant examination and anti-tuberculous therapy with 12 mediastinal tuberculous lymphadenitis cases who received the first retreatment in Shenyang chest hospital from October 2005 to December 2009.Result 12 cases with mediastinal tuberculous lymphadenitis,purified protein derivative was strong positive with faster ESR than normal,and temperature was falling after a week anti-tuberculous therapy.Of 8 cases with contrast-enhanced CT,6 cases have enhancement patterns,2 cases have no enhancement.Of 4 cases with diopsy of superficial lymphnodes,3 cases were tuberculous granulomn,1 case is granuloma.Conclusion Long-term fever patients with non-responsive in antibiotic can think about mediastinal tuberculous lymphadenitis.Purified protein derivative and tuberculosis antibody and diopsy of superficial lymphnode and anti-tuberculous therapy may help the diagnosis.