Abstract

SESSION TITLE:
Tuberculosis Case Report PostersSESSION TYPE: Case Report PosterPRESENTED ON: Sunday,
March 23, 2014 at 01:15 PM - 02:15 PMPURPOSE: To diagnose and treat a young patient with superior
vena cava syndrome
METHODS:
A 28 years old patient, without respiratory exposure to noxious, nonsmoker was admitted to our clinic with
fever (38C), chills - for a week ago, dry cough, irritation, effort dyspnea, night sweats, loss of appetite,
weight loss (10 kg in the last 3 months) . He received one month ago antibiotics with unfavorable
evolution. Physical examination: febrile patient, edema in the mantle, without peripheral adenopathy, right
pleural effusion, moderate hepato-splenomegaly. Chest Xray: upper and middle mediastinum widening
bilateral predominantly on the right.
RESULTS:
CT scan exam reveal: lymph nodes located in isolated and confluent thymic lodge, pretraheal,
laterotracheal bilateral precarinal, and hilarious bilateral infracarinal, pleural effusion in little-medium right
without adenopathy under diaphragmatic area, moderate hepato-splenomegaly. Bronchoscopic exam
found: capillary circulation stasis in third distal trachea, infiltration of tronchus intermedius (external wall) ,
significant stenosis, extrinsic compression and infiltration of mucosa to right Nelson bronchus. In the left
bronchus tree: normal issues.Smear sputum was negative for Ziehl Nelsen stain. At this moment the
common possible diagnosis were: mediastinal lymphoma, sarcoidosis. Bronchial washing: moderate
lymphocytic alveolitis (38% lymphocytes) without tumor cells, negative for Ziehl Neelsen stain. Bronchial
biopsy reveals complete fragments necrosis, with infiltration granulomatous. Mediasthinoscopy with
histopatological examination of a laterotracheal lymph node reveal: tuberculosis lymphadenitis with
extensive areas of caseous necrosis. Under antituberculosis treatment evolution was favorable.
CONCLUSIONS:
Primary tuberculosis, although relatively rare, should not be ignored in judging a case with mediastinal
masses, even in the absence of parenchymal lesions, in a high tuberculosis endemic area.
CLINICAL IMPLICATIONS:
A case of primary tuberculosis of bilateral mediastinal lymph nodes, pleural and bronchial confirmed
hystopathologic, in a young man without a TB contact, which has involved clinically superior vena cava
syndrome is not a common condition
DISCLOSURE:
The following authors have nothing to disclose: Roxana Nemes, Emilia Tabacu, Paraschiva
PostolacheNo Product/Research Disclosure Information.