Sema BİRCAN, Songül ÖZYURT, H.Ahmet BİRCAN, Ahmet AKKAYA, Önder ÖZTÜRK, Ünal ŞAHİN

Mediastinal tuberculous lymphadenitis with anthracosis as a cause of vocal cord paralysis

Bronşiyal mukozada antrakotik pigment görülmesi pnömokonyoz veya yoğun atmosferik kirliliğin bir bulgusu olarak düşünülmektedir. Kalsifik veya kalsifik olmayan lenf nodlarının çevrelediği bronşta antrakotik pigmentasyon ile birlikte bronşiyal daralma veya tıkanıklığın görülmesi antrakofibrozis olarak adlandırılmaktadır. Tüberküloz ve antrakofibrozis arasında da kuvvetli birliktelik saptanmıştır. Süperior mediastende tüberküloz lenfadenitli bir olgunun ses kısıklığı ile başvurması nadir bir durumdur. Bu makalede antrakozis ve mediastinal tüberküloz lenfadenit birlikteliğinin ses kısıklığına neden olduğu bir olgu sunulmuştur. Ses kısıklığı, öksürük, halsizlik, iştahsızlık ve gece terlemesi yakınmaları bulunan 66 yaşındaki kadın hasta mediastinal lenfadenopati etyolojisini araştırmak için kliniğimize yatırıldı. Uygulanan fiberoptik bronkoskopide sol vokal kord paralizisinin yanı sıra bronşiyal mukozada inflamasyon bulguları ve yaygın antrakotik pigmentasyon görüldü. Bronş lavajı ve mukoza biyopsisinde tüberküloz veya malignite bulgularına rastlanmadı. Ancak daha sonra uygulanan torakotomi sonucunda hastada parankimal antrakozis ve çıkarılan lenf nodunda antrakozis ile birlikte kazeifikasyon gösteren granülomatöz inflamasyon tespit edildi. Parankimal antrakozis ve mediastinal tüberküloz lenfadenit tanısı ile hasta standart antitüberküloz tedavi altına alındı. Ancak tedavisinin ikinci ayında gastrik adenokarsinom operasyonunun abdominal komplikasyonu sonucunda hasta kaybedildi.

Vokal kord paralizisi sebebi olarak mediastinal tüberküloz lenfadenit ve antrakozis birlikteliği

Anthracotic pigmentation in the bronchial mucosa has been regarded as a bronchoscopic finding of pneumoconiosis or evidence of heavy atmospheric soot. Anthracotic pigmentation with bronchial narrowing or obliteration, surrounded by calcified or noncalcified lymph nodes is typical finding of anthracofibrosis. There is a potential relationship between bronchial anthracofibrosis and tuberculosis. Tuberculous lymphadenopathy of superior mediastinum presentation with hoarseness is very rare. The paper reports a case of tuberculous mediastinal lymphadenitis with anthracosis causing vocal cord paralysis. A 66-year-old woman was admitted to our clinic with the symptoms of dry cough, hoarseness, malaise, anorexia, night sweats and with the multiple mediastinal lymphadenopathy. Fiberoptic bronchoscopy revealed left vocal cord paralysis, bronchial mucosal inflammation and multiple anthracotic plaques. Bronchial lavage and mucosal biopsy were negative for malignancy and tuberculosis. The thoracotomy was performed and a mediastinal lymph node showing caseating granulomatous inflammation with anthracosis and parenchymal anthracosis were detected. The diagnosis of anthracosis and mediastinal tuberculous lymphadenitis was made and the patients put on antituberculous treatment. But she was unfortunately died in the second month of the treatment because of the abdominal complication of gastric adenocarcinoma operation.

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