9The tuberculous adenopathies are: Sometimes unilateral (latero-tracheal )Most often bilateral and asymetricSometimes compressive, especially in childrenSome lesions are possible inside the bronchi: compression or fistulaAdenopathies are frequent in cases of AIDS: they are often bulky and associated with other pulmonary lesions or extra-pulmonary TBAFB are most often negative in sputum, except in cases of pulmonary lesions (pneumonia, cavern..) associated with adenopathies
10The most important differential diagnosis are: Metastatic adenopathies of bronchial cancerLymphoma and hodgkin diseaseSarcoïdosis (incidence in developping countries ?)Do not forget 2 radiological differential diagnosis:- overlap sign of the hilus (anterior or posterior)- vascular hypertrophy (convergence sign of the hilus)
11Don’t forget:For a good analysis of the mediastinum, it is necessary to have a good quality chest x-ray:Strictly front viewComplete inspirationPatient standing up, postero-anterior incidence
21Widening of the mediastinum: adenopathies of superior and middle mediastinum Normal chest x-ray
22is usefull for diagnosis of adenopaties /In subcarena and inter tracheo bronchial areas (red arrows) , lateral viewis usefull for diagnosis of adenopaties
23Rx normaleLateral view is very usefull for diagnosis of mediastnum adenopathiesin sub carena and inter tracheo bronchial areas
24Notice mediastinum enlargment Chest x ray: bilateral adenpathies, nearly symetric. It could be TB adenopathies. In this case it is sarcoïdosisRight hilar adenopathy. Is there mediastinum associated adenopathies?Notice mediastinum enlargment
25Normal lateral viewLeft side, previous case : hilar and mediastinum adenopathies.. On the right side normal lateral view.Lateral view is useful to confirm hilar and mediastinum adenopathies (red arrow)in the carena area. Notice partial atelectasis of the middle lobe (yellow arrow).
26Bulky left hilar adenopathy. Associated mediastinum adenopathies are well visible on the lateral view
33Tuberculosis with mediastinal adenopathies and pneumonia in a patient with AIDS. AFB++ in sputum
34is very indicative of Tuberculosis, and often, HIV context. The association of unilateral or bilateral pneumonia with mediastinal adenopathiesis very indicative of Tuberculosis, and often, HIV context.
35Normal chest radiography Adenopathy in left aorto-pulmonary space( and widening of superior mediatinum due to TB adenopathies)Normal chest radiography
36Node calcifications: sequela of primary infection
37Left hilar calcification: sequela of a TB primary infection
38However, the mediastinal adenopathies are not always tuberculous…
39Male, poor health condition, smoker, dyspnea Right inferior lobe cancer and metastatic adenopathies (laterotracheal space). Notice the associated emphysema.