SUPERIOR MEDIASTINAL MASSES: SECONDARY TO TUBERCULOUS LYMPHADENITIS IN THE ADULT

Reports of 4 adults with impressive superior mediastinal masses secondary to tuberculous lymphadenitis are briefly presented. Three of the four were young adults, 25 or 26 years old.

All presented with nonspecific clinical symptoms. One patient, however, had a large supraclavicular lymph node mass. All had 4+ positive intermediate strength PPD reactions. One developed polyserositis with large pleural and pericardial effusions. All responded well to antituberculous chemotherapy after the diagnosis was suggested by cervical lymph node biopsy or mediastinoscopic lymph node biopsy (in 1 case).

The differential diagnosis includes mainly lymphoma, substernal thyroid, thymoma, teratoma and other granulomas, including sarcoid, and fungal infections.

It is important for the radiologist to suggest the possibility of tuberculosis as a cause of a superior mediastinal mass, particularly in the young adult, even though no hilar lymphadenopathy on pulmonary densities are evident.

The diagnosis of tuberculous lymphadenitis can usually be made by cervical lymph node biopsy.

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