Contemporary mediastinal tuberculosis

ABSTRACT Mediastinal lymphadenopathy is a prominent feature of adult tuberculosis in immigrant groups in the United Kingdom. Chest radiography of 95 tuberculous immigrants showed mediastinal gland enlargement in 29 cases, whereas none of the 42 Europeans showed this feature. An analysis has been made of the distribution of the disease in all groups together with a more detailed evalu-ation of mediastinal involvement in the immigrants. Pericardial effusions were seen in eight patients together with the following three unusual complications: (1) broncho-oesophageal fistula; (2) bronchial erosion; (3) superior mediastinal obstruction. Mediastinal lymph node involvement has been an uncommon feature of intrathoracic tuberculosis in adults in the United Kingdom, whereas it is the rule in primary tuberculosis, especially in children. It is, however, frequently seen in adult immigrants of all ages, and extrathoracic disease is common. ' The epidemiological aspects of con-temporary tuberculosis have been well re-corded. ' The radiological aspects have received less attention. Methods The radiographs and case notes of all new patients presenting with tuberculosis at St James' Hospital in 1976 and 1977 were reviewed by one of us (CJD). A detailed analysis was made of the 137 patients who were aged 16 years and over. The racial origin was known-79 were Asians from the Indian subcontinent or East Africa, 42 were Europeans, and 13 were Blacks from Africa and the West Indies. In addition, two patients were Chinese and one was an Egyptian. Most were local residents, but a few were visiting the area when they became ill. The diagnosis was made in 95 out of 137 cases by isolation of the organism or by the presence of caseating granulomata. In the remaining patients, particularly those with mediastinal in-volvement alone the Mantoux reaction and res-ponse to treatment were the sole evidence of infection