, Volume 43, Issue 2, pp 254-255
Date: 27 Nov 2012

Tuberculous lymphadenopathy is not only obstructive but also inflammatory—it can erode anything it touches. Reply to Marchiori et al

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We thank Dr. Marchiori [1] and colleagues for taking an interest in our publication on lymphobronchial tuberculosis [2] and for contributing a case demonstrating the development of lymphobronchial fistula in a child with tuberculosis [1].

Members of our research group have reported the consequences of lymph node erosion into adjacent structures through inflammation and necrosis. These include erosion into the oesophagus [3, 4] with subsequent need for oesophageal stenting [5]; erosion into the pleural space with fibrin glue closure as a treatment option [6], erosion into the phrenic nerve with resulting palsy [7] and erosion into the thoracic duct causing chylothorax [8].

We have also performed a CT scan on a 5-month-old infant where the tuberculous lymphadenopathy eroded into the airway, leading to a significant amount of air detectable throughout the mediastinal structures and within the lymph nodes (Fig. 1). Bronchoscopy demonstrated a defect in the wall of the left lower lobe bro ...