The Role of Perforation of Hilar Lymph Nodes Into the Bronchial Tree of Adults

Abstract

In recent years it has been apparent that there is a decreasing incidence in the frequency of the classical caseous, ulcerative type of bronchial tuberculosis. However, localized processes appearing in the bronchial wall are observed much more often, probably as the result of involvement of the hilar lymph nodes. Increasing significance has been attached to these phenomena, particularly in adults, where attention has been drawn to the possible relation of perforation of a node into the bronchial tree and the pulmonary extension of the tuberculous disease. This aspect of primary tuberculosis in children is generally recognized. It has a well defined symptomatology in which a lymph node perforation into the bronchial tree is recognized as the most serious form, often indicating the beginning of tertiary pulmonary tuberculosis. This opinion has been strengthened within the last few years by a vast number of bronchoscopic examinations especially by the French school (Mounier-Kuhn, Le Jeune, Dufourt, Lemoine, etc.). Although reports on identical developments in adults have recently increased in number, with many cases of perforation of the bronchial walls being particularly stressed (Gyselen et al., Levi-Valenti, Boucher), clinicians and pathologists have generally refused to acknowledge such post-primary forms in adults, maintaining that there are different anatomic conditions in the bronchi and a relatively rare appearance of primary tuberculosis in adults. However, late primary Infection today is a common fact as Schwartz and Uehlinger indicated in various papers based on pathological-anatomical examinations which demonstrated that bronchogenic dissemination by perforating hilar lymph nodes is quite common. Furthermore, In thoracic surgery in cases of tuberculosis one almost always finds a large, partly caseous mass of lymph nodes closely linked to the bronchus from which it can be detached only with great difficulty. We would like to give a detailed account of our experiences in this important matter.