title: Mediastinal tuberculosis in Bradford, United Kingdom: the role of mediastinoscopy.
abstract: OBJECTIVE
  To evaluate patients with mediastinal tuberculosis (MT), their demographic profiles, symptoms, radiological features and the role of mediastinoscopy.
  
  
  METHODS
  This retrospective study conducted at Bradford Teaching Hospitals, Bradford, United Kingdom, looked at the case notes of 160 (13%) patients with MT out of a cohort of 1252 notifications of tuberculosis (TB) cases from 1995 to 2004, analysing the demographic data, diagnostic findings, computed tomography (CT) scans and outcomes. Interventions included bronchoscopy, lymph node biopsy and mediastinoscopy.
  
  
  RESULTS
  Patient age ranged from 1 to 75 years; the majority were females and from minority ethnic groups. Contact history was positive in 76% of cases. Cough was the most common symptom (50%); however, asymptomatic patients were also common (45%). Heaf test was positive in 99%. Right paratracheal lymphadenopathy was common on chest X-ray and chest CT scan. Mediastinoscopy was performed in only 37 patients with definitive diagnosis.
  
  
  CONCLUSIONS
  MT should be suspected in adult asymptomatic immigrants presenting with mediastinal adenopathy and a strongly positive Heaf test. Trial of anti-tuberculosis treatment should be initiated and response should guide further management. Mediastinoscopy is required in only a minority of patients.
authors.affiliation: Department of Thoracic Medicine, Bradford Teaching Hospitals National Health Service Trust, Bradford, West Yorkshire, UK.
authors.forename: B
authors.initials: B
authors.lastname: Jacob
authors.forename: R
authors.initials: R
authors.lastname: Parsa
authors.forename: R
authors.initials: R
authors.lastname: Frizzell
authors.forename: A
authors.initials: A
authors.lastname: Mearns
authors.forename: P
authors.initials: P
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D004359:Drug Therapy, Combination; D004641:Emigration and Immigration; D004739:England / Q000453:epidemiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology / Q000382:microbiology; D008481:Mediastinoscopy; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014374:Tuberculin Test; D014388:Tuberculosis, Lymph Node / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents