Decompression of enlarged mediastinal lymph nodes due to mycobacterium tuberculosis causing severe airway obstruction in children.
BACKGROUND
Large airway compression by enlarged tuberculosis (TB) lymph nodes results in life-threatening airway obstruction in a small proportion of children. The indications, safety, and efficacy of TB lymph node decompression are inadequately described. This study aims to describe the indications and efficacy of TB lymph node decompression in children with severe airway compression and investigate variables influencing outcome.


METHODS
A prospective cohort of children (aged 3 months to 13 years) with life-threatening airway obstruction resulting from TB lymph node compression of the large airways were enrolled. The site and degree of airway obstruction were assessed by bronchoscopy and chest computed tomography scan.


RESULTS
Of the 250 children enrolled, 34% (n = 86) required transthoracic lymph node decompression, 29% as an urgent procedure and 71% (n = 63) after failing 1 month of antituberculosis treatment that included glucosteroids. Compression (less than 75%) of the bronchus intermedius (odds ratio 2.28, 95% confidence interval: 1.29 to 4.02) and left main bronchus (odds ratio 3.34, 95% confidence interval: 1.73 to 6.83) were the best predictors for lymph node decompression. Human immunodeficiency virus status, drug resistance, and malnutrition were not associated with decompression. Few complications (self-limiting, 8%) or treatment failures (2%) resulted from the decompression. There were no deaths.


CONCLUSIONS
In one third of children with TB, severe airway obstruction caused by enlarged lymph nodes requires decompression. Transthoracic decompression can be safely performed with low complication, failure, and fatality rates.
Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town. Electronic address: pgouss@sun.ac.za.
Pierre
P
Goussard
Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town.
Robert P
RP
Gie
Department of Cardiothoracic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town.
Jacques T
JT
Janson
Department of Anesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town.
Pieter
P
le Roux
Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town.
Sharon
S
Kling
Radiology Department, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Savvas
S
Andronikou
Department of Cardiothoracic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, Cape Town.
Gawie J
GJ
Roussouw
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008482:Mediastinum / Q000473:pathology / Q000601:surgery; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D016017:Odds Ratio; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D013019:South Africa; D016896:Treatment Outcome; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*