Tuberculous oesophagopleural fistula.

Hydropneumothorax complicating to oesophagopleural and broncho-oesophageal fistula is an unusual presentation and is reported in literature as separate clinical entities. Here we present a case of hydropneumothorax with both oesophagopleural and broncho-oesophageal fistula of tuberculous aetiology occurring simultaneously in the same patient. Oesophagopleural fistula was suspected clinically by colour of pleural fluid. Subsequent barium swallow demonstrated leak of contrast material from oesophagus into pleural cavity. Later on, computed tomography of chest with oral contrast confirmed communication of oesophagus with both right pleural cavity and right main bronchus. The fistulous connection between these structures appeared to be due to tuberculous mediastinal lymphadenopathy as evident on CT thorax.

Role of ultrasonography and computed tomography in complicated cases of tuberculous cervical lymphadenitis.

AIM: To evaluate complicated cases of tuberculous cervical lymphadenitis by ultrasonography and computed tomography in order to detect more lymph nodes, and to study their lesions. MATERIAL AND METHODS: Total 27 patients of tuberculous cervical lymphadenitis previously proved bacteriologically or histopathologically on anti-tuberculosis treatment (ATT) presenting with complications were taken for study. Each case was subjected to ultrasound (USG) and computed tomography (CT) of involved area. Based on USG and CT findings, patients were subjected to repeat fine needle aspiration cytology (FNAC) of involved lymph node or drainage of pus. RESULTS: On USG, all lesions were hypoechoic and showed necrosis. Other findings were: sharp margins in 70.4 %, hilum in 22.2 %, abnormal surrounding tissue in 85.2 %, matting in 37 %, calcification in 29.6 % and posterior enhancement in 22.2 % patients. On CT, majority of lesions were with central low density (CLD) in 16 (59.3 %), followed by large confluent low density (LCLD) in 7 (25.9 %), multilocular central low density (MCLD) in 4 (14.8 %) and homogeneous soft tissue density (HSTD) in 2 (7.4 %) patients. Necrotising granulomatous lymphadenitis was the most common diagnosis in 17 (63%), followed by necrotising in 6 (22.2 %) and granulomatous in 4 (14.8 %) patients. Fifteen (55.5 %) patients were positive for AFB on ZN smear examination. In 17 patients, culture and sensitivity test for Mycobacterium Tuberculosis from lymph node aspirate was done and 12 (70.6 %) patients were found culture positive. Out of these, 2 (16.7 %) were found to be multi-drug resistant (MDR) cases. CONCLUSION: USG and CT modalities are complementary in diagnosis and management of tuberculous lymphadenitis presenting with complications. USG helps in better localization of site for biopsy/FNAC procedure and drainage of pus with high diagnostic yield. While CT helps in better anatomical localization of lymph nodes not usually detected on clinical examination.