Tracheal Obstruction by Spinal Tuberculosis By J. Campistol
P., S. Garcia-Tornel
F., P. Obiols A., J. Herrero CASE
G., and J. Claret C.
REPORT
An 8 mo old female was admitted to the Hospital San Juan de Dios for resprratory drstress. There was no personal or family history of tuberculosis. Twenty-one days before admissron. the patient started to have mild inspiratory distress. This progressed quickly into a croup-like con dition. Treatment with ampicillin and steroids did not improve the situation and she was admitted to the emergency ward of the hosprtal. On physical examination the temperature was 37°C. pulse 100. respirations 40, blood prrssure 100/70 mm/Hg, and weight 8.670 kg. The patient had severe inspiratory stridor, marked suprasternal and intercostal retractions and flaring of the nostrils. Cyanosis was not present. The radiogram of the chest showed an enlarged mediastinum superiorly (Fig. I). Tomography showed glandular masses without calcification in the middle and posterior mediastinum. The radiograph of the vertebral column showed osteolysis of vertebral bodies D, and D4 with flattening of Dj and reduction of the intervertebral spaces. Radiography ol the esophagus showed tracheal displacement towards the right and anteriorly. Laboratory invrstigations showed mild anemia, a sedimentation rate of 27/32, and there was a positive intradermic Mantoux reaction to l/1000. At operation, an inflammatory tumor the size of a walnut was found in the posterior superior mediastinum. A similar but smaller one was found about 3 cm away. On puncturing both tumors, caseous material exuded. There was a communication between these two masses and the vertebral column at the Dj and 04 level. Histologic examination showed that the tumor consisted of inflammatory granulation tissue with numerous histiocytcs and giant multinuclear cells mostly of the Langhans type and large areas of caseation with some granular calcification. The postoperative period was satisfactory and the respiratory diihculty disappeared. Postoperatively. the patient was given chemotherapy. The propnosrs appears to be good.
of the anteriorFig. 1 . The chest x-ray posteriol I sides showing the mass situated in the superior mediastinum.
From the Children’s Address Carretera
reprint
Hospital.
requests
de Es&gas
to:
San Juan de Dios, Barcelona, J.
s/n. Barcelona,
*’ I977 hJ* Grune & Stratton.
Campistol
P.,
M.D..
Spain. Children’s
Hospital
San
Juan
de Dia.
P., S. Garcia-Tornel
F., P. Obiols A., J. Herrero CASE
G., and J. Claret C.
REPORT
An 8 mo old female was admitted to the Hospital San Juan de Dios for resprratory drstress. There was no personal or family history of tuberculosis. Twenty-one days before admissron. the patient started to have mild inspiratory distress. This progressed quickly into a croup-like con dition. Treatment with ampicillin and steroids did not improve the situation and she was admitted to the emergency ward of the hosprtal. On physical examination the temperature was 37°C. pulse 100. respirations 40, blood prrssure 100/70 mm/Hg, and weight 8.670 kg. The patient had severe inspiratory stridor, marked suprasternal and intercostal retractions and flaring of the nostrils. Cyanosis was not present. The radiogram of the chest showed an enlarged mediastinum superiorly (Fig. I). Tomography showed glandular masses without calcification in the middle and posterior mediastinum. The radiograph of the vertebral column showed osteolysis of vertebral bodies D, and D4 with flattening of Dj and reduction of the intervertebral spaces. Radiography ol the esophagus showed tracheal displacement towards the right and anteriorly. Laboratory invrstigations showed mild anemia, a sedimentation rate of 27/32, and there was a positive intradermic Mantoux reaction to l/1000. At operation, an inflammatory tumor the size of a walnut was found in the posterior superior mediastinum. A similar but smaller one was found about 3 cm away. On puncturing both tumors, caseous material exuded. There was a communication between these two masses and the vertebral column at the Dj and 04 level. Histologic examination showed that the tumor consisted of inflammatory granulation tissue with numerous histiocytcs and giant multinuclear cells mostly of the Langhans type and large areas of caseation with some granular calcification. The postoperative period was satisfactory and the respiratory diihculty disappeared. Postoperatively. the patient was given chemotherapy. The propnosrs appears to be good.
of the anteriorFig. 1 . The chest x-ray posteriol I sides showing the mass situated in the superior mediastinum.
From the Children’s Address Carretera
reprint
Hospital.
requests
de Es&gas
to:
San Juan de Dios, Barcelona, J.
s/n. Barcelona,
*’ I977 hJ* Grune & Stratton.
Campistol
P.,
M.D..
Spain. Children’s
Hospital
San
Juan
de Dia.
