術前診断し得なかった小児肺結核の1手術例

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We experienced a case of pulmonary tuberculosis in childhood. This 4-year-old boy was admitted to our hospital because of an abnormal shadow on the chest X-ray. He had a history of having been in the Philippines and complained of asthma during that time. At physical examination, his general condition was quite good except for weak respiratory sounds in the right upper lung field. Laboratory data showed mild inflammatory reactions. No bacteria grew in the culture of sputum. Tuberculin test showed weak positive. Chest X-ray revealed a tumorous shadow in the right upper lung field. Both CT-scan and MRI revealed a tumorous mass in the upper and middle lobe of the right lung. No aberrant artery was demonstrated by angiography. Bronchoscopy revealed severe stenosis of the right upper bronchus. Under the suspicion of a lung tumor, thoracotomy was performed. At thoracotomy, the right upper lobe proved to be the mass and the middle lobe was atelectatic. The right upper lobe was resected and when it was cut, atheromatous content and pus appeared. Mycobacterium was evident in them. Pathological examination revealed the presence of granulomas of which centers consisted of fibrosis and epithelioid cells. Langhans' giant cells and lymphoid cell infiltration were seen around them. The diagnosis was pulmonary tuberculosis. After the operation, he was treated by RFP, INH, EB and is doing well now.
日本小児外科学会の論文
1992-12-20