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LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 447  

'Beehive-like'appearance in thoracic tuberculous lymphadenopathy


Department of Pediatrics, LavKush Nursing Home, NS Road, Siddhartha Nagar, Mulund West, Mumbai, Maharashtra, India

Date of Submission11-Oct-2019
Date of Decision12-Dec-2019
Date of Acceptance16-Dec-2019
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Parag M Tamhankar
LavKush Nursing Home, NS Road, Siddhartha Nagar, Mulund West, Mumbai, Maharashtra - 400 080
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_878_19

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How to cite this article:
Tamhankar PM, Sangoi M. 'Beehive-like'appearance in thoracic tuberculous lymphadenopathy. J Family Med Prim Care 2020;9:447

How to cite this URL:
Tamhankar PM, Sangoi M. 'Beehive-like'appearance in thoracic tuberculous lymphadenopathy. J Family Med Prim Care [serial online] 2020 [cited 2020 Jun 4];9:447. Available from: http://www.jfmpc.com/text.asp?2020/9/1/447/276798



Sir,

A 12-year-old girl presented with intermittent fever of moderate grade, since 15 days with normal examination findings. Mantoux test was positive. Radiograph of chest showed hilar lymphadenopathy ([Figure 1]: Panel a: Red arrow). Computerised tomography of the thorax and abdomen with oral and intravenous contrast showed enlarged lymph node mass in the mediastinum with hypointense spaces giving 'beehive like appearance' likely due to necrosis/caseation at the centre of lymph nodes. Lymph node groups involved included superior mediastinal ([Figure 1]: Red arrows in panels b and e) and inferior mediastinal (yellow arrow in panel c and d) but sparing groups on the left of the aorta. Lung fields were clear. No lymph node masses were present in the abdomen. Blood tests revealed lymphocytosis and elevated erythrocyte sedimentation rate (100 mm/h). She was treated with standard antituberculous therapy [isoniazid 300 mg once a day [OD], rifampicin 450 mg OD, ethambutol 800 mg OD and pyrazinamide 1 g OD] and on follow-up after 1 month was responding to treatment with absence of fever and good appetite. Tuberculous lymphadenopathy has been reported in several publications.[1],[2] However, the 'beehive appearance' in this case is striking in appearance and is important to be recognized for distinguishing from other causes of mediastinal masses in children such as lymphoma, germ cell tumour and neuroblastoma.[3] It is especially important when there is no primary lung focus visible on the chest X-ray as in our case. And it is an important non-invasive sign for tuberculous lymphadenopathy for early and proper management.
Figure 1: (a) X-ray chest: widened mediastinum due to enlarged lymph node mass. (b-d) Computerised tomography scan chest coronal view, e (axial view): beehive sign in tuberculosis-enlarged lymph node mass with cavities of various sizes surrounding tracheobronchial tree

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Teaching point: This is a useful sign to distinguish tuberculous adenopathy from other mediastinal masses. This will help minimise the need for invasive tests such as fine-needle aspiration cytology studies or biopsy to detect tuberculosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Song I, Jeong YJ, Lee KS, Koh WJ, Um SW, Kim TS. Tuberculous lymphadenitis of the thorax: Comparisons of imaging findings between patients with and those without HIV infection. AJR Am J Roentgenol. 2012;199:1234-40.  Back to cited text no. 1
    
2.
Iyengar KB, Kudru CU, Nagiri SK, Rao AC. Tuberculous mediastinal lymphadenopathy in an adult. BMJ Case Rep 2014;2014:bcr2013200718.  Back to cited text no. 2
    
3.
Chen CH, Wu KH, Chao YH, Weng DF, Chang JS, Lin CH. Clinical manifestation of pediatric mediastinal tumors, a single center experience. Medicine (Baltimore) 2019;98:e16732.  Back to cited text no. 3
    


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