Mediastinal tuberculosis in Bradford, United Kingdom: the role of mediastinoscopy.

Objective: To evaluate patients with mediastinal tuberculosis (MT), their demographic profiles, symptoms, radiological features and the role of mediastinoscopy.

Methods: This retrospective study conducted at Bradford Teaching Hospitals, Bradford, United Kingdom, looked at the case notes of 160 (13%) patients with MT out of a cohort of 1252 notifications of tuberculosis (TB) cases from 1995 to 2004, analysing the demographic data, diagnostic findings, computed tomography (CT) scans and outcomes. Interventions included bronchoscopy, lymph node biopsy and mediastinoscopy.

Results: Patient age ranged from 1 to 75 years; the majority were females and from minority ethnic groups. Contact history was positive in 76% of cases. Cough was the most common symptom (50%); however, asymptomatic patients were also common (45%). Heaf test was positive in 99%. Right paratracheal lymphadenopathy was common on chest X-ray and chest CT scan. Mediastinoscopy was performed in only 37 patients with definitive diagnosis.

Conclusions: MT should be suspected in adult asymptomatic immigrants presenting with mediastinal adenopathy and a strongly positive Heaf test. Trial of anti-tuberculosis treatment should be initiated and response should guide further management. Mediastinoscopy is required in only a minority of patients.