Fig. 277.—Lesions in retro-pharyngeal tuberculosis. T, Trachea; Œ, œsophagus; P, pharynx; H, hyoid bone; E, epiglottis; L, tongue; G, tuberculous retro-pharyngeal glands.
Swallowing is difficult, in consequence of compression of the upper part of the œsophagus, and, as the laryngeal nerves may be included in the swelling, dyspnœa or roaring not uncommonly results.
By palpation with one or both hands it is easy to identify the glands and detect enlargement, hardness and sensitiveness. In exceptional instances the caseous masses they contain undergo softening and conversion into purulent material.
When the cervical lymphatic glands are attacked the jugular furrows disappear, and the whole of the pretracheal and lateral regions of the neck exhibit doughy swellings.
These swellings are rarely symmetrical, a fact which admits of this condition being distinguished from lesions due to lymphadenitis, without examining the blood.
The prescapular glands are rarely attacked, but those at the entrance to the chest, which may be found on either side of the trachea by passing the fingers between the two first ribs, are frequently enlarged to the size of a fowl’s egg.
Tuberculosis of the Mediastinum.—Whenever the lungs are much involved, the bronchial glands are also invaded, though the glands of the anterior and posterior mediastina may escape. On the other hand, the mediastinal glands are sometimes much involved, whilst the lung remains intact.
The lymphatic glands, particularly those of the mediastinum, may be enormously enlarged, and the various accidents which result are due as much to mechanical interference with the functions of adjacent organs as to the lesions themselves.
When the glands of the anterior mediastinum are affected, they cause compression of the anterior vena cava, with stasis of blood in the jugular vein and venous pulse, then compression of the œsophagus and trachea, and of the nerves at the entrance to the chest, producing difficulty in swallowing, respiration and circulation.
