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Calcified Ranke Complex
2
190 Calcified ranke complex *Academia Nacional de Medicina. Academia Mexicana de Cirugía. Jefe de UTI de la Fundación Clínica Médica Sur. **Residencia Medicina Interna. Hospital General Dr. Manuel Gea González. Correspondencia: Dr. Raúl Carrillo-Esper Unidad de Terapia Intensiva, Fundación Clínica Médica Sur Puente de Piedra, Núm. 150. Col. Toriello Guerra. C.P. 14050, México, D.F. Tel.: 5424-7200, Ext. 4139. Correo electrónico: [email protected] Raúl Carrillo-Esper,* Juan Andrés Méndez-García** Rev Invest Med Sur Mex, Julio-Septiembre 2013; 20 (3): 190-191 IMÁGENES EN MEDICINA ABSTRACT ABSTRACT ABSTRACT ABSTRACT ABSTRACT Tuberculosis is a slow growing microbe that causes hypersensitivity. The initial focus of primary infection is the Ghon complex. The combination of the Ghon focus and the enlarged lymph nodes form the primary complex the Ranke. Frequently, the only radiological evidence of hematogenous bacteria dissemination is the so-called Ranke complex. Key words. Key words. Key words. Key words. Key words. Mycobacterium tuberculosis. Hypersensitivity. Calcified lymph nodes. RESUMEN RESUMEN RESUMEN RESUMEN RESUMEN La tuberculosis es una bacteria de crecimiento lento que causa hipersensibilidad. El foco primario de infección es el complejo de Ghon. La combinación de ganglios linfáticos calcificados y focos de Gohn se conoce como complejo de Ranke. Con frecuencia este complejo es la única evidencia radiológica de diseminación he- matógena de la bacteria. Palabras clave. Palabras clave. Palabras clave. Palabras clave. Palabras clave. Mycobacterium tuberculosis. Hipersensibilidad. Ganglios linfáticos calcificados. CLINICAL CASE Thirty-four year old female with cough and shortness of breath. Chest X-ray showed calcified left parahiliar and paraaortic lymph node, suggestive of pulmonary tubercu- losis (TB). Her sputum smear was negative. The radiolo- gical diagnosis was pulmonary tuberculosis with calcified Ranke complex (Figure 1). Mycobacterium tuberculosis is a slow growing microbe with generation times between 12 and 24 h. In 1993 the World Health Organization (WHO) declared TB a “global emergency”: 1.7 billion of people were infected with M. tuberculosis, every year 3 million of people died from TB, and approximately 8 million new cases occurred each year. 1 TB is a respiratory tract infection that occurs due to inhalation of droplets from infected people. These dro- plets (2–10 μm) are produced when patients with pulmo- nary or laryngeal TB sneeze, cough, speak, or sing. These droplets laden with a few bacilli (1-4 μm) and are carried by cilia to the terminal bronchioles. The bacteria often Figure 1. Calcified Ranke complex characterized by calcified left parahiliar and paraaortic lymph node (black arrows) associated with a calcified left apical scar, Simon’s foci (white arrow). colonize the best ventilated areas of the lungs. Local al- veolar macrophages orchestrate a complex immunopa- thological process and these results, after a few weeks, in
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Calcified Ranke Complex
Transcript of Calcified Ranke Complex
190 Rev Invest Med Sur Mex, 2013; 20 (3): 190-191
Calcified ranke complex
Calcified ranke complex
*Academia Nacional de Medicina. Academia Mexicana de Cirugía. Jefe de UTI de la Fundación Clínica Médica Sur.**Residencia Medicina Interna. Hospital General Dr. Manuel Gea González.
Correspondencia:Dr. Raúl Carrillo-Esper
Unidad de Terapia Intensiva, Fundación Clínica Médica SurPuente de Piedra, Núm. 150. Col. Toriello Guerra. C.P. 14050, México, D.F.
Tel.: 5424-7200, Ext. 4139. Correo electrónico: [email protected]
Raúl Carrillo-Esper,* Juan Andrés Méndez-García**
Rev Invest Med Sur Mex, Julio-Septiembre 2013; 20 (3): 190-191
IMÁGENES EN MEDICINA
ABSTRACTABSTRACTABSTRACTABSTRACTABSTRACT
Tuberculosis is a slow growing microbe that causes hypersensitivity.The initial focus of primary infection is the Ghon complex. Thecombination of the Ghon focus and the enlarged lymph nodes formthe primary complex the Ranke. Frequently, the only radiologicalevidence of hematogenous bacteria dissemination is the so-calledRanke complex.
Key words.Key words.Key words.Key words.Key words. Mycobacterium tuberculosis. Hypersensitivity.Calcified lymph nodes.
RESUMENRESUMENRESUMENRESUMENRESUMEN
La tuberculosis es una bacteria de crecimiento lento que causahipersensibilidad. El foco primario de infección es el complejo deGhon. La combinación de ganglios linfáticos calcificados y focosde Gohn se conoce como complejo de Ranke. Con frecuencia estecomplejo es la única evidencia radiológica de diseminación he-matógena de la bacteria.
Palabras clave. Palabras clave. Palabras clave. Palabras clave. Palabras clave. Mycobacterium tuberculosis. Hipersensibilidad.Ganglios linfáticos calcificados.
CLINICAL CASE
Thirty-four year old female with cough and shortnessof breath. Chest X-ray showed calcified left parahiliar andparaaortic lymph node, suggestive of pulmonary tubercu-losis (TB). Her sputum smear was negative. The radiolo-gical diagnosis was pulmonary tuberculosis with calcifiedRanke complex (Figure 1).
Mycobacterium tuberculosis is a slow growing microbewith generation times between 12 and 24 h. In 1993 theWorld Health Organization (WHO) declared TB a “globalemergency”: 1.7 billion of people were infected with M.tuberculosis, every year 3 million of people died from TB,and approximately 8 million new cases occurred eachyear.1
TB is a respiratory tract infection that occurs due toinhalation of droplets from infected people. These dro-plets (2–10 µm) are produced when patients with pulmo-nary or laryngeal TB sneeze, cough, speak, or sing. Thesedroplets laden with a few bacilli (1-4 µm) and are carriedby cilia to the terminal bronchioles. The bacteria often
Figure 1. Calcified Ranke complex characterized by calcified leftparahiliar and paraaortic lymph node (black arrows) associatedwith a calcified left apical scar, Simon’s foci (white arrow).
colonize the best ventilated areas of the lungs. Local al-veolar macrophages orchestrate a complex immunopa-thological process and these results, after a few weeks, in
191Rev Invest Med Sur Mex, 2013; 20 (3): 190-191
Carrillo-Esper R, et al.
formation of epitheloid granulomas, which can developinto larger tuberculomas.
Delayed hypersensitivity manifests approximately 4-10weeks after initial infection. At this moment, the tubercu-lin reaction becomes positive. The macroscopic hallmarkof hypersensitivity is the development of caseous necrosisin the pulmonary focus and/or in the involved lymph no-des. The primary parenchymal focus is known as the Ghonfocus. The combination of the Ghon focus and the enlar-ged draining lymph nodes form the primary Ranke com-plex or Ghon complex.2,3 The radiological counterpart ofthese silent and healed lesions is a calcified pulmonaryfocus and/or mediastinal or hilar node. Proof of hemato-genous dissemination can be calcifications in the lungapices (“Simon’s foci”). Frequently, the only radiological
evidence is the so-called Ranke complex, the combina-tion of a parenchymal scar (whether calcified or not), theGhon lesion, and calcified hilar and/or paratracheal lymphnodes.4
REFERENCESREFERENCESREFERENCESREFERENCESREFERENCES
1. Rieder HL, Cauthen GM, Kelly GD, Bloch AB, Snider DE. Tuberculosisin the United States. J Am Med Assoc 1989; 262: 385-9.
2. Agrons GA, Markowitz RI, Kramer SS. Pulmonary tubercu-losis in children. Semin Roentgenol 1993; 28: 158-72.
3. Goodwin RA, DesPrez RM. Apical localization of pulmonary tu-berculosis, chronic pulmonary histoplasmosis and progressivemassive fibrosis of the lung. Chest 1983; 83: 801-5.
4. Van Dyck P, Vanhoenacker FM, Van den Brande P, DeSchepper AM. Imaging of pulmonary tuberculosis. EurRadiol 2003; 13: 1771-785.
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