Vagal Cervicomediastinal Neurofibroma in Neurofibromatosis Type 1 mimicking Pulmonary Tuberculosis: A Case Report

Abstract

 Mediastinal neurofibroma, a rare complication of Neurofibromatosis type 1, (NF1), rarely mimics tuberculosis. We report the case of a 12-year old boywho presented at a health establishment during infancy with clinical and roentgenographic features suggestive of pulmonary tuberculosis for received antituberculosis drug therapy. This time, he presented with hoarseness, left ptosis, posterior neck gibbus and dermal nodules. Radiograph and computed tomography (CT) of the chest showed a left cervicomediastinal tumour extending to the right superior mediastinum. At thoracotomy, a globular tumour measuring 10x7x6 cm and arising from the left vagus nerve was resected with a segment of the nerve. The cervical extension and a rim encroaching on the left brachial plexus were spared to minimize post-operative morbidity. The histopathological diagnosis was neurofibroma. Although neurofibroma originating from the vagus nerve has been reported before, this, to our knowledge, is the first reported case from the middle-belt of Nigeria. Since vagal neurofibroma can manifest earlier than cutaneous neurofibroma in patients with NF1 and mimicother chest lesions, clinicians should endeavour to investigate suspicious infantile chest lesions with other modalities in addition to chest radiography.

Keywords: neurogenic, mediastinal, vagus nerve, tumour