Mediastinal lymphatic tuberculosis is a chronic disease caused by the invasion of Mycobacterium tuberculosis into multiple lymph nodes in the mediastinum. Because there is often no substantial lung lesion and no specific signs in the early stage, clinical symptoms of tuberculosis poisoning are not typical, and it is easy to be misdiagnosed as other diseases, such as malignant lymphoma, metastatic cancer and nodal disease. This disease is easily missed on chest X-ray, mainly manifested as round or oval shadows next to the mediastinum on one side, arranged in a bead-like pattern, with paratracheobronchial and hilar lymph nodes being common, more unilateral than bilateral, and more right than left, which is related to the lymphatic drainage of the lung and the aortic arch on the left side, while the mediastinal tissue on the right side is loose and soft, so the lesions tend to develop to the right. Therefore, when the chest radiograph is abnormal, CT examination of the chest should be chosen. In more than 85% of patients with enhanced CT scans, the mediastinal lymph nodes are circumferentially enhanced at the edges, while the central region is less dense, and even less so when there is liquefaction. Mediastinal lymph nodes need to be differentiated from malignant lymphoma, metastatic carcinoma, and nodal disease. The clinical manifestations of malignant lymphoma usually include high fever, hepatosplenomegaly, superficial lymph node enlargement, marked anemia, and cachexia, while metastatic cancer usually has a primary lesion, most commonly lung cancer causing mediastinal lymph node metastasis, followed by gastrointestinal tumor or prostate cancer. The hypodensity of metastatic lymph node cancer is only seen in cases of large, centrally necrotic malignant tumors, when the primary lesion is also very obvious. The pathological stages of mediastinal lymph node tuberculosis: Ⅰ lymphoid tissue-like hyperplasia, formation of lymph nodes and granulomas, proliferation of lymphocytes and epithelioid cells, Ⅱ caseous necrosis in the center of lymph nodes, destruction of lymph node envelope, but the surrounding fat layer still exists, Ⅲ caseous necrosis in lymph nodes expands, multiple lymph nodes fuse, and the surrounding fat layer disappears, Ⅳ caseous necrotic material ruptures into the surrounding soft tissues and forms a fused pus cavity. The fused pus cavity is formed. Mediastinal lymph node enlargement should be actively searched for other sites of tuberculosis. Mediastinoscopy is less invasive, shorter and safer, and is the best means to clarify the nature of mediastinal lymph node enlargement. Indications for surgery: 1, the lesion continues to expand after regular diagnostic anti-tuberculosis treatment; 2, the lesion is more than 75px and there is no obvious calcification in the lesion; 3, with pulmonary atelectasis, caseous pneumonia by medical treatment is ineffective; 4, with compression symptoms, because it is prone to serious complications, especially the left side of the lesion, should be operated; 5, can not exclude the tumor. 1.If the enlarged lymph node is not firmly attached to the lung and mediastinal organs, complete removal is the ideal procedure. However, in most cases, the history of the disease is long, the lymph node is necrotic and liquefied, and it is obviously attached to the trachea, superior vena cava, odd vein and esophagus. 2, if the lesion invades the lung tissue, part of the lung tissue can be removed at the same time, if there is a combination of intrapulmonary tuberculosis or bronchial stenosis, pulmonary atelectasis, and if there is significant fibrosis over time, lobectomy is feasible. 3, bronchial lymphatic fistula is a serious complication of mediastinal lymphatic tuberculosis, bad food penetrating the bronchus can cause asphyxia, intrapulmonary dissemination, etc., the fistula is not large without intrapulmonary comorbidity, simple repair plus pleural coverage is feasible. If the fistula is large but confined to the bronchi of the lobe, lobectomy or bronchoplasty with preservation of the bronchial wall should be performed to avoid total lung resection. The majority of stage I and II patients do not require surgery and can be treated with regular and adequate anti-tuberculosis medication to achieve the desired therapeutic effect. If surgery is not possible, the breakdown of necrotic material will bring serious consequences. If the symptoms of compression of trachea, bronchus and esophagus appear, the effect of drug treatment is not good, or complications (such as formation of abscess chest, parasternal sinus tract, cervical sinus tract, etc.) may not be considered staging, and surgery is performed directly. For patients with esophageal perforation and bronchial lymphatic fistula, the choice and operation of surgery should be cautious.