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Objective:To investigate the application of transbronchial needle aspiration (TBNA) in the diagnosis of tuberculosis with mediastinal lymphadenopathy in children.Methods:A retrospective study was conducted on clinical data in 8 children of tuberculosis with mediastinal lymphadenopathy treated in the Center for Respiratory Intervention, Children′s Hospital Affiliated to Shandong University from March 2014 to July 2019.TBNA was performed after the mediastinal lymphadenopathy were diagnosed by chest enhanced CT and the final diagnosis was made.The diagnostic experience of TBNA was summarized.Results:Eight children with mediastinal lymphadenopathy included in this present study aged from 7 months to 8 years and 6 months (infants accounted for 75.0%), with a median age of 22.5 months.There were 3 males (37.5%) and 5 females (62.5%). The body mass was 8.5-39.0 kg, and the median body mass was 10.7 kg.The course of disease was 15-90 days, and the median number of days was 18.5 days.The clinical manifestations included cough in 8 cases, fever in 4 cases, wheezing in 1 case and laryngeal ringing in 1 case.Bronchoscopy and TBNA biopsy were performed.Cytology, etiology and pathology were examined after TBNA.A definite diagnosis could be made in 6 children, with a diagnosis rate of 75.0%.Among them, 4 cases were found with acid-fast bacilli in smear but pathological examination was negative; 1 case was pathologically conformed to the characteristics of tuberculosis infection but the smear was negative; the smear and pathology of 1 case were both suggestive of tuberculosis; 2 cases did not present etiological and histological evidence with TBNA.The diagnosis was made according to the positive acid-fast bacilli of alveolar lavage fluid smear.There were no complications during and after operation.Conclusions:TBNA is an important method to diagnose tuberculosis in children, which is effective, safe and has high clinical application value.
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Background: Interstitial lung disease (ILD) represents a heterogeneous non-infectious group of acute and chronic diseases affecting the lung parenchyma. ILDs are usually associated with significant morbidity and mortality, particularly when fibrosis occurs. ILD is usually associated with mediastinal lymph node enlargement, the extent of lymph node enlargement may correlate to disease activity or progression of fibrosis. In the present study, authors have correlated the spectrum of high-resolution CT findings in ILDs with mediastinal lymph node enlargements.Methods: One hundred and four cases of ILDs confirmed by HRCT findings and pulmonary function tests were included in this study. HRCT was performed using a GE 128 SLICE CT OPTIMA 660 scanner, USA with 1.5 mm collimation at full inspiration. The findings were classified into three groups-fibrotic, ground glassing and nodular pattern. Authors assessed the presence, number and sites of enlarged lymph nodes (short axis ≥10 mm in diameter).Results: The largest subsets of patients were found in the 51-60 age groups. Fibrotic pattern was the most common pattern in this study (50%) followed by ground glassing (44%). Nodular pattern was the least predominant pattern (6%). Lymphadenopathy was seen in 84% of UIP and 63% cases of NSIP. P value was 0.049 which indicates a significant relation between lymphadenopathy and various ILDs. A strong relationship between lymphadenopathy and the predominant fibrotic pattern followed by ground glassing was observed.Conclusions: A significant association was established between lymphadenopathy and the type of ILD where fibrotic pattern had the maximum association.
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Lipomatous hypertrophy of the interatrial septum (LHIS) is an uncommon cause of superior vena cava syndrome (SVCS). Fibrosing mediastinal lymphadenopathy is another cause of SVCS. We present a 65‑year‑old female patient with a history of tuberculosis (TB) and the coexistence of LHIS and fibrosing mediastinitis due to TB of the lung. Fibrosing or sclerosing mediastinitis is a rare entity with few cases published in the western literature. She presented with mild symptomatology of SVCS and she underwent on transthoracic and transesophageal echocardiography, computed tomography scan, magnetic resonance imaging, and venography. Due to the development of an abundant collateral venous system seen on venography and her negation for any treatment, she did not undergo yet on any intervention. To our knowledge, this is the first case reported in the international bibliography in which LHIS and sclerosing lymphadenopathy are simultaneously diagnosed in the same patient.
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PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate and minimally invasive technique used routinely for investigation of mediastinal and hilar lymphadenopathy. However, few studies have addressed its role in comparison to the traditional diagnostic approaches of transbronchial lung biopsy (TBLB), endobronchial biopsy (EBB), and bronchoalveolar lavage (BAL) in the diagnosis of sarcoidosis. We evaluated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis compared to TBLB, EBB, and BAL. MATERIALS AND METHODS: Consecutive patients with suspected sarcoidosis (stage I and II) on chest radiography and chest computed tomography were included. All 33 patients underwent EBUS-TBNA, TBLB, EBB, and BAL during the same session between July 2009 and June 2011. EBUS-TBNA was performed at 71 lymph node stations. RESULTS: Twenty-nine of 33 patients, were diagnosed with histologically proven sarcoidosis; two patients were compatible with a clinical diagnosis of sarcoidosis during follow-up; and two patients were diagnosed with metastatic carcinoma and reactive lymphadenopathy, respectively. Among 29 patients with histologically proven sarcoidosis in combination with EBUS-TBNA, TBLB, and EBB, only EBUS-TBNA and TBLB revealed noncaseating granuloma in 18 patients and one patient, respectively. The overall diagnostic sensitivities of EBUS-TBNA, TBLB, EBB, and BAL (CD4/CD8 > or =3.5) were 90%, 35%, 6%, and 71%, respectively (p<0.001). The combined diagnostic sensitivity of EBUS-TBNA, TBLB, and EBB was 94%. CONCLUSION: EBUS-TBNA was the most sensitive method for diagnosing stage I and II sarcoidosis compared with conventional bronchoscopic procedures. EBUS-TBNA should be considered first for the histopathologic diagnosis of stage I and II sarcoidosis.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biopsy, Fine-Needle/methods , Bronchoscopy , Lymph Nodes/pathology , Sarcoidosis/diagnosisABSTRACT
La infección por Micobacterium tuberculosis constituye un problema frecuente en nuestra sociedad representando una de las enfermedades infecto-contagiosas de alta prevalencia en niños menores de 15 años. Se realizó un estudio de las características sociales como la procedencia de los casos y características personales como género, y edad de la enfermedad tomando en cuenta: tipo de presentación, complicaciones primarias o tardías, vías de transmisión y el tipo de diagnóstico en menores de 15 años de edad que fueron diagnosticados con tuberculosis (TB) durante las gestiones 2009 - 2010 en el Hospital del niño/a "Manuel Ascencio Villarroel", Cercado - Cochabamba. El estudio fue descriptivo de corte transversal. Se estableció el universo de 1444 casos registrados para atención en el servicio de consulta externa en menores de 15 años. El diagnóstico realizado para la detección de TB fue 100% mediante baciloscopía directa. Entre los resultados representativos, observamos que 54% de los casos corresponden al sexo femenino y los meses Marzo y Noviembre del 2009 y Noviembre de 2010 presentan un mayor número de casos, siendo la procedencia de los menores; zonas periurbanas (46%), zona rural con 38% y la zona central con 7%. Observando las características sociales y de presentación de la enfermedad podemos concluir que la condición social-económica son factores que agravan la prevalencia de esta enfermedad. La incidencia real de los casos que cursan con tuberculosis en menores de 15 años es una situación muy delicada, ya que la mayoría de los casos pueden ser diagnosticados como falsos positivos.
Infection with M.Tuberculosis is a common problem in our society it represents one of the infectious diseases of high prevalence in children under 15 years. A study of the social and the relevance of the cases, personal characteristics such as gender, age and disease, type of presentation, primary or delayed complications, modes of transmission and type of diagnosis in children under 15 years who were diagnosed with TB during 2009-2010 in the Hospital efforts of the child "Manuel Ascencio Villarroel," Cochabamba. The study was cross sectional. It established the universe of 1444 cases registered for care in the outpatient service under 15 years. Among the representative results, we note that 54% of cases are female and the months of March and November 2009 and November 2010 have a higher number of cases. As the origin of minors, peri-urban areas (46%), rural area with 38% and the central area with 7%. The diagnostic method for detection of tuberculosis was 100% by direct smear. Noting the social and presentation of the disease we can conclude that the social-economic statuses are factors that increase the prevalence of this disease.The actual incidence of tuberculosis cases that developed in children under 15 years is a very delicate situation, as most cases can be diagnosed as false positives.
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A case report of male patient with a right neck mass is discussed .The initial diagnosis was tuberculosis. The plain film chest and CT chest also demonstrated mediastinal lymphadenopathy. The autopsy and pathology findings indicated adenocarcinoma of lung.
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Approximately half of the patients with systemic lupus erythematosus(SLE) develop localized or diffuse lymphadenopathy during the evolution of the disease. But hilar and mediastinal lymph node enlargement due to SLE is rare. The histologic findings of lupus lymphadenitis range from nonspecific lymphadenitis with variable degrees of cellular necrosis to the less common but more specific appearance of extensive necrosis. Advanced lesions are characterized by hematoxylin bodies and condensation of DNA on the vessel walls. Hematoxylin bodies are amorphous homogeneous violet or lilac colored structures composed of partially depolymerized DNA, mixed with protein, carbohydrates and globulins which may be seen deposited on vessel walls and within the paracortex of lymph node. They are virtually diagnostic of SLE and would exclude malignant lymphoma. SLE with mediastinal lymphadenopathy is rare so we report this case with a review of literatures, which was diagnosed by hematoxylin bodies on pathologin findings of cervical lymph node.