Burkholderia pseudomallei infection manifests as mediastinal/hilar lymphadenopathy: A case report

Rationale: This case report presents the diagnosis and etiology of hilar/mediastinal lymphadenopathy in a male patient. Patient concerns: A 49-year-old man presented with fever and dyspnea after physical exertion. Diagnosis: The patient was diagnosed with melioidosis by cultivation of lymph node aspirate on blood agar using the VITEK 2 compact system. Interventions: The patient was treated with ceftazidime intravenously, combined with trimethoprim/sulfamethoxazole orally for 1 week. Once the patient was discharged, he began a 12-week course of trimethoprim/sulfamethoxazole. Outcomes: The patient recovered after treatment with ceftazidime and trimethoprim/sulfamethoxazole. Conclusions: Melioidosis is an infectious disease that mainly occurs in tropical regions. It can cause severe sepsis and pneumonia, and the infection in some patients may become chronic. Endobronchial ultrasound-transbronchial needle aspiration is a useful technique in the diagnosis of patients with hilar/mediastinal lymphadenopathy.

Clinical feature analysis of patients failed for diagnosis by EBUS-TBNA / 中华胸心血管外科杂志

Objective Analyze the clinical feature of patients failed for diagnosis through endobronchial ultrasound transbronchial needle aspiration(EBUS-TBNA).Optimize the indication and increase diagnosis rate of EBUS-TBNA.Methods A total of 669 patients failed for diagnosis of EBUS-TBNA were included.Fifty-three of them(7.92％) were not exactly diagnosed.Perioperation clinical data and clinical feature were collected and evaluated based on specific disease,lesion location,size and operator' s experience.Results The undiagnosis rate was higher in lymphoma (77.78％),tuberculosis (23.08％) and sarcoidosis(9.09％) when analyzed from specific diseases.If the lesion location was taken into consideration,15.38％ upper paratracheal lymph nodes(R2) could not be diagnosed exactly by EBUS-TBNA,and the bilateral hilar lymph nodes(15.00％ for right,11.54 for left) were followed.Size of the lesion was not associated with the diagnosis rate.The operator's experience could also affect the results.The undiagnosis rate was highest in the first 10 cases among all operators.After at least 10 EBUS-TBNA processes,the undiagonsis rate stayed near 7.50％,which was close to the average.Conclusion It is necessary to select suitable indications for EBUS-TBNA based on the disease,lesion location and operatior experience,and cooperate with mediastinoscopy to rise diagnosis rate.