scholarly journals Ultrasound-Guided Cervical Lymph Node Sampling Performed by Respiratory Physicians

2019 ◽  
Vol 4 (2) ◽  
pp. 1-6
Author(s):  
Mohammed Ahmed ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lymph Node ◽  
Cervical Lymph Node ◽  
Diagnostic Yield ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Competency Assessment ◽  
Neck Lymph Node ◽  
Lymph Node Sampling ◽  
Significant Difference ◽  
Respiratory Physician

Background: A variety of disease processes investigated by respiratory physicians can lead to cervical lymphadenopathy. Ultrasound (US) has revolutionised respiratory investigations, and neck ultrasound (NUS) is increasingly recognised as an additional important skill for respiratory physicians. Objectives: We aimed to assess the feasibility of NUS performed by respiratory physicians in the workup of patients with mediastinal lymphadenopathy. Methods: This is a single-centre retrospective cohort study. All patients that underwent US-guided cervical lymph node sampling were included. The diagnostic yield is reported, and specimen adequacy is compared for respiratory physicians and radiologists. Results: Over 5 years, 106 patients underwent NUS-guided lymph node sampling by respiratory physicians compared to 35 cases performed by radiologists. There was no significant difference in the adequacy of sampling between the two groups (respiratory physicians 91.5% [95% CI 84.5–96%] compared to 82.9% [95% CI 66.4–93.4%] for radiologists [p = 0.2]). In the respiratory physician group, a diagnosis was achieved based on lymph node sampling in 89 cases (84%). Neck lymph node sampling was the only procedure performed to obtain tissue in 48 cases (45.3%). Conclusion: NUS and sampling performed by respiratory physicians are feasible and associated with an adequacy rate comparable to that of radiologists. It can reduce the number of invasive procedures performed in a selected group of patients. Guidelines for training and competency assessment are required.

scholarly journals Routine neck ultrasound by respiratory physicians in the diagnosis and staging of patients with lung cancer and mediastinal lymphadenopathy: a prospective pilot study

2020 ◽  
Vol 6 (1) ◽  
pp. 00180-2019
Author(s):  
Mohammed Ahmed ◽  
Cyrus Daneshvar ◽  
David Breen
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cervical Lymphadenopathy ◽  
Mediastinal Lymphadenopathy ◽  
Second Phase ◽  
Neck Node ◽  
Neck Lymph Node ◽  
Neck Ultrasound ◽  
Respiratory Physician

IntroductionCervical lymphadenopathy in lung cancer indicates advanced disease. The presence of mediastinal lymphadenopathy is commonly associated with involvement of neck lymph nodes and some studies suggest routine neck ultrasound (NUS) in this group of patients. We conducted a two-phase study looking at training a respiratory physician to perform ultrasound-guided neck lymph node aspiration in patients with suspected lung cancer.MethodsIn the first phase of the study, one of the authors underwent training in NUS according to predetermined criteria. The adequacy of sampling was prospectively recorded. In the second phase, consecutive patients with suspected lung cancer and mediastinal lymphadenopathy underwent NUS and sampling of abnormal lymph nodes. The outcomes were the adequacy of samples for pathological analysis and molecular analysis, prevalence of cervical lymphadenopathy, and change in stage.ResultsFollowing the period of training, 35 patients underwent neck node sampling with an overall adequacy of 88.6% (95% CI 78.1–99.1%). Cervical lymph node involvement was confirmed in 13 out of 30 patients with lung cancer (43.3%, 95% CI 25.5–62.6%). Further immunohistochemistry and molecular studies were possible in all patients when it was required (nine cases). NUS led to nodal upstaging in four out of 30 (13.3%) cases.ConclusionTraining a respiratory physician to perform NUS and needle sampling to an acceptable level is feasible. Benefits of embedding this procedure in lung cancer diagnosis and pathway staging need to be explored in further studies.

scholarly journals Disseminated Coccidioidomycosis Following Insufficient Treatment at Initial Presentation: Case Report

2020 ◽  
Vol 8 ◽  
pp. 232470962094931 ◽  
Author(s):  
Ameesh Dev ◽  
Dawn Janysek ◽  
James Gnecco ◽  
Kamyar Haghayeghi
Keyword(s):  
Lymph Node ◽  
Cervical Lymph Node ◽  
Cervical Lymphadenopathy ◽  
Psoas Muscle ◽  
Skin Lesions ◽  
Initial Presentation ◽  
Mediastinal Lymphadenopathy ◽  
Enzyme Linked Immunosorbent Assay ◽  
Bone Lesions ◽  
Laboratory Test Results

A 35-year-old male presented to our university hospital with night sweats, fevers, ulcerated skin lesions to the lower mouth and posterior neck, shortness of breath, and an enlarging cervical lymph node. The patient was evaluated 2 months prior for respiratory symptoms, cervical lymphadenopathy, and skin lesions resulting in a diagnosis of primary pulmonary coccidioidomycosis and was treated with a 4-week course of fluconazole. On presentation to our hospital, initial laboratory test results revealed leukocytosis, increased liver enzymes, elevated inflammatory markers, and hypercalcemia. Computed tomography scan of the chest revealed lung nodules in a miliary pattern and prominent mediastinal lymphadenopathy. Magnetic resonance imaging revealed multiple vertebral and iliac bone lesions, as well as bilateral psoas muscle lesions. Serum ELISA (enzyme linked immunosorbent assay) detected elevated serological markers against coccidioides, and sputum culture revealed coccidioides arthroconidia, confirming the presence of an acute coccidioides infection. Biopsy of the right iliac crest and cervical lymph node revealed spherules resembling coccidioides, escalating the diagnosis to disseminated coccidioidomycosis. The patient’s hospital course was complicated by septic shock, acute respiratory distress syndrome requiring several days of mechanical ventilation, and acute kidney injury. He was ultimately treated with several weeks of voriconazole and liposomal amphotericin-B. He made a full recovery and was discharged on an extended course of oral voriconazole. Our case highlights the importance of recognition and appropriate treatment duration of disseminated coccidioidomycosis at initial presentation. Failure to do so may lead to increased morbidity and mortality.

scholarly journals A Study of FNAC of Cervical Lymph Nodes

1970 ◽  
Vol 7 (1) ◽  
pp. 1-5 ◽  
Author(s):  
G Shakya ◽  
S Malla ◽  
KN Shakya ◽  
R Shrestha
Keyword(s):  
Lymph Node ◽  
Fine Needle Aspiration ◽  
Fine Needle Aspiration Cytology ◽  
Cervical Lymph Node ◽  
Cervical Lymphadenopathy ◽  
Needle Aspiration ◽  
Aspiration Cytology ◽  
Cervical Lymph Nodes ◽  
Fine Needle ◽  
Needle Aspiration Cytology

Background: Fine Needle Aspiration Cytology (FNAC) is a reliable and least expensive method suitable for developing countries like Nepal for the investigation of lymphadenopathy. Knowledge about the pattern of lymphadenopathy is useful in pathological reporting as well as in many clinical settings with diagnostic dilemma. This is a baseline study to investigate the pattern of cervical lymphadenopathy by lymph node FNAC in Nepalese population. Methods: A retrospective study was conducted by critically analyzing the case reports on cervical lymph node FNAC from three years' records (July 2005 to June 2008) at the National Public Health Laboratory, Teku, Kathmandu. Review of all cytological reports were done according to standard guidelines and the diagnosis was classified and correlated with patients' age and ethnicity to explore the pattern and association. Results: Of 508 cervical lymph node FNAC cases, 50.4% was reactive non-specific, 22.4% was tubercular, 4.8 % malignant, 10% chronic granulomatous and the remaining was acute suppurative (12.4%). Highest incidence of malignancy was seen in the fifth decade (50%). Whereas, tubercular lymphadenopathy was found with increasing frequency through childhood (10.5%) and adolescence (21.7%) to young adulthood (30.4%), probably indicative of waning immunity of BCG vaccination. Ethnic groups comprising of Tamang, Sherpa and Bhote had the highest incidence of malignant as well as tubercular lymphadenopathy. Conclusion: The relationship of malignant and tubercular lymphadenopthy with age and ethnicity deserves further study. Efforts at preventing tubercular and early diagnosing malignant lymphadenopathy and reducing morbidity in general will find great usefulness in such associations. Key words: Cervical Lymphadenopathy, Fine Needle Aspiration Cytology, Pattern   DOI: 10.3126/jnhrc.v7i1.2267 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 1-5

scholarly journals Lymphogranuloma Venereum: a Croatian Case Report of a Patient with Proctitis and Concurrent Cervical Lymphadenitis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S106-S106
Author(s):  
Branimir Gjurasin ◽  
Josip Begovac
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Cervical Lymph Node ◽  
Rectal Swab ◽  
Cervical Lymphadenopathy ◽  
Lymphogranuloma Venereum ◽  
Purulent Discharge ◽  
Fine Needle Aspirate ◽  
Cervical Lymphadenitis ◽  
Fine Needle

Abstract Background Lymphogranuloma venereum (LGV) can present with genital ulcers, proctitis, or femoral/inguinal lymphadenopathy with or without constitutional symptoms. There have been reports on the infection characterized by supraclavicular or cervical lymphadenopathy, although there is no published data on the detection of Chlamydia trachomatis (CT) in the affected lymph node. Methods We report a patient with pharyngitis, proctitis and cervical lymphadenitis, in whom LGV specific DNA was detected by polimerase chain reaction (PCR) in both the rectal swab and cervical lymph node fine needle aspirate. Results A 48-year-old Croatian HIV-positive male patient attended our outpatient HIV clinic complaining of a 10-day perianal pain, bloody rectal discharge with normal stool consistency and painful and enlarged cervical lymph node. On the first day he had fever, which subsided on the following day. Clinical examination demonstrated exudate on the right tonsil, painful, and enlarged right cervical lymph node (5 × 2 cm, Figure 1), perianal pain on palpation and rectal purulent discharge. During the preceding 10-year period, the patient was taking his antiretroviral therapy regularly and had an undetectable HIV RNA by PCR. We started treatment with ceftriaxone and doxycycline. The fine needle aspirate of the affected lymph node showed a pyogranulomatous inflammation. Indirect immunofluorescence assay on CT antibodies detected positive titers in IgG (>512) and IgA (256) classes. LGV-specific DNA was detected in both the rectal swab and the cervical lymph node fine needle aspirate. Ceftriaxone was discontinued after 5 days and doxycycline therapy was continued for a total of 6 weeks because of the persistence of the cervical lymphadenopathy. The patient came to a full recovery. Conclusion We found six published case reports on LGV with associated cervical lymphadenopathy in which the infection with CT was established by serologic testing and/or by nucleic acid amplification tests of the pharyngeal and/or rectal swabs. Some of the mentioned reports demonstrated granulomatous inflammation present in the affected cervical lymph node, as was evidenced in our patient. To our knowledge, this is the first case report of a patient with CT infection in whom LGV-specific DNA was detected in the cervical lymph node. Disclosures All authors: No reported disclosures.

What is the added diagnostic yield of mediastinoscopy following nondiagnostic EBUS-TBNA thoracic lymph node sampling?

2020 ◽  
Author(s):  
Abdulrahman Hasan Almadani ◽  
Mohammad Aladaileh ◽  
Brian Mccullagh ◽  
Donna Eaton ◽  
Karen Redmond ◽  
...  
Keyword(s):  
Lymph Node ◽  
Diagnostic Yield ◽  
Lymph Node Sampling ◽  
Thoracic Lymph Node

scholarly journals Toxoplasmosis presenting as isolated cervical lymphadenopathy-A rare case

2021 ◽  
Vol 3 (2) ◽  
pp. 55-57
Author(s):  
P B Benny ◽  
P K Thomas ◽  
Rishikesan Nair ◽  
M. Gowri
Keyword(s):  
Lymph Node ◽  
Cervical Lymph Node ◽  
Rare Case ◽  
Cervical Lymphadenopathy ◽  
Immunocompetent Patient ◽  
Excision Biopsy

Lymphadenopathy is not uncommon in toxoplasmosis. Its rare in an immunocompetent patient. We present a case of toxoplasmosis in an asymptomatic lady with isolated cervical lymph node. The diagnosis was confirmed by excision biopsy of lymph node and serology

Cosmetic Outcome of Wound Closure between Steri-Strips (3M™ Steri-Strip) and Simple Interrupted Nylon 6-0 Sutures in Out-Patient Cervical Lymph Node Excision: A Randomized Controlled Trial

2021 ◽  
Vol 104 (7) ◽  
pp. 1088-1094
Keyword(s):  
Randomized Controlled Trial ◽  
Lymph Node ◽  
Cervical Lymph Node ◽  
Controlled Trial ◽  
Nylon 6 ◽  
Lymph Node Excision ◽  
Skin Closure ◽  
Randomized Controlled ◽  
Significant Difference ◽  
The Aesthetic

Objective: To compare the aesthetic outcome of cervical lymph node excision skin closure between Steri-Strips closure and simple interrupted sutures using Nylon 6-0. Materials and Methods: The present study was a single-blinded randomized controlled trial of forty patients with cervical lymph node excision. They were randomized into two groups of twenty. The first group was allocated to close the skin by simple interrupted sutures with Nylon 6-0, the other group received the Steri-Strips for skin closure. Complications were observed at the first and second week. The aesthetic outcomes for skin closure were evaluated at 12 weeks postoperatively using the predetermined Sakka’s cosmetic assessment criteria and scoring system. Results: There was no statistically significant difference between the two groups in terms of gender, age, length of surgical wound, and pathology. The Steri-Strips group showed significantly lower Sakka’s aesthetic score compared to the 6-0 Nylon sutures group (6.25±0.85 and 7.75 ±1.33, p<0.001). There was no significant difference in aesthetic outcomes between genders. Moreover, the operative time of the Steri-Strips group was significantly less than that of the 6-0 Nylon sutures group (2.2±0.41 and 4.75±0.44 minutes, p<0.001). Conclusion: Skin closure with Steri-Strips gave better aesthetic outcomes compared to the 6-0 Nylon sutures (p<0.001). However, the aesthetic outcomes were assessed by physicians, so the patients’satisfaction could not be assessed. Keywords: Lymph node biopsy; Hypertrophic scar; Keloid; Cosmetic outcome; Steri-strip

Brugia malayi in Cervical Lymph Node Aspirate: A Rare Case Report

2016 ◽  
Vol 1 (2) ◽  
pp. 79-80
Author(s):  
Abhinav Srivastava ◽  
Shivesh Kumar ◽  
Ranjan Agarwal
Keyword(s):  
Case Report ◽  
Lymph Node ◽  
Cervical Lymph Node ◽  
Rare Case ◽  
Cervical Lymphadenopathy ◽  
Brugia Malayi ◽  
Wuchereria Bancrofti ◽  
Peripheral Blood Smear ◽  
Cervical Lymphadenitis ◽  
Rare Case Report

ABSTRACT Filariasis is endemic worldwide with the main focus in the tropical areas. Reported cases of filarial lymphadenopathy are caused by Wuchereria bancrofti, which is limited to the groin, the femoral triangle, and axilla, causing lymphedema of lower and upper limbs, and is usually diagnosed clinically and by the presence of microfilaria in peripheral blood smear. We are reporting an unusual case of cervical lymphadenitis, which on fine needle aspiration cytology (FNAC) showed microfilaria of a rare species, Brugia malayi. The purpose of this article is to make clinicians aware of this rare disease as one of the differential diagnoses of cervical lymphadenopathy in an endemic country like India. How to cite this article Srivastava A, Mohan C, Kumar S, Agarwal R. Brugia malayi in Cervical Lymph Node Aspirate: A Rare Case Report. Int J Adv Integ Med Sci 2016;1(2):79-80.

scholarly journals A Case of Nasopharyngeal Tuberculosis with Cervical Lymph Node Tuberculosis Suspected of Cervical Malignant Disease at the First Examination

2021 ◽  
Vol 11 (1) ◽  
pp. 43-46
Author(s):  
Takeshi Kusunoki ◽  
Hirotomo Homma ◽  
Yoshinobu Kidokoro ◽  
Akihisa Yoshikawa ◽  
Kumiko Tanaka ◽  
...  
Keyword(s):  
Lymph Node ◽  
Malignant Lymphoma ◽  
Cervical Lymph Node ◽  
Nasopharyngeal Cancer ◽  
Neck Lymph Node ◽  
Female Immigrant ◽  
Left Neck ◽  
Neck Lymph Node Metastasis ◽  
Lymph Node Tuberculosis ◽  
Bacteria Culture

A case of nasopharyngeal tuberculosis with cervical lymph node tuberculosis is reported. The patient was a 20-year-old female immigrant from Vietnam and cook apprentice. Her chief complaint was left neck swelling with pain for three months. She was diagnosed with left neck lymphadenitis at a previous hospital, which suspected malignant lymphoma and referred her to our hospital. At the time of the first visit, she had left lymph swelling with tenderness and granuloma-like masses in the nasopharynx. PET-CT showed accumulations in both the swollen left neck lymph and nasopharynx. The diagnosis of this case would appear to be nasopharyngeal cancer with left and neck lymph node metastasis or nasopharyngeal tuberculosis with cervical lymph node tuberculosis in addition to malignant lymphoma. Based on some examinations (biopsy, bacteria culture, and imaging), it was diagnosed as nasopharyngeal tuberculosis with cervical lymph node tuberculosis. Therefore, she was treated with anti-tuberculosis agent in respiratory medicine.

scholarly journals The Use of Neck Sonography in Identifying Cervical Lymph Node: A Single Center Study from 2019 to 2020

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Azim Motamedfar ◽  
Mohammad Momen Gharibvand ◽  
Mojgan Sametzade ◽  
Mahsa Akhavan Sabagh
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Cervical Lymphadenopathy ◽  
Primary Source ◽  
Needle Aspiration ◽  
Tnm Staging ◽  
Lymph Node Biopsy ◽  
Cervical Lymph Nodes ◽  
Primary Tumors ◽  
Neck Lymph Node

Background: Tumor metastasis, as one of the most important prognostic factors in solid tumors, affects survival remarkably. Cervical lymphadenopathy (LAP) reflects an advanced-stage disease and changes the tumor-node-metastasis (TNM) staging of tumor, resulting in a multidisciplinary approach to the management of cancer. Objectives: This study aimed to assess the importance of neck sonography in monitoring primary tumors. Methods: Records of 166 patients with distant primary cancers who underwent neck sonography from February 2019 to February 2020 were studied. Abnormal lymph nodes were reported, and then the patients underwent neck sonography and fine needle aspiration (FNA) or core needle biopsy (CNB) under direct US guidance. Thirty-two patients who were confirmed for malignant cervical LAP underwent neck lymph node biopsy as an easy and safe way to provide tissue diagnosis instead of providing biopsy from the primary source of tumor. Results: Malignant cervical LAP was confirmed in 32 patients (19.2%) by neck sonography. Seventy-seven patients (46.4%) were male and 89 patients (53.6%) were female. The patients were 22 to 88 years old (mean age = 57.7 years; standard deviation = 12.7). Thirty-two patients (19.2%) had pathological cervical lymph nodes and 134 patients (80.8%) did not have. Conclusions: Metastatic cervical LAP found by neck ultrasound will change pretreatment TNM staging of disease to provide optimal treatment on a case-by-case basis. According to the result of this study, routine neck sonography in patients with distant primary tumors is recommended.

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