scholarly journals A case report on expanding horizon of endobronchial ultrasound through esophagus

2020 ◽  
Vol 90 (3) ◽  
Author(s):  
Mario Tamburrini ◽  
Parikshit Thakare ◽  
Francesca Zampieri ◽  
Angelo Scarda ◽  
Alessandra Di Paolo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Pleural Effusion ◽  
Squamous Carcinoma ◽  
Final Diagnosis ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Malignant Cells ◽  
Necrotic Tissue ◽  
Fluid Collections ◽  
Cytology Report

Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS) through oesophageal approach and rationale behind using this approach. We report a case of 70 years old man who has been referred from physician for the EBUS in view of hilar mass with mediastinal lymphadenopathy with pleural effusion. The endobronchial ultrasound through oesophagus (EUS-B) was done for thoracocentesis and lymph node cytology evaluation and ultimately endobronchial biopsy of hilar mass was done as rapid on-site (ROSE) analysis of lymph node was suggestive of necrotic tissue. The cytology report of lymph node and pleural effusion was positive for malignant cells. The final diagnosis was metastatic poorly differentiating adeno-squamous carcinoma.

scholarly journals Transcriptional Profiling of Endobronchial Ultrasound-Guided Lymph Node Samples Aids Diagnosis of Mediastinal Lymphadenopathy

CHEST Journal ◽  
2016 ◽  
Vol 149 (2) ◽  
pp. 535-544 ◽  
Author(s):  
Gillian S. Tomlinson ◽  
Niclas Thomas ◽  
Benjamin M. Chain ◽  
Katharine Best ◽  
Nandi Simpson ◽  
...  
Keyword(s):  
Lymph Node ◽  
Transcriptional Profiling ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Ultrasound Guided ◽  
Aids Diagnosis

scholarly journals Endobronchial ultrasound: morphological predictors of benign disease

2016 ◽  
Vol 2 (1) ◽  
pp. 00053-2015 ◽  
Author(s):  
Pratibha Gogia ◽  
Tabassum Z. Insaf ◽  
William McNulty ◽  
Afroditi Boutou ◽  
Andrew G. Nicholson ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Univariate Analysis ◽  
Morphological Characteristics ◽  
Final Diagnosis ◽  
Benign Disease ◽  
Endobronchial Ultrasound ◽  
Malignant Cells ◽  
Predictive Probability ◽  
Lymph Node Size ◽  
Node Size

The objective of this study was to assess the utility of endobronchial ultrasound (EBUS) morphology of lymph nodes in predicting benign cytology of transbronchial needle aspirates in a prospective observational study.Five ultrasonic morphological characteristics of mediastinal and hilar lymph nodes were recorded: size, shape, margins, echogenic appearance and the presence of a central blood vessel. These characteristics were correlated with the final diagnosis. A total of 402 consecutive patients (237 males and 165 females) undergoing EBUS were studied.The final diagnosis was malignant disease in 244 (60.6%) and benign disease in 153 (38.05%) subjects. Out of 740 sampled nodes, in 463 (62.6%) malignant cells were identified, whereas in 270 (36.5%) nodes, no malignant cells were identified. On univariate analysis small size, triangular shape and the presence of a central vessel were predictive of a benign aetiology. In the final multivariate model, a predictive probability of 0.811 (95% CI 0.72–0.91) for benign disease was found if lymph node size was <10 mm and a central vessel was present.Sonographic appearances of lymph nodes improve the predictive probability of EBUS for benign aetiologies, and may reduce the number of nodes requiring sampling and the need for further invasive investigations.

scholarly journals Endobronchial Ultrasound Guided Transbronchial Needle Aspiration

2018 ◽  
Vol 16 (3) ◽  
pp. 351-353
Author(s):  
Ashesh Dhungana ◽  
Prajowl Shrestha ◽  
Kiran Shrestha ◽  
Shristi Shah ◽  
Pratikchya Karki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Mediastinal Lymph Node ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Transbronchial Needle Aspiration ◽  
Sonographic Guidance ◽  
History Of ◽  
The Right

Evaluation of mediastinal lymphadenopathy is often challenging. Endobronchial Ultrasound (EBUS) is a novel technique which provides real time sonographic guidance during Transbronchial Needle Aspiration (TBNA) from mediastinal and hilar lesions. A 60-year-old smoker presented with two months history of cough and chest pain on the right side. CT thorax revealed a right upper lobe spiculated mass with paratracheal (Station 4R) and subcarinal (Station 7) lymph nodes. Bronchoscopy did not reveal any endobronchial mass. Since EBUS-TBNA is superior to conventional TBNA for malignant mediastinal node, an EBUS- TBNA was performed from both lymph node stations. . Cytopathology and histopathology revealed non-small cell lung cancer. We hereby report the first use of EBUS-TBNA in Nepal, in a patient with lung cancer and mediastinal lymphadenopathy.Keywords: Endobronchial ultrasound; lung cancer; mediastinal lymph node; transbronchial needle aspiration.

scholarly journals Methimazole-Induced Pleural Effusion in the Setting of Graves’ Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Le Yu Khine ◽  
Dong Won Kim ◽  
Omolola Olajide ◽  
Chelsey White ◽  
Yousef Shweihat ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Lower Lobe ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Endobronchial Ultrasound ◽  
Ventricular Rate ◽  
Mediastinal Lymphadenopathy ◽  
Graves Disease ◽  
X Ray ◽  
Chest X Ray ◽  
The Right

Methimazole is a thionamide drug that inhibits the synthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland. We report a case of methimazole-induced recurrent pleural effusion. A 67-year-old female with recently diagnosed Graves’ disease on methimazole 20mg daily was admitted with dyspnea and new onset atrial fibrillation with rapid ventricular rate. Chest X-ray revealed a unilateral right pleural effusion, which was consistent with a transudate on thoracocentesis. She was managed as a case of congestive heart failure and methimazole dose was increased to 30 mg daily. She was readmitted twice with recurrent right pleural effusion. The fluid revealed an exudative process on repeat thoracocentesis. CT scan of the chest with contrast showed mediastinal lymphadenopathy and a diffuse ground glass process involving the right lower lobe suggestive of pneumonitis. Bronchoalveolar lavage showed neutrophil predominant fluid, and cytology and adenosine deaminase were negative. Patient also had an endobronchial ultrasound guided biopsy of the lymph nodes (EBUS). She was treated empirically with steroids 40 mg for 10 days and the methimazole was also discontinued. The antinuclear antibodies (ANA) came back positive with a speckled pattern; antineutrophil cytoplasmic antibody (c-ANCA) and antimyeloperoxidase were also positive. The effusion resolved but recurred on rechallenge with methimazole. She was referred for urgent thyroidectomy. The patient’s repeat chest X-ray showed complete resolution of the pleural effusion after stopping the methimazole. Few weeks later, repeat ANCA and antimyeloperoxidase antibody were both negative. Our case report highlights the importance of the recognition of a rare side effect of methimazole. Timely diagnosis would ensure that appropriate treatment is given.

scholarly journals Phlegmonous Appearance in the Ipsilateral Paracardiac Fat without Paracardiac Lymph Node Enlargement on Chest CT Favors the Diagnosis of Pleural Tuberculosis over Malignant Pleural Effusion

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1041
Author(s):  
Dongjun Lee ◽  
Min Ji Son ◽  
Seung Min Yoo ◽  
Hwa Yeon Lee ◽  
Charles S. White
Keyword(s):  
Lymph Node ◽  
Pleural Effusion ◽  
Malignant Pleural Effusion ◽  
Chest Ct ◽  
Reactive Protein ◽  
Ct Findings ◽  
Pleural Tuberculosis ◽  
Lymph Node Enlargement ◽  
Fluid Collections ◽  
Fat Stranding

This study investigated the potential role of paracardiac fat stranding (FS) interspersed with multiple fluid collections (FC) as a clue to differentiate between pleural tuberculosis (pleural TB) and malignant pleural effusion (MPE). The authors retrospectively analyzed chest computed tomography (CT) findings of 428 patients, 351 with pleural TB and 77 with MPE, focusing on the paracardiac fat, and level of pleural adenosine deaminase (ADA) and blood C-reactive protein (CRP). Two radiologists independently evaluated the chest CT findings regarding the paracardiac fat pad ipsilateral to the effusion, including FS, FC, phlegmonous appearance (a combination of the FS and multiple FC), and the presence of lymph node enlargement (>1 cm in short axis diameter). There were significant differences between patients with pleural TB and those with MPE with respect to the prevalence of phlegmonous appearance in the ipsilateral paracardiac fat (47.6% and 10.4%, p < 0.001, OR = 7.8; 95% CI 3.7–16.8) and paracardiac lymph node enlargement (1.4% and 19.5%, p < 0.001, OR = 0.06; 95% CI 0.02–0.2) on CT. In contrast, there was no difference in the prevalence of isolated FS or multiple FC within the ipsilateral paracardiac fat between the two groups. Median pleural ADA and serum CRP level were higher in patients with pleural TB accompanied by phlegmonous appearance in paracardiac fat compared to those without that appearance (ADA: median 104 IU/L versus 90 IU/L, p < 0.001; CRP: 6.5 mg/dL versus 4.2 mg/dL, p < 0.001). In conclusion, phlegmonous appearance in the ipsilateral paracardiac fat without paracardiac lymph node enlargement on chest CT favors a diagnosis of pleural TB over MPE.

scholarly journals Purulent Appearing Material in an Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Mediastinal Lymph Node: A Diagnostic Challenge

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Damaris Pena ◽  
Gilda Diaz-Fuentes ◽  
Sindhaghatta Venkatram
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Malignant Tumors ◽  
Mediastinal Lymph Node ◽  
Lung Nodule ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has increasingly been performed for the diagnosis and staging of thoracic malignancies. Findings of a necrotic lymph node raise concern for infectious process and malignancy. A hypoechoic area on ultrasound/EBUS within a lymph node without blood flow is suggestive of pathologies like infections or malignancy. Inspection of the fluid could suggest a diagnosis; clear aspirates usually suggest bronchogenic or mediastinal cysts and purulent material suggests abscesses or necrotic lymph nodes. Growing tumor cells require a blood supply; if the vascular stroma is insufficient due to rapidly growing malignant tumors this could lead to large central areas of ischemic necrosis. Necrotic aspiration of lymph nodes is not always of infectious etiology. Aspiration of fluid in EBUS-TBNA is a rare occurrence, and malignancy should be considered when purulent fluid material is obtained. We present an elderly woman who underwent bronchoscopy with EBUS-TBNA for evaluation of upper lung nodule and mediastinal lymphadenopathy. Pus-like material was obtained on needle aspiration and endobronchial biopsy and mediastinal core biopsy revealed squamous cell carcinoma.

scholarly journals The Use of Endobronchial Ultrasound in the Diagnosis of Subacute Pulmonary Histoplasmosis

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Katarine von Lang Egressy ◽  
Mohammed Mohammed ◽  
J. Scott Ferguson
Keyword(s):  
Clinical Setting ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Transbronchial Needle Aspiration ◽  
Pulmonary Histoplasmosis ◽  
Mediastinal Disease ◽  
High Degree

Objective. Endobronchial ultrasound (EBUS) utility in diagnosis in malignant and granulomatous mediastinal disease has been well demonstrated. We propose to examine the role of EBUS transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of subacute pulmonary histoplasmosis (SPH) with mediastinal lymphadenopathy in an area where histoplasmosis is endemic. Methods. A retrospective review was performed in a single academic institution between 2009 and 2012 of patients referred for EBUS-TBNA who had radiographic imaging and clinical symptomatology suspicious for SPH. Seven patients were reviewed. TBNA results showing granulomatous disease with areas of necrosis in the appropriate clinical setting were considered to be adequate for the diagnosis of SPH when alternative diagnosis was excluded. Patients underwent further clinical follow-up of 12 months to determine the final diagnosis. Results. All seven patients were felt to have SPH diagnosis reached by a combination of clinical presentation, EBUS-TBNA results, fungal serologies, and antigen testing. None of the patients needed further invasive procedures. Conclusions. EBUS-TBNA is a minimally invasive tool that can be used to support a diagnosis of SPH in patients with a high degree of clinical suspicion. EBUS-TBNA should be considered as an adjunctive diagnostic procedure for patients with SPH in an appropriate clinical setting.

scholarly journals The Differential Diagnosis of Bilateral Pleural Effusion and Multiple Mediastinal Lymphadenopathies Includes Kikuchi-Fujimoto Disease

2020 ◽  
Vol 8 ◽  
pp. 232470962093342
Author(s):  
Chienhsiu Huang
Keyword(s):  
Differential Diagnosis ◽  
Lymph Node ◽  
Pleural Effusion ◽  
Thoracoscopic Surgery ◽  
Mediastinal Lymph Node ◽  
Cervical Lymphadenopathy ◽  
Oral Prednisolone ◽  
Disease Diagnosis ◽  
Bilateral Pleural Effusion ◽  
Mediastinal Lymphadenopathy

Kikuchi-Fujimoto disease is an uncommon lymphohistiocytic disorder that frequently presents with acute or subacute clinical disease course. Cervical lymphadenopathy is the most common involved lymph node. Very rare cases of pathologic diagnosis of Kikuchi-Fujimoto disease with bilateral pleural effusion and multiple mediastinal lymphadenopathies have been reported in the literature. In this article, we report the case of a 60-year-old male presented with bilateral pleural effusion and multiple mediastinal lymphadenopathies. He received video-assisted thoracoscopic surgery of the right pleura and thoracoscopic excision of the mediastinal lymph node. The pathologic findings from the lymph node and pleura were compatible with Kikuchi-Fujimoto disease. He was treated with oral hydroxychloroquine and oral prednisolone. A computed tomography scan of the chest 4 months later showed regressive mediastinal lymphadenopathy and bilateral pleural effusion. Our case is a first reported case of Kikuchi-Fujimoto disease diagnosis by the pathology of the lymph node and pleura in the literature. Results from our case suggest that Kikuchi-Fujimoto disease should be included in the differential diagnosis of bilateral pleural effusion and multiple mediastinal lymphadenopathies.

scholarly journals The Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Technique in Assessment of Mediastinal Lymph Nodes

2021 ◽  
Author(s):  
Shahab Rafieian ◽  
Reza Ershadi ◽  
Hossein Ebrahimpoor ◽  
Matin Vahedi
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Diagnostic Yield ◽  
Mediastinal Lymph Node ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Mediastinal Lymphadenopathy ◽  
Mediastinal Lymph Nodes ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration

Abstract Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) technique provides a complementary assessment of the areas of mediastinal lymph node involvement, and allows sampling of suspected lymph nodes. But, the usefulness of EBUS-TBNA in assessing all areas of mediastinal lymph nodes is little known and it seems that such assess is dependent to various factors related to the patient's condition and especially the characteristics of local lymph nodes. We aimed to evaluate the utility of EBUS-TBNA in assessing mediastinal lymph nodes and the factors associated with this utility.Methods: This cross-sectional study was performed on 40 patients suspected to mediastinal lymphadenopathy scheduled for assessment by EBUS-TBNA and mediastinoscopy. The diagnostic yield of EBUS-TBNA to mediastinal lymph nodes was evaluated and non diagnostic cases evaluated by mediastinoscopy .Results: In evaluation with EBUS-TBNA, the diagnostic yield of EBUS in assess to mediastinal lymph nodes including 34 out of 40 cases was equal to 85%. The size of lymph node (lower than 10mm), the area of sample (left and right upper paratracheal), and the nature of the lymph node sample (benign type) were associated with lower diagnostic yield for EBUS-TBNA.Conclusion: The diagnostic yield of EBUS in assessing mediastinal lymph nodes for sampling and diagnosis is 85%. This benefit is expected in the case of lesions larger than 10 mm, lesions of a malignant nature, as well as lesions in the inferior paratracheal and subcarinal stations.

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