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Tuberculosis with mediastinal lymph node involvement: Current diagnostic techniques in clinical practice

Estefania Sanchez, Felipe Andreo, Enric Cases, A. Briones, Jose Sanz, R. Moreno, Cristina Prat, C. Navarro, Mariona Llatjos, Carlos Martinez, Joan Ruiz
European Respiratory Journal 2013 42: P4437; DOI:
Estefania Sanchez
1Pneumology, Germans Trias I Pujol University Hospital, Badalona, Spain
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Felipe Andreo
1Pneumology, Germans Trias I Pujol University Hospital, Badalona, Spain
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Enric Cases
5Pneumology, La Fe University Hospital, Valencia, Spain
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A. Briones
5Pneumology, La Fe University Hospital, Valencia, Spain
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Jose Sanz
1Pneumology, Germans Trias I Pujol University Hospital, Badalona, Spain
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R. Moreno
5Pneumology, La Fe University Hospital, Valencia, Spain
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Cristina Prat
2Microbiology, Germans Trias I Pujol University Hospital, Badalona, Spain
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C. Navarro
5Pneumology, La Fe University Hospital, Valencia, Spain
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Mariona Llatjos
3Pathology, Germans Trias I Pujol University Hospital, Badalona, Spain
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Carlos Martinez
4Thoracic Surgery, Germans Trias I Pujol University Hospital, Badalona, Spain
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Joan Ruiz
1Pneumology, Germans Trias I Pujol University Hospital, Badalona, Spain
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Abstract

INTRODUCTION:Analyse the use and diagnostic yield of the different current techniques employed in the diagnosis of patients with tuberculosis with mediastinal and/or hiliar lymph node involvement.

MATERIAL AND METHODS:Patients diagnosed with thoracic lymph node tuberculosis in two Spanish University Hospitals,were retrospectively analyzed.Were confirmed by microbiology and/or pathological examination after endobronchial ultrasound transbronchial needle aspiration(EBUS-TBNA)or trans-oesophageal endobronchial ultrasound-guided fine-needle aspiration(EUS-B-FNA), transtracheal needle aspiration using standard bronchoscopy (TTNA-SB)and/or mediastinoscopy.

RESULTS:33 patients were included.Mean age was 47 years,11 immunosuppressed,and mainly Spanish population.58% have had prior clinical suspicion,tuberculin test,was positive in 68%(13/19)of cases,in 2 of them Quantiferon was performed and was positive.SB had been previously performed in 16 patients and bronchial aspirates were positive in 2 cases.TTNA-SB was performed in 1 case,EUS-B-FNA in 3 cases,EBUS-TBNA in 22 cases and mediastinoscopy in 12,7 of them without prior.Necrosis was observed in 17 cases(68%), granulomas in 14(56%),the smear of the aspirate was positive in 24% and culture in 47.6%.Endosonography was diagnostic of tuberculosis in 63.6% of cases. In two cases EBUS-TBNA was negative (8%),and it was necessary to perform mediastinoscopy.

CONCLUSIONS:Ultrasound bronchoscope should be implemented in the routine diagnostic algorithm.In cases where there is a clinical suspicion, it is advisable to have the results of mycobacterial cultures before performing other more invasive techniques.

  • Tuberculosis - diagnosis
  • Bronchoscopy
  • Infections
  • © 2013 ERS
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Tuberculosis with mediastinal lymph node involvement: Current diagnostic techniques in clinical practice
Estefania Sanchez, Felipe Andreo, Enric Cases, A. Briones, Jose Sanz, R. Moreno, Cristina Prat, C. Navarro, Mariona Llatjos, Carlos Martinez, Joan Ruiz
European Respiratory Journal Sep 2013, 42 (Suppl 57) P4437;

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Tuberculosis with mediastinal lymph node involvement: Current diagnostic techniques in clinical practice
Estefania Sanchez, Felipe Andreo, Enric Cases, A. Briones, Jose Sanz, R. Moreno, Cristina Prat, C. Navarro, Mariona Llatjos, Carlos Martinez, Joan Ruiz
European Respiratory Journal Sep 2013, 42 (Suppl 57) P4437;
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