Category Archives: Lymphadenopathy

Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (4)

Prior to the development of TBNA and its adaptation for use with the fiberoptic bronchoscope, mediastinal lymphadenopathy required more invasive diagnostic procedures such as mediastinoscopy, anterior mediastinotomy, or thoracotomy. A number of studies have now confirmed the utility of TBNA for diagnosing mediastinal cancer, thus often obviating the need for surgical intervention.- In addition, these studies have confirmed the safety of TBNA with most investigators not encountering complications of clinical significance.’ Nevertheless, despite the well-established role of fine-gauge TBNA for diagnosing mediastinal carcinoma, its usefulness in making benign diagnoses has been limited.

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Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (3)

Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (3)The patient was begun on a regimen of antituberculosis therapy for presumed extrapulmonary tuberculosis, but the patient remained persistently febrile and showed no clinical improvement. Three weeks following the bronchoscopy, blood cultures, bronchoalveolar lavage fluid, transbronchial biopsy specimens, and sputa all grew MAI. Despite the addition of numerous antimycobacterial agents, the patient remained clinically unchanged and was subsequently discharged from the hospital on a regimen of only AZT and aerosolized pentamidine.

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Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (2)

Physical examination revealed an alert male, febrile to 39.4°C with a pulse of 104 beats per minute; findings from the remainder of the examination were unremarkable. Laboratory studies, including acid-fast smears, blood, urine, sputum, and stool cultures were nondiagnostic, and a tuberculin skin test and anergy panel were nonreactive.
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Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (1)

Diagnosis of Mediastinal Mycobacterial Lymphadenopathy by Transbronchial Needle Aspiration (1)Fine-gauge flexible transbronchial needle aspiration (TBNA) is a useful technique for diagnosing mediastinal spread of cancer, but it has had a limited role in the diagnosis of benign disease in the mediastinum. This report describes a patient with the acquired immunodeficiency syndrome (AIDS) diagnosed with Mycobacterium avium-intracellularv (MAI) complex infection by TBNA of subca-rinal lymph nodes, and thus illustrates the potential role of TBNA in diagnosing intrathoracic mycobacterial lymphadenopathy.
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