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Velasquez-Rodriguez JG, Maisterra S, Ramos R, Escobar I, Gornals JB. The Role of Endoscopic Ultrasound in the Interventional Management of Mediastinal Collections: A Narrative Review. Cureus 2022; 14:e27803. [PMID: 36106250 PMCID: PMC9452048 DOI: 10.7759/cureus.27803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections.
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Mian A, Ray A. Thoracic sarcoidosis versus tuberculosis: Need for a multi-disciplinary approach. Indian J Radiol Imaging 2018; 28:267-268. [PMID: 30050255 PMCID: PMC6038207 DOI: 10.4103/ijri.ijri_61_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Agrima Mian
- Department of Medicine, AIIMS, New Delhi, India E-mail:
| | - Animesh Ray
- Department of Medicine, AIIMS, New Delhi, India E-mail:
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Endoscopic Ultrasound (EUS) Guided Fine Needle Aspiration: A New Modality to Diagnose Peritoneal Tuberculosis in Presence of Decompensated Cirrhosis-A Case Series and Review of Literature. J Clin Exp Hepatol 2018; 8:205-209. [PMID: 29892185 PMCID: PMC5992303 DOI: 10.1016/j.jceh.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The gold-standard for diagnosis is growth of Mycobacterium tuberculosis on ascitic fluid or peritoneal culture. Due to the non-specific signs and symptoms of disease, its early diagnosis is difficult, especially in patients with decompensated cirrhosis. The reported sensitivity of ascitic fluid is low and to obtain tissue for peritoneal biopsy in patients with cirrhosis is difficult. Endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) is a good alternative to obtain peritoneal tissue for establishing the diagnosis of peritoneal TB. OBJECTIVE To assess the role of EUS-FNA in the diagnosis of peritoneal tuberculosis in patients with decompensated cirrhosis. METHODS Consecutive patients with peritoneal thickening, ascites and decompensated cirrhosis underwent EUS-FNA from the thickened omentum. Presence of granuloma or demonstration of acid fast bacilli was diagnostic of peritoneal tuberculosis. RESULTS A total of 5 patients with CLD underwent EUS-FNA from omentum. FNA cytology revealed granuloma with multinucleated cells in all patients (100%) and AFB stain was positive in 2 of them (40%). CONCLUSION We hereby report the use of EUS guided fine needle aspiration (FNA) of peritoneum as a newer, safe and unexplored technique for diagnosis of peritoneal TB.
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Santini M, Fiorelli A. Surgery: Recommendations for Surgeons. CURRENT CLINICAL PATHOLOGY 2018:43-64. [DOI: 10.1007/978-3-319-90368-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Chopra A, Modi A, Chaudhry H, Yucel R, Rane N, Fantauzzi J, Hellwitz FJ, Judson MA. Assessment of Mediastinal Lymph Node Size in Pneumococcal Pneumonia with Bacteremia. Lung 2017; 196:43-48. [PMID: 29147774 DOI: 10.1007/s00408-017-0071-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/09/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The significance of mediastinal lymphadenopathy in bacterial pneumonia is unclear. METHODS We performed a retrospective analysis of mediastinal lymph node size determined by chest CT in patients with bacteremic pneumococcal pneumonia. All patients who had positive blood cultures for streptococcus pneumonia over an 11-year period and had a chest CT scan (index CT) within 2 weeks of the positive blood culture were included in the study. Two thoracic radiologists and one pulmonologist independently examined the index CT plus any chest CT scans performed prior (pre-CT) or after (post-CT) the bacteremic episode. RESULTS The study cohort of 49 patients was 57% male, 65% White, with mean age of 53 (SD = 20) years. Mediastinal lymphadenopathy was detected in 25/49 (51%) of the cases. The mean size of the largest mediastinal lymph node in short axis was 0.99 (SD = 0.71), ranging from 0.0 to 2.05 cm. There was no correlation noted between the number of lobes involved with pneumonia, and the size of the largest mediastinal lymph node (p = 0.33) or the number of pathologically enlarged mediastinal lymph nodes (p = 0.08). There was a statistically significant increase in the mean size of the largest lymph node between the pre-CT and index-CT group (p = 0.02), and decrease between the index-CT group and the post-CT (p = 0.03). CONCLUSION Pneumococcal pneumonia with bacteremia is associated with mild mediastinal lymph node enlargement. The presence of marked mediastinal lymphadenopathy (short axis LN size > 2 cm) should not be assumed from pneumococcal pneumonia.
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Affiliation(s)
- Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, MC-91, 47 New Scotland Avenue, Albany, NY, 12208, USA.
| | - Aakash Modi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, MC-91, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Haroon Chaudhry
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, MC-91, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Recai Yucel
- Department of Epidemiology and Biostatistics, School of Public Health, SUNY at Albany, Rensselaer, NY, 12144, USA
| | - Neha Rane
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, MC-91, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - John Fantauzzi
- Department of Radiology, Albany Medical Center, Albany, NY, USA
| | | | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, MC-91, 47 New Scotland Avenue, Albany, NY, 12208, USA
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Thangakunam B, Isaac BTJ, Christopher DJ. Endobronchial ultrasound experience in a high tuberculosis prevalence setting. Indian J Tuberc 2017; 64:196-200. [PMID: 28709488 DOI: 10.1016/j.ijtb.2016.11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most of the published endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) data are from the western countries, establishing the role of EBUS-TBNA in the diagnosis and staging of lung cancer. The etiology of mediastinal lymphadenopathy may be different in an ethnic group with a high prevalence of tuberculosis (TB). OBJECTIVE To assess the etiology of mediastinal adenopathy in a high TB prevalence setting and to determine the performance of various tests in the diagnosis of tuberculous mediastinal lymphadenitis. METHODS Retrospective analysis of bronchoscopic data of patients who underwent endobronchial ultrasound (EBUS) in a tertiary care center in India. RESULTS Out of 138 patients who underwent EBUS, 63 (46%) had granulomatous disease. Of the 35 patients with a diagnosis of TB, in 10 (29%), microbiology of EBUS specimens was diagnostic and in 3 (9%), this was the sole diagnostic feature. In 5 (14%) mycobacterial cultures were positive, in 6 (17%) GeneXpert for Mycobacterium tuberculosis/rifampicin resistance (Xpert MTB/RIF) was positive, and in 3 (9%) acid fast smears were positive. CONCLUSION In high TB prevalence countries, EBUS diagnoses a higher number of granulomatous than malignant diseases. EBUS specimen should, therefore, be subjected also to mycobacterial smear, culture, and Xpert MTB/RIF for optimal results.
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Guo J, Bhutani MS, Giovannini M, Li Z, Jin Z, Yang A, Xu G, Wang G, Sun S. Can endoscopic ultrasound-guided needle-based confocal laser endomicroscopy replace fine-needle aspiration for pancreatic and mediastinal diseases? Endosc Ultrasound 2017; 6:376-381. [PMID: 29251271 PMCID: PMC5752759 DOI: 10.4103/eus.eus_87_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
New applications of confocal laser endomicroscopy (CLE) have been developed, such as needle-based CLE (nCLE) for pancreatic masses, pancreatic cystic tumors, and lymph nodes. nCLE is feasible during endoscopic ultrasound (EUS) examination, and preliminary results are very encouraging and suggest this technology may be used in future as a useful adjunct in cases of inconclusive EUS-guided fine-needle aspiration. The aim of this paper is to give an update in this new technology and to define its place in the diagnosis of pancreatic masses and mediastinal diseases.
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Affiliation(s)
- Jintao Guo
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition-Unit1466, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Marc Giovannini
- Endoscopy Center, Institute Paoli-Calmettes, Marseille, France
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Aiming Yang
- Division of Gastroenterology, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Guoqiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Guiqi Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Grover A, Kaur G, Kumar A, Gupta V, Bakshi P, Jain S, Arora A, Verma K. Abdominal lymphadenopathy: An interesting and rare case diagnosed on endoscopic ultrasound-guided fine needle aspiration cytology. Cytojournal 2016; 13:8. [PMID: 27081396 PMCID: PMC4812873 DOI: 10.4103/1742-6413.178997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/10/2016] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ankita Grover
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gagandeep Kaur
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashish Kumar
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Varun Gupta
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pooja Bakshi
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunila Jain
- Department of Histopathology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anil Arora
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Kusum Verma
- Address: Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
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Sharma M, Ecka RS, Somasundaram A, Shoukat A, Kirnake V. Endoscopic ultrasound in mediastinal tuberculosis. Lung India 2016; 33:129-34. [PMID: 27051097 PMCID: PMC4797428 DOI: 10.4103/0970-2113.177451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Tubercular lymphadenitis is the commonest extra pulmonary manifestation in cervical and mediastinal locations. Normal characteristics of lymph nodes (LN) have been described on ultrasonography as well as by Endoscopic Ultrasound. Many ultrasonic features have been described for evaluation of mediastinal lymph nodes. The inter and intraobserver agreement of the endosonographic features have not been uniformly established. Methods and Results: A total of 266 patients underwent endoscopic ultrasound guided fine needle aspiration and 134 cases were diagnosed as mediastinal tuberculosis. The endoscopic ultrasound location and features of these lymph nodes are described. Conclusion: Our series demonstrates the utility of endoscopic ultrasound guided fine needle aspiration as the investigation of choice for diagnosis of mediastinal tuberculosis and also describes various endoscopic ultrasound features of such nodes.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Ruth Shifa Ecka
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Aravindh Somasundaram
- Department of Gastroenterology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Vijendra Kirnake
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
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Wang Z, Jiang C. Endoscopic ultrasound in the diagnosis of mediastinal diseases. Open Med (Wars) 2015; 10:560-565. [PMID: 28352755 PMCID: PMC5368883 DOI: 10.1515/med-2015-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 11/10/2015] [Indexed: 12/25/2022] Open
Abstract
EUS is a useful tool for diagnosis of mediastinal diseases. EUS-FNA plays an important role in staging of lung cancer and in tissue acquisition in patients with mediastinal masses. In this review, the following issues will be addressed: EUS-FNA and EBUS-TBNA, metastatic mediastinal lymph nodes diagnosed by EUS, EUS in assessment of mediastinal lymph node status for staging of lung cancer, mediastinal lymphoma diagnosed by EUS, sarcoidosis and tuberculosis diagnosed by EUS.
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Affiliation(s)
- Zhiguo Wang
- The Second Hospital of Dalian Medical University, China
| | - Chunmeng Jiang
- The Second Hospital of Dalian Medical University, NO.467, Zhongshan Road, 116027 Dalian, Liaoning, China
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Kaur G, Dhamija A, Augustine J, Bakshi P, Verma K. Can cytomorphology of granulomas distinguish sarcoidosis from tuberculosis? Retrospective study of endobronchial ultrasound guided transbronchial needle aspirate of 49 granulomatous lymph nodes. Cytojournal 2013; 10:19. [PMID: 24228066 PMCID: PMC3814850 DOI: 10.4103/1742-6413.119008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 08/09/2013] [Indexed: 02/01/2023] Open
Abstract
Background: The differential diagnosis of tuberculosis (TB) and sarcoidosis on fine needle aspiration material is very challenging in tubercular endemic regions. We carried out a pilot study to explore cytomorphologic features of granulomas which could help in differentiation between sarcoidosis and TB. Final diagnoses in these patients were based on clinical, microbiologic and follow-up studies. Materials and Methods: Endobronchial ultrasound guided transbronchial needle aspiration smears of 49 consecutive patients with a final cytologic diagnosis of granulomatous lymphadenitis were reviewed. Based on cytologic features two cytologic categories were enunciated and the results were correlated with microbiologic studies and/follow-up of minimum of 6 months. Results: The cytologic categories did not correlate with the final clinical outcome of patients. Conclusions: Different patterns of granulomas observed in cytology smears do not help distinguish TB from sarcoidosis. The novel non-invasive techniques of mediastinal sampling though help in confirming granulomatous pathology, distinction between these entities and treatment decisions still depend upon correlating cytologic, microbiologic, clinical and radiological data in a large number of cases in tubercular endemic regions.
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Affiliation(s)
- Gagandeep Kaur
- Address: Department of Cytopathology, Sir Gangaram Hospital, New Delhi, India
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