Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct;17(4):250-256.

The Contribution of Ultrasonographic Characteristics of Mediastinal Lymph Nodes on Differential Diagnosis of Tuberculous Lymphadenitis from Sarcoidosis

Serhat Erol  1 , Ceyda Anar  2 , Onur Fevzi Erer  2 , Can Biçmen  3 , Zekiye Aydoğdu  4
Affiliations

The Contribution of Ultrasonographic Characteristics of Mediastinal Lymph Nodes on Differential Diagnosis of Tuberculous Lymphadenitis from Sarcoidosis

Serhat Erol et al. Tanaffos. 2018 Oct.

Abstract

Background: Sarcoidosis and Mediastinal Tuberculous Lymphadenitis (MTLA) are two granulomatous diseases. Differentiation between these two diseases is dependent on clinical presentation, microbiological investigation, and cytopathological examination. In endemic regions, differential diagnosis of MTLA and sarcoidosis might be difficult. Endobronchial ultrasound guided Transbronchial Needle Aspiration (EBUS-TBNA) is a new diagnostic procedure for the diagnosis of mediastinal lymphadenopathy. EBUS not only enables the sampling of Lymph Nodes (LN), but also visualization of sonographic features of them. We hypothesized that the sonographic features of LN may help to differentiate MTLA from sarcoidosis.

Materials and methods: This is a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent EBUS-TBNA and were finally diagnosed as sarcoidosis or MTLA. Size, shape, margin, echogenicity, and coagulation necrosis were compared between the groups.

Results: A total of 257 LNs (215 sarcoidosis, 42 MTLA) were examined in 101 patients. A heterogeneous echotexture of lymph nodes was significantly more common (P <0.0001) in MTLA (69%) than sarcoidosis (36.2%). Also, necrosis was statistically significantly higher in MTLA compared to sarcoidosis (P<0.0001). The vascular pattern was similar in both groups (P=0.9050). Nearly half of the patients had grade 1 vascular pattern in both groups. The odds for diagnosis of MTLA were significantly higher in the presence of heterogeneous echotexture (odds ratio [OR], 7,00) or necrosis sign (OR, 131,2).

Conclusion: Vascular patterns of two diseases were similar. Heterogeneous echotexture and necrosis sign in the LNs on EBUS are specific for MTLA. Combination of these findings with a positive tuberculin skin test, favors the diagnosis of MTLA over sarcoidosis.

Keywords: Endobronchial ultrasonography; Mediastinal tuberculous lymphadenitis; Sarcoidosis.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Lymph node with a round shape.
Figure 2.
Figure 2.
Lymph node with heterogeneous echogenicity.
Figure 3.
Figure 3.
Lymph node with necrosis.
See this image and copyright information in PMC

References

    1. Gupta D, Agarwal R, Aggarwal AN, Jindal SK. Sarcoidosis and tuberculosis: the same disease with different manifestations or similar manifestations of different disorders. Curr Opin Pulm Med 2012;18(5):506–16. - PubMed
    1. Guleria R, Mahashur A, Ghoshal AG, Thomas PK, Raghu G, Baughman RP. Challenges in diagnosing Sarcoidosis in tuberculosis endemic regions: Clinical scenario in India. Sarcoidosis Vasc Diffuse Lung Dis 2016;33(4):381–384. - PubMed
    1. Khan A, Agarwal R, Aggarwal AN, Gupta N, Bal A, Singh N, et al. Blind transbronchial needle aspiration without an on-site cytopathologist: experience of 473 procedures. Natl Med J India 2011;24(3):136–9. - PubMed
    1. Agarwal R, Aggarwal AN, Gupta D. Efficacy and safety of conventional transbronchial needle aspiration in sarcoidosis: a systematic review and meta-analysis. Respir Care 2013;58(4):683–93. - PubMed
    1. Trisolini R, Tinelli C, Cancellieri A, Paioli D, Alifano M, Boaron M, et al. Transbronchial needle aspiration in sarcoidosis: yield and predictors of a positive aspirate. J Thorac Cardiovasc Surg 2008;135(4):837–42. - PubMed

LinkOut - more resources