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Review
. 2020 Nov 23;15(1):331.
doi: 10.1186/s13019-020-01360-3.

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review

Yong Fang  1 , Liping Cheng  2 , Junhong Guo  3 , Chunyan Wu  3 , Ye Gu  4 , Xiaofang You  5 , Wei Sha  6
Affiliations
Review

Application of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and treatment of mediastinal lymph node tuberculous abscess: a case report and literature review

Yong Fang et al. J Cardiothorac Surg. .

Abstract

Background: This study aimed to report the experience of diagnosis and treatment of one rare case of mediastinal lymph node tuberculous abscess (MLNTA) using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Case presentation: An 18-year-old female patient was hospitalized in the Affiliated Hospital of Xuzhou Medical University in November 2017, due to intermittent left chest pain. She was suspected of infecting tuberculosis (TB) and thus received anti-TB treatment. Since April 1, 2018, she began to exhibit symptoms of chest distress. The patient was then admitted to Shanghai Pulmonary Hospital and continued receiving systemic anti-TB treatment during the whole course. On April 11, 2018, she received EBUS-TBNA to puncture pus and inject isoniazid. Simultaneously, the pus was sent for cytopathological and bacteriological examination, both supporting the diagnosis of TB in the patient. On April 24 and May 10, she received two times of EBUS-TBNA treatment. The symptoms of chest distress were relieved, but granulomatous neoplasm occurred at the EBUS-TBNA site on the trachea wall. The patient then received local clamp removal and cryotherapy on May 29 and Jul 19, respectively. Chest computed tomography (CT) reexamination on September 28 revealed that the MLNTA lesion had been completely absorbed, and electronic bronchoscopic reexamination on September 30 demonstrated that the granulomatous neoplasm on the trachea wall was entirely invisible.

Conclusions: Using EBUS-TBNA to puncture and aspirate pus and inject drugs can be effectively used to diagnose and treat MLNTA, which provides a new, less invasive, safe and reliable method for diagnosis and treatment of MLNTA.

Keywords: Diagnosis; Endobronchial ultrasonography; Mediastinal lymph node tuberculous abscess; Transbronchial needle aspiration; Treatment.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chest CT reexamination on April 6, 2018
Fig. 2
Fig. 2
Pus was punctured and aspirated through EBUS-TBNA on April 11, 2018
Fig. 3
Fig. 3
Cytopathological observation of the aspirated pus. a, b Hyperplasia of epithelioid cells and lymphocytes infiltration and granuloma was formed in the aspirated pus (A, X 100; B, X 200). c, d Necrotic cells and a few lymphocytes were observed in the aspirated pus (C, X 40, D, X100)
Fig. 4
Fig. 4
Electronic bronchoscopic examination on May 29, 2018
Fig. 5
Fig. 5
Chest CT reexamination on May 30, 2018
Fig. 6
Fig. 6
Chest CT reexamination on September 28, 2018
Fig. 7
Fig. 7
Electronic bronchoscopic reexamination on September 30, 2018
Fig. 8
Fig. 8
The timeline for the diagnosis and treatment of MLNTA in this patient
See this image and copyright information in PMC

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