Hypercalcemia in a patient with tuberculous mediastinal lymphadenopathy

We describe the case of a 48 year old Indian female with hypercalcemia due to tuberculosis. She presented with symptoms of hypercalcemia and chest radiographs showed bilateral hilar lymphadenopathy with normal lung fields. The diagnosis of tuberculosis was made histologically from biopsy of the enlarged hilar nodes. Her hypercalcemia resolved following one month of anti-tuberculous treatment. The prevalence of hypercalcemia in tuberculosis has been reported to be high in western series. There is, however, a paucity of local data on the subject. The presence of 1-alpha-hydroxylase-like activity in pulmonary alveolar macrophages with resulting increased formation of active vitamin D metabolites is the postulated mechanism of tuberculosis associated hypercalcemia.     

Flexible bronchoscopy in the evaluation of mediastinal and hilar lymphadenopathy

Background: The diagnosis in cases of mediastinal and/or hilar lymphadenopathy with no lung parenchymal involvement is often difficult. We undertook this study to assess the diagnostic value of flexible bronchoscopy (FOB) especially transbronchial needle aspiration (TBNA) and transbronchial lung biopsy (TBLB) in these patients.     

超声弹性成像在颈部淋巴结结核诊断中的价值

目的 分析对比各型颈部淋巴结结核的超声弹性成像表现,探讨超声弹性成像在颈部淋巴结结核分型诊断中的应用价值和局限性。方法 纳入2017年7月至2018年3月同济大学附属上海市肺科医院收治的经病理或诊断性治疗证实为颈部淋巴结结核的患者70例,选择每例患者的最大淋巴结,回顾性分析其常规超声及弹性成像表现。依据淋巴结结核的常规超声分型标准,将病灶分为急性炎症型（Ⅰ型）、干酪坏死型（Ⅱ型）、寒性脓肿型（Ⅲ型）和愈合钙化型（Ⅳ型）。总结并比较4型颈部淋巴结结核病灶的弹性评分和应变率比值。结果 Ⅰ型24枚（34.29%）、Ⅱ型28枚（40.00%）、Ⅲ型12枚（17.14%）、Ⅳ型6枚（8.57%）。Ⅰ、Ⅱ型病灶硬度较高,弹性评分以3~4分为主（47/52,90.38%）,应变率比值为3~5;Ⅲ型病灶硬度最低,弹性评分以1~2分为主（10/12,83.33%）,应变率比值多<2;Ⅳ型硬度最高,弹性评分为4~5（6/6,100.00%）,应变率比值多>5。4型病灶之间弹性评分与应变率比值差异均有统计学意义（H=30.756,F=23.177,P均<0.001）;两两比较除Ⅰ、Ⅱ型病灶之间弹性评分与应变率比值差异无统计学意义外,其他各型比较差异均有统计学意义（P均<0.05）。结论 超声弹性成像对颈部淋巴结结核的分型诊断价值有限;在Ⅰ型中确定是否有明显肉芽肿形成,以及在Ⅲ型中判断病灶张力可能具有一定作用。     

Endobronchial ultrasound-guided transbronchial needle aspiration of undiagnosed mediastinal lymphadenopathy

Background Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） can sample the enlarged mediastinal lymph nodes which are unreachable by conventional bronchoscopy.It is a relatively simple and safe method to see beyond the bronchial tree.We describe and discuss its initial application and our experience.Methods From July 2009 to December 2009, 52 patients with undiagnosed enlarged mediastinal lymph nodes were accessed with EBUS-TBNA in the People＇s Liberation Army General Hospital.Conventional bronchoscopy was performed before EBUS-TBNA, and patients with endobronchial lesions were excluded from this study.Smears fixed in 95% alcohol and histological specimens fixed in formalin were sent to Department of Pathology.Results EBUS-TBNA was diagnostic in 33 （63%） patients, with diagnosis of lung cancer in 23 patients （14 patients of small cell lung cancer, eight patients with adenocarcinoma, and one patient of squamous carcinoma）.Four patients, who had negative EBUS-TBNA results, were later diagnosed with malignancy at thoracotomy.One patient with negative EBUS-TBNA results died of cancer cachexia.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of neoplastic disease were 85%, 100%, 100%, and 50% respectively.Among the 16sarcoidosis patients, who were diagnosed by a combination of the clinical and radiological information as well as pathological results obtained by EBUS-TBNA, nine of them had granulomas and benign lymphoid cells detected by EBUS-TBNA.The sensitivity, specificity, and positive and negative predictive value of EBUS-TBNA for the diagnosis of sarcoidosis were 56%, 100%, 100%, and 13%, respectively.Five patients with no definite diagnosis from EBUS-TNBA examination are under close follow-up.Conclusions EBUS-TBNA can provide a safe and effective method to sample mediastinal leisions suspected of malignancy.It also adds pathological information needed to make the diagnosis of sarcoidosis.     

Cervical tuberculous lymphadenopathy: changing clinical pattern and concepts in management

Tuberculosis is one of the biggest health challenges the world is facing. In this study the clinical pattern of patients with cervical lymphadenitis, who presented to the ear, nose, and throat outpatient department of the Government Medical College Hospital, Chandigarh, India between June 1997 and May 1998 is recorded. Tuberculosis accounted for 60 out of 94 cases of cervical lymph node enlargement. The commonest age group affected was 11-20 years. Constitutional symptoms were not present in most of the patients. Multiple matted nodes were seen in 23 patients but a single discrete node was seen in 18 patients. Upper deep jugular nodes were the most commonly affected lymph nodes. Discharging sinus and abscess formation were uncommon. Fine needle aspiration cytology yielded a positive diagnosis in 52 out of 56 patients. Chest lesions on radiography were evident in 16% of the patients. Mantoux test was positive and was more than 15 mm in most of the patients. This study shows that the classical picture of "scrofula" is no longer seen nowadays and can probably be explained by the earlier presentation of the disease. All the patients were treated with short course daily chemotherapy for six months. Surgery was not required in the majority of patients except in four cases where excision biopsy was performed. Patients with abscess formation were managed with wide bore needle aspiration only. With a minimum six month period of follow up, no patient was found to have a recurrence of local or systemic disease. This study emphasises the role of fine needle aspiration cytology in diagnosis and confirms the efficacy of six months short course chemotherapy.     

Polymerase chain reaction to identify mycobacterium tuberculosis in patients with tuberculous lymphadenopathy

Tuberculous lymphadenopathy is often diagnosed and treated on clinical and cytopathological grounds as Mycobacterium tuberculosis remains undetected in tissue specimens from such patients. At times, lymph nodes are known to respond sluggishly to and reappear during antitubercular therapy. We report a polymerase chain reaction-based approach to confirm the presence of M. tuberculosis in 4 such patients.     

A rare case of pancreatic mediastinal pseudocyst.

Pancreatic pseudocysts are the most common cystic lesions of the pancreas, accounting for 75-80% of such masses. Pancreatic pseudocyst with mediastinal extension is a rare clinical entity and only a handful cases report on dysphagia associated with mediastinal pseudocyst formation.1 We present a case of pancreatic mediastinal pseudocyst that presented with palpitations and dysphagia. Demonstration of cystic lesion in relation to the pancreas on ultrasound and mediastinal extension of the cyst on CT suggested the diagnosis. Key words: pseudocyst, mediastinal cyst, pancreas.     

Immunoblastic lymphadenopathy: case report and literature review.

A patient with immunoblastic lymphadenopathy (IL) had an unusual course of illness, with frequent episodes, over a 20-month period, of chills, fever, abdominal pain, hepatosplenomegaly and weight loss. The episodes were short-lived and many resolved spontaneously. Eventually generalized lymphadenopathy and profound monoclonal IgG gammopathy developed, with atypical mononuclear cells in the peripheral blood and increased numbers of plasmacytoid cells in the bone marrow. Lymph node biopsy revealed the morphologic triad typical of IL: proliferation immunoblasts, proliferation of small blood vessels and the deposit of an amorphous acidophillic material in the vascular walls and the interstitium. Up to October 1976 110 cases had been reported of this disorder, first described 3 years ago, which indicates that IL is not rare. Remissions have occurred spontaneously and after steroid therapy or chemotherapy or both. However, death has been reported in almost 50% of the cases, and the best approach to therapy remains to be determined.     

Angio-immunoblastic lymphadenopathy: a case with a 17-year follow-up

A case of angioimmunoblastic lymphadenopathy with a 17-year follow-up is reported. The patient, who first presented with benign hypergammaglobulinaemic purpura of Waldenstrom and autoimmune haemolytic anaemia appears to be the longest survivor with this condition reported so far.     

64排螺旋CT对纵隔淋巴结结核和纵隔淋巴瘤的鉴别价值

目的探讨64排螺旋CT在纵隔淋巴结结核与纵隔淋巴瘤中的鉴别价值。方法20例纵隔淋巴结结核和15例纵隔淋巴瘤患者均行全肺容积扫描,所有患者均强化分析病变区淋巴结特征及CT表现。结果纵隔淋巴结结核好发于10区、密度多不均匀、钙化多见、淋巴结融合少见、环状或不均匀强化、胸部原发灶等;纵隔淋巴瘤多好发于2R和3区,密度较均匀,钙化少见,淋巴结融合多见,多数普遍均匀强化,常见结外器官受累等。结论64排螺旋CT在纵隔淋巴结结核和纵隔淋巴瘤的细节显示上有明显优势。     

经支气管镜针吸活检术在肺部及纵隔疾病诊断中的价值

目的探讨经支气管镜针吸活检术（TBNA）对纵隔及肺门肿大淋巴结的诊断价值,评估其安全性。方法选择胸部CT检查发现纵隔、肺门淋巴结肿大、估计气管镜检查不能发现气道内新生物的患者,采用TBNA技术进行检查,观察其诊断的阳性率及并发症。结果 84例患者中57例诊断为肺癌,13例诊断为结节病,3例诊断为肺结核,1例诊断为恶性淋巴瘤,10例最终无明确诊断。84例患者共穿刺136组淋巴结,其中TBNA阳性结果69例（82.14%）。TBNA联合黏膜活检及肺泡灌洗等方法的阳性率（88.1%）高于单行TBNA（82.1%）,但差异无统计学意义（P=0.252）。TBNA阳性率与淋巴结大小相关（P〈0.05）。有1例患者穿刺中出现大出血,其余均为少量出血,无其他并发症。结论 TBNA对纵隔、肺门淋巴结肿大的诊断具有重要的应用价值,对肺癌的诊断和分期有很大的帮助,对肺部良性病变的诊断亦有一定价值,其安全性高,操作简单,费用低,值得临床推广应用。     

成人纵隔淋巴结结核的误诊和减少误诊的对策

目的探讨成人纵隔淋巴结核的诊断及鉴别诊断方法。方法总结分析了我院收治的三例成人纵隔淋巴结结核的误诊原因,并复习了相关诊断技术新进展的文献。结果成人纵隔淋巴结结核缺乏特异的临床症状和普通CT影像学特征,临床医生利用增强CT,FDG-PET,经支气管针吸术（TBNA）等技术对纵隔淋巴结肿大的鉴别诊断能力还不足。结论PPD试验强阳性。或伴支气管内膜结核。或抗酸染色镜下找到杆菌（哪怕仅有一条,非分支状）,纵隔淋巴结在增强CT下有环行强化,其内有网格状增强,诊断性抗结核治疗有效等是临床确诊纵隔淋巴结结核最重要的依据。检测血管紧张素转换酶,皮肤结节和外周淋巴结（尤其是PEF—CT显示高浓聚的外周淋巴结）病理活检有益于鉴别诊断。准确定位下TBNA有利于提高诊断。动员患者进行纵隔镜检查以取得病理鉴别依据,但必须严格遵循隔淋巴结肿大一般疾病鉴别诊断的程序和步骤。     

气管镜针吸活检联合刷检在诊断纵隔、肺部肿瘤中的作用

目的 探讨经气管镜行纵隔淋巴结及肺部肿瘤针吸活检联合刷检的诊断作用.方法 对经CT检查的67例纵隔淋巴结肿大和(或)叶、段支气管腔外占位的患者通过经气管镜行针吸活检和刷检并与传统的常规钳取活检对照.结果 针吸阳性诊断率为74.63%,针吸联合刷检阳性诊断率82.09%;常规钳取阳性诊断率17.91%.单纯针吸和针吸联合刷检诊断率均高于常规活检(P＜0.01).结论 经气管镜针吸活检术是一种简便、安全、阳性率高的检查技术.