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2.
J UOEH ; 42(2): 223-227, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32507846

RESUMO

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to be useful not only for the diagnosis of lymph node metastasis of lung cancer but also for benign diseases. We retrospectively analyzed the results of patients with tuberculous lymphadenitis (TL) who had undergone EBUS-TBNA between November 2010 and January 2016. EBUS-TBNA was performed in 427 cases during that period. Six cases were finally diagnosed as TL. The punctured lymph node was 8 lesions. Pathological findings consistent with TL were obtained in all 6 cases (100%), and the tissue specimens were positive in Ziehl-Neelsen staining in 3 of the 6 cases (50%). In all 6 cases, the acid-fast bacteria (AFB) smear test of the needle rinse fluid was negative, 2 cases were positive for AFB culture (33.3%), and 2 cases were positive for Mycobacterium tuberculosis (MTB)-PCR test (33.3%). In this study, the positive rate of mycobacterial culture and the MTB-PCR test of the needle rinse fluid was low, though the concordance rate of pathological findings with TL was high (100%). The results suggest that EBUS-TBNA should be carefully evaluated in patients with TL, considering the low positive rate of mycobacterial culture and MTB-PCR test in the needle rinse fluid.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Tuberculose dos Linfonodos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose dos Linfonodos/diagnóstico por imagem
3.
Radiographics ; 39(7): 2023-2037, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31697616

RESUMO

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.


Assuntos
Imagem por Ressonância Magnética/métodos , Tuberculose/diagnóstico por imagem , Abscesso/diagnóstico por imagem , Abscesso/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Doenças Musculares/diagnóstico por imagem , Doenças Musculares/fisiopatologia , Risco , Tuberculoma/diagnóstico por imagem , Tuberculose/fisiopatologia , Tuberculose do Sistema Nervoso Central/diagnóstico por imagem , Tuberculose do Sistema Nervoso Central/fisiopatologia , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/fisiopatologia , Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/fisiopatologia , Tuberculose Osteoarticular/diagnóstico por imagem , Tuberculose Osteoarticular/fisiopatologia , Tuberculose Urogenital/diagnóstico por imagem , Tuberculose Urogenital/fisiopatologia
7.
J Ultrasound Med ; 38(11): 3025-3036, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30945325

RESUMO

OBJECTIVES: This study aimed to assess the value of Superb Microvascular Imaging (SMI; Canon Medical Systems, Otawara, Japan) for distinguishing between benign and malignant cervical lymph nodes (LNs) and to compare SMI with power Doppler ultrasound (PDUS). METHODS: Power Doppler ultrasound and SMI examinations were performed for patients' cervical LNs. The distribution of feeding vessels, number, and appearance of internal vessels were analyzed by 2 readers, and the results of PDUS and SMI were compared. Interobserver agreement was assessed. A subgroup analysis was performed to assess differences in vascular patterns between metastasis and tuberculous lymphadenitis and between Kikuchi disease and lymphoma. The diagnostic performance for distinguishing between benign and malignant LNs was calculated. RESULTS: In total, 147 patients with 147 cervical LNs (85 benign and 62 malignant) were assessed. Interobserver agreement was moderate to strong for SMI. There were significant differences in the vascular patterns between benign and malignant LNs on SMI (distribution, number, and appearance, all P < .001), but not on PDUS. In the subgroup analysis, SMI showed a significant difference in the vascular patterns observed between metastasis and tuberculous lymphadenitis (distribution, P = .012; number, P = .014; and appearance, P = .005). Superb Microvascular Imaging detected significantly greater numbers of vessels in lymphoma than in Kikuchi disease (P = .012). The sensitivity of SMI was significantly greater than that of PDUS in distinguishing malignant from benign LNs (86.9% versus 54.1%; P < .001). CONCLUSIONS: Superb Microvascular Imaging yields more detailed information about nodal vessels than does PDUS by enabling visualization of small nodal vessels. Superb Microvascular Imaging is useful and feasible for differentiating between malignant and benign cervical LNs.


Assuntos
Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Linfonodos/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Pescoço , Sensibilidade e Especificidade , Ultrassonografia Doppler , Adulto Jovem
8.
J Med Imaging Radiat Oncol ; 63(3): 329-339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30932343

RESUMO

Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.


Assuntos
Tuberculose/diagnóstico por imagem , Humanos , Peritonite Tuberculosa/diagnóstico por imagem , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose Hepática/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose Esplênica/diagnóstico por imagem
9.
Clin Lab ; 65(3)2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30868854

RESUMO

BACKGROUND: Anemia combined with increased serum sedimentation (ESR) can be secondary to many diseases and may be ignored when the patient had few clinical symptoms. We report a case of persistent anemia combined with ESR for more than 2 years firstly misdiagnosed as lymphoma. When she received a chest CT scan multiple enlarged lymph nodes were found. METHODS: The chest contrast-enhanced CT scan and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the right hilum enlarged lymph nodes were performed for diagnosis. RESULTS: The chest CT scan and EBUS showed multiple enlarged right hilum and mediastinum lymph nodes without calcification. Pathology of EBUS-TBNA showed multiple granulomas; Zeihl-Neelsen acid-fast stain was positive. CONCLUSIONS: Systemic lymph node tuberculosis is rarely seen in adult patients. In a young patient who has anemia combined with increased ESR should be excluded if those changes are secondary to tuberculosis.


Assuntos
Tuberculose dos Linfonodos/diagnóstico por imagem , Adulto , Anemia/etiologia , Sedimentação Sanguínea , Broncoscopia , Erros de Diagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Linfoma/diagnóstico , Tuberculose dos Linfonodos/sangue , Tuberculose dos Linfonodos/complicações
10.
J Int Med Res ; 47(4): 1512-1520, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30632441

RESUMO

OBJECTIVE: This study was performed to assess the feasibility, effectiveness, and safety of percutaneous ultrasound (US)-guided laser ablation (LA) for the treatment of cervical tuberculous lymphadenitis (CTBL). METHODS: We retrospectively reviewed 11 patients with CTBL (mean age, 32.0 ± 8.6 years; range, 18-47 years) who underwent percutaneous US-guided LA from June 2014 to December 2016 with a subsequent 12-month follow-up. We assessed the mean volume reduction and contrast-enhanced US (CEUS) changes of the target lymph nodes as well as the tolerability and adverse effects of LA. RESULTS: The mean ablation energy was 522 ± 312 J (range, 204-1317 J). All 17 enrolled target lymph nodes were completely non-enhanced after LA treatment as detected by CEUS, indicating complete ablation of all lymph nodes (100%). The target lymph nodes significantly decreased in volume by a mean of 74.0% ± 15.6% from baseline to 12 months after LA. The LA procedure was well tolerated, and none of the 11 patients developed severe complications during the 12-month follow-up. CONCLUSION: Percutaneous US-guided LA for the treatment of CTBL exhibits good tolerability, minimal invasiveness, and few adverse effects. Further investigations with larger sample sizes and longer follow-up periods are warranted to confirm these findings.


Assuntos
Terapia a Laser/métodos , Cirurgia Assistida por Computador/métodos , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/cirurgia , Ultrassonografia/métodos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Retrospectivos , Tuberculose dos Linfonodos/patologia , Adulto Jovem
11.
Clin J Gastroenterol ; 12(1): 76-81, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30141183

RESUMO

Owing to effective treatments and sanitary improvements, the incidence of latent tuberculosis infection (LTBI) has decreased. However, approximately one-quarter of the world's population is thought to have LTBI, and the reactivation of tuberculosis (TB) sometimes occurs in immunocompromised hosts. A 54-year-old man presented with a fever. The patient had past histories of alcoholic and hepatitis C virus-related cirrhosis and hepatocellular carcinoma (HCC). He was treated with drug-eluting beads transarterial chemoembolization (DEB-TACE) for HCC three times, beginning 10 months before his current visit. A computed tomography scan showed enlarged intraabdominal lymph nodes with calcification, and the interferon-gamma release assay for TB infection was positive. The patient was diagnosed with tuberculous reactivation. Anti-TB therapy was administered to the patient, after which we restarted TACE and the TB infection remains controlled. In this case, we presumed that DEB-TACE is associated with the reactivation of TB infection and that anthracycline increases the risk of reactivating TB infection. In summary, we experienced a case of TB reactivation during the clinical course of a patient with HCC who was treated with DEB-TACE. When patients with HCC are treated with TACE, their symptoms, laboratory data, and imaging results should be monitored when latent TB infections are suspected.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica/efeitos adversos , Tuberculose Latente/virologia , Neoplasias Hepáticas/tratamento farmacológico , Tuberculose Gastrointestinal/virologia , Tuberculose dos Linfonodos/virologia , Ativação Viral , Quimioembolização Terapêutica/métodos , Meios de Contraste , Humanos , Tuberculose Latente/diagnóstico por imagem , Masculino , Microesferas , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X/métodos , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem
12.
Abdom Radiol (NY) ; 44(1): 11-21, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30027495

RESUMO

PURPOSE: Abdominal tuberculosis (ATB) mimics various infectious, inflammatory, and neoplastic conditions and hence requires a high index of suspicion for accurate diagnosis, especially in low prevalence areas. It is difficult to consistently establish a histopathological diagnosis of ATB which underlines the importance of supportive evidences for institution of prompt empirical therapy to prevent associated morbidity and mortality. METHODS: We retrospectively evaluated clinical and imaging features of 105 ATB cases and classified their CT findings based on peritoneal, lymph node, bowel, and solid organ involvement. Concomitant pulmonary and extra-pulmonary involvement was assessed. RESULTS: Abdominal pain (78.1%) followed by fever (42.9%) were the commonest presenting symptoms. Peritoneal TB (77.14%) most commonly presented with a mix of ascites (49.38%), peritoneal (28.40%), and omental involvement (27.16%). Lymphadenopathy (57.1%) most commonly presented as necrotic nodes (81.67%) at mesenteric, peripancreatic, periportal, and upper paraaortic regions. Commonest site of bowel involvement (cumulative of 62.85%) was ileocecal region, with the commonest pattern of involvement being circumferential bowel wall thickening without bowel stratification with mild luminal narrowing. Hepatic (13.33%) and splenic (16.2%) involvement predominantly presented as multiple microabscesses. Adrenal and pancreatic involvement was noted in 4.7% and 1.9% of patients, respectively. 38.1% patients showed concomitant pulmonary and extra-pulmonary TB. CONCLUSION: ATB has varied radiological features; however, peritoneal involvement in the form of mild ascites, smooth peritoneal thickening, smudgy omentum, multi-focal bowel involvement, necrotic nodes, and multiple visceral microabscesses point towards a diagnosis of ATB in appropriate clinical setting.


Assuntos
Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Tuberculose Gastrointestinal/diagnóstico por imagem , Tuberculose Hepática/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
Medicine (Baltimore) ; 97(37): e11724, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30212925

RESUMO

INTRODUCTION: The diagnosis of tuberculous mediastinal lymphadenitis remains a challenge, and the use of transbronchoscopic needle aspiration (TBNA) combined with rapid on-site cytological evaluation (ROSE) is still unclear. A case of tuberculous mediastinal lymphadenitis was illustrated to show the diagnostic value of TBNA and ROSE. CASE PRESENTATION: In this case report, we presented a typical case of a 44-year-old male who underwent obvious odynophagia and mild symptom of dyspnea. One isolated mass positioned on posterior mediastinum was examined as positive discovery. Finally, he was diagnosed with tuberculous mediastinal lymphadenitis by using TBNA combined with ROSE and treated with anti-TB. CONCLUSIONS: TBNA is an efficacious and safe approach, which is worth popularizing for the clinical diagnosis of mediastinal masses. Meanwhile, ROSE is useful to reduce the numbers of needle passes during TBNA. We aimed to emphasize 2 key points in this case report. Firstly, a rare symptom of Tuberculosis in adults was supported by the patient. Secondly, TBNA combined with ROSE is useful for the diagnosis of tuberculous mediastinal lymphadenitis.


Assuntos
Broncoscopia/métodos , Tuberculose dos Linfonodos/diagnóstico , Adulto , Biópsia por Agulha , Humanos , Masculino , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/patologia
15.
Rev. cuba. med. mil ; 47(2): 0-0, abr.-jun. 2018. ilus
Artigo em Espanhol | LILACS | ID: biblio-960601

RESUMO

Introducción: La tuberculosis es una enfermedad que aún se diagnostica en Cuba. Aunque la forma pulmonar predomina, se presentan en ocasiones diversas formas localizadas a otros órganos y tejidos, dentro de ellas la forma ganglionar. Caso clínico: Se presenta una joven de 21 años con fiebre de 15 días de evolución y aumento de volumen no doloroso de los ganglios del cuello y preauricular izquierdo. Luego de tratamiento antibiótico la fiebre desaparece pero las adenopatías persisten. Se hace una primera exéresis ganglionar la cual arroja una adenitis crónica agudizada con abscedación. Se realiza Mantoux el cual arroja un resultado de 32 mm. El Rx de tórax y la tomografía axial computadorizada tóraco-abdominal no arrojaron ninguna alteración. Se hace una nueva exéresis ganglionar cuyo estudio anatomopatológico informa la presencia de granulomas caseificados. El estudio microbiológico del tejido arrojó Mycobacterium tuberculosos, codificación 8. Comentarios: La tuberculosis ganglionar es la primera forma de tuberculosis extrapulmonar en aquellos países con baja incidencia de esta enfermedad. Es más frecuente en mujeres y en la localización cervical. La cutirreacción de Mantoux hiperérgica es orientadora en el diagnóstico, pero se requiere del estudio histológico de un ganglio con la presencia de granulomas caseificados y la demostración del bacilo en este tejido. Se presenta este caso para recordar que esta entidad debe ser tenida en cuenta en el estudio de todo síndrome adénico febril y que es necesario que en el estudio histológico de toda exéresis ganglionar deben realizarse las técnicas necesarias para llegar a este diagnóstico(AU)


Introduction: Tuberculosis continues to be a disease diagnosed in Cuba. Although the pulmonary form continues to predominate, several localized forms are sometimes presented to other organs and tissues, including the ganglionic form. Clinical case: A 21-year-old girl presented with a fever of 15 days of evolution and a non-painful volume increase of the neck and left preauricular lymph nodes. After antibiotic treatment the fever disappears but the adenopathies persist. A first lymph node excision is performed, which results in acute chronic adenitis with abscess. Mantoux is performed with a result of 32 mm. The chest X-ray and the thoraco-abdominal CT scan did not show any alteration. A new lymph node excision is performed, whose anatomopathological study reports the presence of caseified granulomas. The microbiological study of the tissue resulted tuberculous Mycobacterium, coding 8. Comments: Lymph node tuberculosis is the first form of extrapulmonary tuberculosis in those countries with low incidence of this disease. It is more frequent in women and in the cervical location. The hyperergic Mantoux is a guide in the diagnosis, but the histological study of a ganglion with the presence of caseified granulomas and the demonstration of the bacillus in this tissue is required. This case is presented to remember that this entity must be taken into account in the study of any febrile adenic syndrome and that it is necessary that in the histological study of any lymph node excision the necessary techniques must be performed to reach this diagnosis(AU)


Assuntos
Humanos , Feminino , Adulto , Tuberculose/epidemiologia , Tuberculose dos Linfonodos/diagnóstico por imagem , Linfadenite/diagnóstico , Técnicas Microbiológicas/métodos
16.
BMJ Case Rep ; 20182018 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-29545423

RESUMO

Tuberculosis (TB) continues to represent an important public health challenge in the world and the USA, especially given its association with HIV infection and population migration. Cervical tuberculous lymphadenitis represents the most common extrapulmonary presentation of TB in the USA. Considerations for other causes of neck mass often contribute to delay in diagnosis. In this report, we describe the case of a 41-year-old man who presented with painful swelling of the neck and was diagnosed with tuberculous lymphadenitis, complicated by HIV therapy-associated immune reconstitution syndrome. Prior to this diagnosis, he presented with a chronic intermittent cough, repeatedly treated as bronchitis. Furthermore, TB is a recognised occupational risk for primary care physician, as they are often the first contact for patients. With the Patient Protection and Affordable Care Act in the USA, the risk is likely to increase with the influx of newly insured often poor,and/or immigrants.


Assuntos
Infecções por HIV , Tuberculose dos Linfonodos/diagnóstico , Adulto , Terapia Antirretroviral de Alta Atividade , Antituberculosos/uso terapêutico , Tosse/etiologia , Diagnóstico Diferencial , Humanos , Masculino , Pescoço , Tomografia Computadorizada por Raios X , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/tratamento farmacológico
17.
Ocul Immunol Inflamm ; 26(2): 217-219, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27437932

RESUMO

PURPOSE: To report the clinical, investigational and PET/CT scan findings of patients with presumed ocular tuberculosis and suggest a hypotheses for the pathogenesis. METHODS: Retrospective case review. Included were 10 males and 17 females with an age range: 23-71 years. RESULTS: Clinical findings include granulomatous or non-granulomatous anterior uveitis, intermediate uveitis, panuveitis, vasculitis, and multifocal serpiginous-like choroidopathy. A total of 13 PET/CT scans were normal and 14 showed systemic disease. The commonest finding was metabolically active lymphadenopathy and was seen in 14 patients. Mediastinal lymphadenitis was seen in 12 patients, 3 patients had abdominal/pelvic lymphadenopathy and 3 patients had additional cervical lymphadenopathy. Two patients had only cervical lymphadenitis. One patient had lung parenchymal disease and one had bone/joint disease. The commonest pathology was lymphadenitis. CONCLUSIONS: Uveitis is part of an immune response to mycobacteria that manifests as lymphadenitis in the chest/abdomen and as a uveitis.


Assuntos
Doenças da Coroide/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose Ocular/diagnóstico por imagem , Uveíte/diagnóstico por imagem , Vasculite/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Linfonodos , Masculino , Mediastino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
J Ultrasound Med ; 37(1): 83-92, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28691324

RESUMO

OBJECTIVES: To evaluate the diagnostic value of contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of tuberculous and metastatic lymph nodes. METHODS: Nineteen cervical tuberculous lymph nodes and 43 cervical metastatic lymph nodes were investigated. The CEUS perfusion patterns and parameters of time-intensity curve (TIC) were analyzed. Diagnostic accuracy and consistency of two physicians were compared before and after CEUS and TIC analysis. RESULTS: Conventional ultrasonography showed no significant differences between tuberculous and metastatic lymph nodes. Concentric enhancement at the arterial phase of CEUS occurred in 15 of 19 (78.9%) tuberculous lymph nodes and 42 of 43 (97.7%) metastatic lymph nodes (P < .05). For the TIC curve, a steep descending curve with an apparent notch was commonly found in tuberculous lymph nodes (13 of 16). Although a shallow descending curve was common (40 of 43) in metastatic lymph nodes, most did not have a notch on the curve (39 of 43) (P < .01). The k-value and the peak intensity (PI) value of tuberculous lymph nodes were significantly higher and the △PI value was significantly lower than that of metastatic lymph nodes (P < .05, respectively). Kappa values for the diagnosis consistency of the two physicians before and after CEUS and TIC analysis were 0.582 and 0.761, respectively. Diagnostic accuracy before and after CEUS and TIC analysis was 47.4% (28 of 59) and 96.6% (57 of 59), respectively (P < .001). CONCLUSIONS: Contrast-enhanced ultrasonography with TIC analysis is helpful in differentiating tuberculous from metastatic lymph nodes.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Tempo , Adulto Jovem
19.
Medicine (Baltimore) ; 96(45): e8764, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29137108

RESUMO

RATIONALE: Lymph node is a preferred site for extrapulmonary tuberculosis (TB). In the thorax, mediastinal tuberculous lymph nodes can erode adjacent structures such as heart, aorta, and esophagus, forming fistula, and causing fatal consequences. However, tuberculous bronchonodal fistula as a complication of lymph node TB in adults is rarely known in terms of imaging or clinical findings. Here, a case of isolated tuberculous bronchonodal fistula appearing as the first presentation of TB in a 74-year-old male with systemic lupus erythematosus (SLE) is reported. PATIENT CONCERN: A 74-year-old male with SLE visited the hospital with dry cough. In family history, his son was treated for pulmonary TB 9 years previously. Laboratory test revealed increased C-reactive protein level and erythrocyte sedimentation rate. Chest computed tomography (CT) scan revealed a necrotic lymph node in the right hilar area connected to the inferior wall of the right upper lobe bronchus and the lateral wall of bronchus intermedius. DIAGNOSES: On bronchoscopy performed under guidance of 3-dimensionally reconstructed CT image, fistula formation between the right hilar lymph node and 2 bronchi (the right upper lobe and intermediate bronchus) was confirmed. Sputum culture revealed growth of Mycobacterium tuberculosis. INTERVENTION: Anti-TB medication with isoniazid, ethambutol, pyrazinamide, and moxifloxacin for 9 months. OUTCOME: The patient's symptom was gradually improved. Follow-up bronchoscopy performed at 3 months after starting the medication revealed decreased size of the fistula. LESSONS: This is a rare case of bronchonodal fistula appearing as the first presentation of TB in a 74-year-old male patient with SLE. CT provided useful information regarding the origin and progress of the disease.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/diagnóstico por imagem , Idoso , Antituberculosos/uso terapêutico , Broncoscopia , Diagnóstico Diferencial , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Masculino , Mycobacterium tuberculosis , Tomografia Computadorizada por Raios X , Tuberculose dos Linfonodos/tratamento farmacológico , Tuberculose dos Linfonodos/microbiologia
20.
Pneumologie ; 71(11): 798-812, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-29139101

RESUMO

Endobronchial Ultrasound (EBUS) with the two modalities curved and radial EBUS significantly improved the diagnostics in several pulmonary diseases. The examination and staging of mediastinal and hilar lymph nodes in patients with known or suspected lung malignancy as well as the evaluation of unknown pulmonary or mediastinal lesions can be achieved with minimal invasive means when using EBUS. More invasive surgical procedures for diagnostic purposes can be omitted. The diagnostic yield also increases when EBUS is applied in sarcoidosis or mediastinal lymph node tuberculosis but only to some extend in case of lymphoma. Samples obtained by EBUS-TBNA should be handled efficiently to allow molecular analysis in lung cancer. EBUS is a safe procedure, and complication rate is extremely low. Further advances of the EBUS technology focus on improving analysis of the information provided by the ultrasound image and a better tissue sampling by developing of new EBUS bronchoscopes and TBNA-needles.


Assuntos
Broncoscopia/métodos , Endossonografia/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Biópsia por Agulha , Humanos , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Linfoma/diagnóstico por imagem , Linfoma/patologia , Neoplasias do Mediastino/patologia , Estadiamento de Neoplasias , Sarcoidose Pulmonar/diagnóstico por imagem , Sarcoidose Pulmonar/patologia , Sensibilidade e Especificidade , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/patologia
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