CASES OF THE WEEK – “Mediastinal Lymph nodes Tuberculosis diagnosed by Endoscopic Ultrasound (EUS) guided biopsy” by Dr Piyush Somani, Specialist Gastroenterology & Dr Ehsan Ahmed, Specialist Clinical Pathologist, NMC Royal Hospital Sharjah
Mediastinal Lymph nodes Tuberculosis diagnosed by Endoscopic Ultrasound (EUS) guided biopsy
46 years male presented with complains of dry cough, weight loss, low grade fever and anorexia since 3 months.
CT chest: There were multiple enlarged mediastinal lymph nodes including subcarinal, pretracheal, paratracheal prevascular, aortopulmonary window and right lung hilar lymph nodes.
There was raised ESR/CRP.
Patient visited many pulmonologists and was referred for Endoscopic ultrasound guided biopsy/FNAC of mediastinal lymph nodes to make the final diagnosis. Patient underwent EUS as day case procedure.
The EUS revealed multiple, hypoechoic lymph nodes of different sizes in the entire mediastinum including right lower paratracheal, subcarinal region, aortopulmonary window and right lung hilar regions. Using 22 gauge needle, 3 passes were taken from subcarinal lymph nodes; 4 passes were taken from right lung hilar lymph nodes and the material was sent for FNAC/biopsy.
Biopsy/FNAC was reviewed by Dr. Ehsan Ahmed which was suggestive of features of Tuberculosis. There were caseating granulomas present. Patient was started on antitubercular medications with improvement in symptoms. The differential diagnosis of Enlarged mediastinal lymph nodes with symptoms include tuberculosis, sarcoidosis, lymphoma and other rare aetiologies.
EUS guided biopsy/FNAC is a minimally invasive day-care procedure to make diagnosis in enlarged mediastinal lymph nodes. This facility is available only in few hospitals in UAE.
This is the first case of EUS guided biopsy of mediastinal lymph nodes performed in Al Zahra Hospital, Sharjah