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

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.

Staphylococcus aureus bacteremia complicated with non-traumatic mediastinal abscess in children: A case report

“…Non-traumatic MA, which can be caused by hematogenous or lymphatic spread from distant sites of infection, or direct extension along contiguous anatomic pathways and fascial planes such as peritonsillar or retropharyngeal abscess (12), odontogenic infection, mediastinal lymph node tuberculous abscess (13) and S. aureus pneumonitis (14), is rare in children. The most common etiology identified in non-traumatic mediastinitis is S. aureus (9, 10), manifesting as disseminated staphylococcal infection (15).…”

Endobronchial Ultrasound-Guided Transbronchial Incision and Drainage in the Treatment of Mediastinal Abscess

“…EBUS-TBNA is a minimally invasive sampling strategy for the diagnosis of mediastinal lesions using real-time ultrasound monitoring [6,7]. Outside of its ability of tissue acquisition, recent studies have reported therapeutic application of EBUS-TBNA in mediastinal abscess, which is minimally invasive and allows for the combination of other methods to achieve better outcomes [2][3][4]8]. Casal et al [3] were the first to use EBUS-guided needle aspiration for treating infected mediastinal bronchogenic cyst.…”

Role of EBUS-TBNA in Non-Neoplastic Mediastinal Lymphadenopathy: Review of Literature

“…EBUS may have a therapeutic role in the drainage of tubercular abscesses, a rare complication of colliquation of multiple lymph nodes [ 104 ].…”