Internal Mammary Lymph Node Visualization as a Sentinel Sonographic Sign of Tuberculous Pleurisy

Abstract

Background Tuberculous pleurisy is one of the primary sites of extrapulmonary tuberculosis, but clinicians currently lack the diagnostic tools necessary for early recognition in the absence of typical signs and symptoms. With this study, we aimed to test the association between internal mammary adenopathies and tuberculous pleurisy (TP). Methods 60 patients with a post-thoracoscopic histological diagnosis of granulomatosis or acute infective pleurisy were retrospectively enrolled. All of them had chest sonography and/or CT scan data available. At least two expert chest sonography physicians re-analyzed the sonography images to look for any internal mammary adenopathy. Such findings were compared to the CT data. Results Chest sonography showed internal mammary adenopathy ipsilateral to the pleural effusion in 97 % of 29 patients who had a diagnosis of TP, and in 13 % of those with an acute infective pleurisy (p < 0.001). Receiver operator characteristic analysis revealed 97 % sensitivity and 87 % specificity for this technique in predicting TP (area under curve 0.92 ± 0.04, p < 0.001). CT detection power and node measures were significantly similar (p < 0.001). Conclusion Sonographic internal mammary node visualization ipsilateral to the pleural effusion may become a sentinel sign for TP, contributing to early diagnosis or orienting the diagnostic management towards invasive procedures in uncertain cases.

Internal mammary lymph node metastasis in breast cancer patients based on anatomical imaging and functional imaging

“…Fourth, various tissues can mimic IMLNs during parasternal imaging, such as mature adipose tissue, costal cartilage, part of a vessel, skeletal muscle, or fibroblasts [ 25 ]. Finally, granulomatosis or acute infective pleurisy are also potential confounding factors [ 79 ]. Therefore, for patients with large IMLNs or functional imaging-positive IMLNs after surgery, it may be more appropriate to use a short-interval follow-up with enhanced CT, MRI, US, or biopsy, rather than an immediate full oncologic work-up, depending on the size and location of the IMLNs.…”

Accuracy of lung and abdominal ultrasound for tuberculosis diagnosis: a prospective cohort study from India

“…(13) A further issue with current LUS research is comparability due to the varying definitions used and also entities such as SUNs lack a pathophysiological correlate. Other possible targets for POCUS, such as lymphadenopathy in the internal mammary region, mediastinal lymph nodes (14)(15)(16), or peritoneal changes (17), have only been described in case studies or series. Their prevalence and potential value for POCUS applications remains to be elucidated in prospective studies with robust reference standards.…”