Paralysis and a perihilar protuberance: An unusual presentation of sarcoidosis in a child

Abstract

Sarcoidosis in children can present with extra-pulmonary manifestations, making diagnosis difficult. We describe a case of sarcoidosis in a child, presenting as a Guillain-Barré-like illness with the incidental finding of a perihilar mass. We also report the first successful use of the minimally invasive technique of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) to delineate the cause of hilar lymphadenopathy in a child.

ERS statement: interventional bronchoscopy in children

“…Adequate sampling can be achieved in 95% of cases, although diagnostic yield may only be 47%. The complication rate in children appears to be very low [65][66][67][68].…”

“…Diagnostic yield for lung cancer is 89% [63] and for tuberculous lymphadenopathy is 80% [61]. In children, linear probe EBUS TBNA is suitable for investigation of mediastinal or hilar lesions to diagnose leukaemia [65], lymphoma [65], sarcoidosis [66] and tuberculosis [67]. Although a 6.9-mm diameter puncturescope can be passed through a 2.5 laryngeal mask airway (LMA), ventilation is limited and a 4.0 LMA is preferable.…”

The use of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in a pediatric population: A multicenter study

“…The mean age of patients was 13.7 years of age (±4.1 years) with a range of 1.5–18 years of age. The indications for EBUS‐TBNA were lymphadenopathy, mediastinal mass, or lung mass . Five patients underwent EBUS‐TBNA in the setting of a previously diagnosed malignancy and concern for recurrence.…”

“…The use of CP‐EBUS has rapidly increased within the adult pulmonology and thoracic oncology field, yet has limited reported use within the pediatric population. There are currently no studies and only one case report of convex probe EBUS‐TBNA in a pediatric patient . A review article on the potential for the use of EBUS (both convex and radial probe) in the pediatric population offered no pediatric data to confirm its true feasibility or utility.…”

The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal lymphadenopathy

“…Due to size constraints of the pediatric bronchoscopes this technique has not been widely used in children. There is one case report on its use in diagnosing sarcoidosis in a young child 16. One of the major applications of TBNA in pediatric pulmonology would be in the diagnosis of tuberculosis, but the sophisticated equipment required is expensive and requires extensive training, making its use in resource‐limited countries highly unlikely 11…”