Friday, November 30, 2007

Lymphocytic effusion

Since another question from a doc is related to TB, I'll post that here as well:

55 y old gentleman presented with few weeks history of progressive dyspne and right sided pleuritic chest pain, with history of contact with a case of pulmonary TB, no symptoms of toxemia, clinically the patient got signs of right sided pleural effusion which was aspirated and shown to be lymphocytic exudate,because the patient also presented with hoaseness of voice CT chest was done showed no lung masses or lymphadenopathy, BAL showed no malignant cells, PPD test was highly positive, laryngeal examination showed cordal polyp. culturing the fluid and sputum for TB was negativethe patient was started on antituberculous ttt , 1st 2 months quadrible therpy and then dual therapy and the patient still have re accumulating effusion? any suggestions?

TB treatment and a followup BAL

A physcian from Florida recently asked how one should approach the following. A younger man from a TB-endemic area with cavitary upper lobe lesions. He is not productive of sputum. Obviously, the physician elected to treat empirically for TB. In terms of getting sensitivities, a BAL should be done, but his question was, how long after initiation of 4-drug therapy would the BAL give a false positive. By false positive, I guess you could view that as as either afb negative, or culture negative (if the former represents dead TB bugs).

He was considering waiting 2 weeks to help decrease the risk to those in the bronchoscopy suite.
What do you think?

Monday, November 12, 2007

need for lymph node biopsy?

Question submitted by anonymous:

24 year old Asian female presented with chronic productive cough of green/yellow sputum for the last year. Travelled to Malaysia and Pakistan in the last year. Some mild episodes of haemoptysis. CXR when the patient initially presented was NAD. Bloods all normal, barring a bilirubin of 16.

A CT a year after initial presentation showed right upper lobe collapse with a 2cm mass. Left upper lobe bronchiectasis. Also widespread mediastinal adenopathy.

Sputum cultures negative. Bronchoscopy showed a sputum plug sent for MC+S - negative. Nil else on bronchoscopy.

Why is there mediastinal adenopathy? Should a biopsy be performed in order to aid diagnosis?