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?
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4 comments - CLICK HERE to read & add your own!:
If the cultures are negative, then I'd want those lymph nodes biopsied if they were in my chest. I'd do a Wang/transbronchial needle aspirate, and if negative I'd get a medistinoscopy.
What are your qualifications darenberg?
CT guided FNAC would be a reasonable first option either.
mediastinoscopy is fast/ relatively safe, and allows for a larger / intact sample. If intraoperative pathology report warrents - surgeon can procede with VATs and remove the mass. That would save the patient considerable anxiety, and speed the process as well. Being able to visually identify the mass by VATs if necessary is also helpful.
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