Pena Damaris, Diaz-Fuentes Gilda, Venkatram Sindhaghatta
Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center Affiliated to Icahn School of Medicine at Mount Sinai, Bronx, NY 10457, USA.
Case Rep Pulmonol. 2017;2017:3851849. doi: 10.1155/2017/3851849. Epub 2017 Oct 19.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has increasingly been performed for the diagnosis and staging of thoracic malignancies. Findings of a necrotic lymph node raise concern for infectious process and malignancy. A hypoechoic area on ultrasound/EBUS within a lymph node without blood flow is suggestive of pathologies like infections or malignancy. Inspection of the fluid could suggest a diagnosis; clear aspirates usually suggest bronchogenic or mediastinal cysts and purulent material suggests abscesses or necrotic lymph nodes. Growing tumor cells require a blood supply; if the vascular stroma is insufficient due to rapidly growing malignant tumors this could lead to large central areas of ischemic necrosis. Necrotic aspiration of lymph nodes is not always of infectious etiology. Aspiration of fluid in EBUS-TBNA is a rare occurrence, and malignancy should be considered when purulent fluid material is obtained. We present an elderly woman who underwent bronchoscopy with EBUS-TBNA for evaluation of upper lung nodule and mediastinal lymphadenopathy. Pus-like material was obtained on needle aspiration and endobronchial biopsy and mediastinal core biopsy revealed squamous cell carcinoma.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）越来越多地用于胸部恶性肿瘤的诊断和分期。坏死性淋巴结的发现会引发对感染性病变和恶性肿瘤的担忧。淋巴结内超声/EBUS显示的无血流低回声区提示感染或恶性肿瘤等病变。对吸出液的检查有助于诊断；清亮的吸出液通常提示支气管源性或纵隔囊肿，脓性物质提示脓肿或坏死性淋巴结。生长中的肿瘤细胞需要血液供应；如果由于快速生长的恶性肿瘤导致血管基质不足，可能会导致大片中央缺血性坏死。淋巴结的坏死性吸出物并不总是由感染引起。EBUS-TBNA中吸出液体的情况罕见，当获得脓性液体物质时应考虑恶性肿瘤。我们报告一位老年女性，她接受了支气管镜检查及EBUS-TBNA，以评估上肺结节和纵隔淋巴结肿大。针吸活检获得了脓性物质，支气管内活检和纵隔芯针活检显示为鳞状细胞癌。
