| Objective: All clinical data of 38 patients with granulomatous lesions of mediastinal lymph nodes confirmed by EBUS-TBNA were retrospectively analysed,in order to summary the disease spectrum composition,clinical manifestation,imaging and pathological features of granulomatous lesions in mediastinal lymph nodes,and to provide reference for the diagnosis and treatment of this kind of disease.Methods:A total of 38 patients who underwent EBUS-TBNA in the second department of Pulmonary and Critical Care Medicine(PCCM-2)of the second hospital of Hebei Medical University from January 2014 to December 2019 and were pathologically diagnosed as granulomatous lesions of mediastinal lymph nodes were studied.General clinical data,imaging and pathological data of patients were collected to analyze the disease spectrum composition of granulomatous lesions of mediastinal lymph nodes,and to compare the characteristics of different diseases that gave rise to these lesions.Results:1.General data analysis: 9 cases were male,accounting for 23.68%,and 29 cases were female,accounting for 76.32%.All ages varied from 25 to 73 years old,with an average age of 50.81±12.19 years old.There were 5 patients with smoking history and 33 patients without smoking history.2.The number of mediastinal lymph nodes punctured by EBUS-TBNA and the number of passes: 144 passes were performed in 68 lymph nodes for biopsy,which respectively were 24 paratracheal lymph nodes(22 in 4R group,2 in 4L group),35 subcarinal lymph nodes(35 in 7 group),1 hilar lymph node(1 in 10 R group),7 interlobular lymph nodes(5 in 11 R group,2 in 11 L group)and 1 lobar lymph node(1 in 12 R group),with an average of 2.12 passes per lymph node and 3.79 passes per patient.3.Disease spectrum of 38 patients with granulomatous lesions of mediastinal lymph nodes: There were 32 cases with definite etiology,accounting for 84.21%,and 6 cases with unclear etiology,accounting for 15.79%.The clinical diagnoses of the 32 cases with definite etiology were: sarcoidosis(16 cases),mediastinal lymph node tuberculosis(13 cases),fungal infection(1 case),mediastinal lymph node metastasis of lung cancer(1 case),and silicosis(1 case).The proportions were 42.11%,34.21%,2.63%,2.63%,and 2.63%.4.Analysis of clinical manifestations: Sarcoidosis was characterized by cough(56.25%),chest tightness or shortness of breath(43.75%),and sputum(37.50%).Mediastinal lymph node tuberculosis was mainly characterized by cough(92.31%),sputum(76.92%)and fever(61.54%).Four patients with sarcoidosis showed no symptoms.The incidence of fever and cough in patients with mediastinal lymph node tuberculosis was more than that in patients with sarcoidosis(P<0.05).5.Analysis of characteristics of bronchoscopy: In patients with sarcoidosis,the first three most common bronchoscopy manifestations were mucosal congestion and edema(75.00%),airway secretions(68.75%),and nodules(43.75%).Among patients with mediastinal lymph node tuberculosis,the first three most common bronchoscopy manifestations were airway secretions(76.92%),mucosal congestion and edema(69.23%),and nodules(53.85%).There was no statistical difference in the bronchoscopy manifestations between sarcoidosis and mediastinal lymph node tuberculosis(P>0.05).6.Analysis of imaging characteristics:The lesions in mediastinal lymph nodes of sarcoidosis patients were mainly bilateral and multiple.The average value of the short axis diameter(SAD)was 18.83 ± 7.39 mm,and the SAD mainly ranged from 10 to 20mm(including 20mm),a total of 7 cases(43.75%),The first three imaging manifestations were pulmonary nodule shadow,subpleural nodule and interlobular septal thickening,accounting for 56.25%,37.50% and 37.50% of the sarcoidosis patients.The lesions in mediastinal lymph nodes of mediastinal lymph node tuberculosis patients were mainly bilateral and multiple.The average value of the SAD was 20.33±4.44 mm,and the SAD mainly ranged from 10 to 20mm(including 20mm),a total of 5 cases(38.46%).The first three imaging manifestations were pulmonary nodule shadow,subpleural nodule and patch/consolidation shadow,accounting for 53.85%、38.46%、38.46% of the mediastinal lymph node tuberculosis patients.There was no significant difference in the diameter,number and location of mediastinal lymph nodes between the two diseases(P> 0.05).Patients with mediastinal lymph node tuberculosis could be accompanied by cavity and pleural effusion,but sarcoidosis did not.7.Follow-up results: Follow-up was completed in 27 patients(13 cases of sarcoidosis and 10 cases of mediastinal lymph node tuberculosis).Among the 13 patients with sarcoidosis,symptoms improved in 12(92.32%)patients.9 patients received treatment(hormone or hormone combined anti-tuberculosis treatment),among which 7(58.33%)patients had smaller lymph nodes,2(16.67%)had no significant changes in lymph nodes,and 4 patients did not receive treatment,among which 3(25.00%)had smaller lymph nodes.Among the 10 patients with mediastinal lymph node tuberculosis,symptoms improved in 10 cases(100.00%).9 patients received anti-tuberculosis treatment,among which 7 patients(70.00%)had smaller lymph nodes and 1 patient(10.00%)had no significant changes in lymph nodes.Conclusions:1.Sarcoidosis is the most common cause of granulomatous lesions of mediastinal lymph nodes,and mediastinal lymph node tuberculosis is the second most common cause.2.The mean age of patients with sarcoidosis is greater than that of patients with mediastinal lymph node tuberculosis.The incidence of fever and cough in patients with mediastinal lymph node tuberculosis is more than that in patients with sarcoidosis.3.There is no significant difference in bronchoscopy between sarcoidosis and mediastinal lymph node tuberculosis.4.There is no significant difference in the SAD,number and location of mediastinal lymph nodes between sarcoidosis and mediastinal lymph node tuberculosis.Patients with mediastinal lymph node tuberculosis can be accompanied by cavity and pleural effusion,but sarcoidosis do not.5.The prognosis of granulomatous lesions of mediastinal lymph nodes is good,and some patients with sarcoidosis can recover by themselves. |
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