Correct!
2. Endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA)
Chest MRI is useful for evaluation of large anterior mediastinal masses. PET would be correct if there was a high suspicion for lymphoma or there was need for further identification of a biopsy location. Percutaneous biopsy is useful for lesions distant to airways or located in the anterior or posterior mediastinal compartments. EUS often does not allow for biopsy of the stations 2 and 4R which are often involved in TB. Due to this patients paratracheal lymphadenopathy EBUS with biopsy is the ideal choice.
For undiagnosed intrathoracic lymphadenopathy in HIV patients, EBUS-TBNA has a diagnostic yield of 77% (3). In one study of HIV patients with intrathoracic lymphadenopathy, the most common lymph node stations involved were 7, 4R, and 11L (3). These results were comparable to findings of Navani et al. (4) in which 7 and 4R were the most common nodal stations involved.
The patient was consented and EBUS was performed with multiple lymph node station biopsies including station 7 shown below (Figure 2). Acid fast sputum results were 3/3 negative, few acid fast bacilli were seen on smear and mycobacterium tuberculosis complex was detected by PCR of station 7.
Figure 2. EBUS showing lymphadenopathy with heterogeneous appearance in station 7.
Does the diagnostic yield of acid fast sputum smear and nucleic acid amplification vary with cluster differentiation (CD)4 count? (Click on the correct answer to be directed to the fifth of six pages)