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Tuesday, August 4, 2015
Need alternate diagnostic choices to r/o ca
ct scan of chest revealed significant appearing mediastinal, hilar &subcarinal adenopathy. Told mediatinoscopy was only diagnostic option. Told trans-thoracic needle biopsy approach wouldn`t be an option considered. Previous hx & concerns include cervical radiculapthy c-3 down to the t level (on disability for this) and right sided heart thickness with occasional arrthymias. Aware wait & see approach could be lethal. Help
This question has been forwarded by Pulmonary Hypertension:
Mediastinoscopy is not the only diagnostic option for mediastinal lymphadenopathy (enlarged lymph nodes). Mediastinal lymphadenopathy specially subcarinal lymphadenopathy and in some cases hilar nodes are easily accessible with Trans Bronchial Needle Aspiration (TBNA). I agree that transthoracic needle biopsy will not be an option to access these nodes.
The process involves bronchoscopy and then inserting a needle through the bronchoscope in the location of the lymph node. Without looking at your CT scan of chest, it is hard to say whether your nodes will be easily accessible. The diagnostic yield depends on the size of the lymph node, location and the skill of the operator. Pulmonologists at any major center can perform this procedure. It is an outpatient procedure and does not require hospital stay usually unless there is a complication. It can be done with similar sedation that is used for colonoscopy.
Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University