The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-as...The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery（VATS） for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment（ATT）, and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.展开更多
Background Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography （PET） of me...Background Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography （PET） of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography （CT）, and PET-CT in patients with mediastinal disease. Methods Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. ^11C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value （SUV） and were compared with pathologic data. Results There were 13 men and 19 women aged from 21 to 74 （mean 45.2） years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical ＂sarcoid＂ finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative （the pathological diagnosis was reactive hyperplasia）. The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% （12/32）, 63% （20/32）, and 91% （29/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=11.130, P〈0.001）. The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% （17/32）, 75% （24/32）, 100% （32/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=22.042, P〈0.001）. The SUV of malignant lesions （6.9, 3.2-9.8; n=11） appeared to be higher than that of benign lesions （4.9, 2.9-8.3; n=21）, however, this difference was not statistically significant （P=0.054）. Conclusions To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone （SUV） may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.展开更多
文摘The mediastinal lymph node tuberculous abscesses（MLNTAs） are secondary to mediastinal tuberculous lymphadenitis. Surgical excision is often required when cold abscesses form. This study was aimed to examine video-assisted thoracoscopic surgery（VATS） for the treatment of MLNTA. Clinical data of 16 MLNTA patients who were treated in our hospital between December 1, 2013 and December 1, 2015 were retrospectively analyzed. All of the patients underwent the radical debridement and drainage of abscesses, and intrathoracic lesions were removed by VATS. They were also administered the intensified anti-tuberculosis treatment（ATT）, and engaged in normal physical activity and follow-up for 3 to 6 months. The results showed that VATS was successfully attempted in all of the 16 MLNTA patients and they all had good recovery. Two patients developed complications after surgery, with one patient developing recurrent laryngeal nerve injury, and the other reporting poor wound healing. It was concluded that VATS is easy to perform, and safe, and has high rates of success and relatively few side-effects when used to treat MLNTA.
基金This study was supported by a grant from Shangdong Provincial Ministry of Science and Technology (No. 2004BS03018).
文摘Background Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography （PET） of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography （CT）, and PET-CT in patients with mediastinal disease. Methods Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. ^11C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value （SUV） and were compared with pathologic data. Results There were 13 men and 19 women aged from 21 to 74 （mean 45.2） years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical ＂sarcoid＂ finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative （the pathological diagnosis was reactive hyperplasia）. The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% （12/32）, 63% （20/32）, and 91% （29/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=11.130, P〈0.001）. The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% （17/32）, 75% （24/32）, 100% （32/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=22.042, P〈0.001）. The SUV of malignant lesions （6.9, 3.2-9.8; n=11） appeared to be higher than that of benign lesions （4.9, 2.9-8.3; n=21）, however, this difference was not statistically significant （P=0.054）. Conclusions To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone （SUV） may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.
