Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculosis Jiayuan Sun, MD, PhD, Jiajun Teng, MD, Huizhen.

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Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Diagnosing Intrathoracic Tuberculosis Jiayuan Sun, MD, PhD, Jiajun Teng, MD, Huizhen Yang, MD, Zhifu Li, MD, Jie Zhang, MD, Heng Zhao, MD, David H. Garfield, MD, Baohui Han, MD, PhD The Annals of Thoracic Surgery Volume 96, Issue 6, Pages 2021-2027 (December 2013) DOI: 10.1016/j.athoracsur.2013.07.005 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Flowchart of patients with intrathoracic tuberculosis (TB) undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). aUnderwent anti-TB treatment before procedure. (+) = positive for TB; (-) = negative for TB; AFB = acid-fast bacilli on Ziehl-Neelsen staining; CT-TTNA = computed tomography–guided transthoracic needle aspiration; Culture = culture for Mycobacterium tuberculosis; Grade I = granulomas with caseation; Grade II = granulomas without caseation; Grade III = nongranulomatous reaction with caseation; Grade IV = nonspecific; WLB = white light bronchoscopy. The Annals of Thoracic Surgery 2013 96, 2021-2027DOI: (10.1016/j.athoracsur.2013.07.005) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Representative cases of EBUS-TBNA in diagnosing intrathoracic TB. (A) Tuberculous lymphadenitis diagnosed by EBUS-TBNA in 25-year-old man who underwent anti-TB pretreatment for 3 months: (A-1) Chest CT demonstrating enlarged right hilar nodes (12R); (A-2) localization and measurement of 12R lymph node by EBUS; (A-3) EBUS images of real-time aspiration with needle in target lymph node; (A-4) TBNA tissue of 12R lymph node revealing epithelioid granuloma with caseous necrosis (×20), together with (A-5) positive acid-fast staining (×100) found in TBNA specimen. (B) Lung TB diagnosed by EBUS-TBNA in 53-year-old man with cough for 2 weeks: (B-1) CT demonstrates RLL mass; (B-2) localization and measurement of RLL by EBUS; (B-3) EBUS images of real-time aspiration with needle in target mass; (B-4) TBNA tissue of RLL revealing epithelioid granuloma (×20), together with positive culture for Mycobacterium tuberculosis (data not shown). (C) Lung TB accompanying intrathoracic lymph node involvement diagnosed by EBUS-TBNA in 31-year-old woman with a fever for 4 weeks: (C-1) CT demonstrating enlarged 7,10L lymph nodes and left upper lobe mass; (C-2) localization and measurement of lymph node 7 by EBUS; (C-3) EBUS images of real-time aspiration with needle within target lymph node; (C-4) appearance of TBNA specimen showing caseous necrosis; (C-5) TBNA tissue of lymph node 7 revealing epithelioid granuloma with caseous necrosis (×20), together with positive smear and culture for M tuberculosis (data not shown). (CT = computed tomography; EBUS-TBNA = endobronchial ultrasound-guided transbronchial needle aspiration; RLL = right lower lobe; TB = tuberculosis.) The Annals of Thoracic Surgery 2013 96, 2021-2027DOI: (10.1016/j.athoracsur.2013.07.005) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions