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Ultraschall Med 2019; 40(04): 488-494
DOI: 10.1055/a-0879-1758
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Internal Mammary Lymph Node Visualization as a Sentinel Sonographic Sign of Tuberculous Pleurisy

Darstellung der inneren Mamma-Lymphknoten als sonografischer Sentinelmarker der tuberkulösen Pleuritis
Ludovico Messineo
1   Department of Experimental and Clinical Sciences, University of Brescia, Italy
,
Federico Quadri
2   Pleural Unit, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Italy
,
Alberto Valsecchi
2   Pleural Unit, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Italy
,
Sara Lonni
1   Department of Experimental and Clinical Sciences, University of Brescia, Italy
,
Antonio Palmiotti
3   Department of Medical and Surgical Sciences, University of Foggia, Italy
,
Marchetti Giampietro
2   Pleural Unit, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Italy
› Author Affiliations
Further Information

Publication History

30 August 2018

06 March 2019

Publication Date:
25 June 2019 (online)

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Abstract

Background Tuberculous pleurisy is one of the primary sites of extrapulmonary tuberculosis, but clinicians currently lack the diagnostic tools necessary for early recognition in the absence of typical signs and symptoms. With this study, we aimed to test the association between internal mammary adenopathies and tuberculous pleurisy (TP).

Methods 60 patients with a post-thoracoscopic histological diagnosis of granulomatosis or acute infective pleurisy were retrospectively enrolled. All of them had chest sonography and/or CT scan data available. At least two expert chest sonography physicians re-analyzed the sonography images to look for any internal mammary adenopathy. Such findings were compared to the CT data.

Results Chest sonography showed internal mammary adenopathy ipsilateral to the pleural effusion in 97 % of 29 patients who had a diagnosis of TP, and in 13 % of those with an acute infective pleurisy (p < 0.001). Receiver operator characteristic analysis revealed 97 % sensitivity and 87 % specificity for this technique in predicting TP (area under curve 0.92 ± 0.04, p < 0.001). CT detection power and node measures were significantly similar (p < 0.001).

Conclusion Sonographic internal mammary node visualization ipsilateral to the pleural effusion may become a sentinel sign for TP, contributing to early diagnosis or orienting the diagnostic management towards invasive procedures in uncertain cases.

Zusammenfassung

Hintergrund Die tuberkulöse Pleuritis ist eine der primären Stellen der extrapulmonalen Tuberkulose. Derzeit fehlt es den Ärzten jedoch an diagnostischen Mitteln für die Früherkennung, wenn typische Anzeichen und Symptome fehlen. Mit dieser Studie wollten wir den Zusammenhang zwischen interner Mamma-Adenopathie und tuberkulöser Pleuritis (TP) untersuchen.

Methoden 60 Patienten mit der post-thorakoskopischen histologischen Diagnose einer Granulomatose oder akuten infektiösen Pleuritis wurden retrospektiv aufgenommen. Bei allen wurde eine Thorax-Sonografie durchgeführt und/oder es lagen CT-Aufnahmen vor. Mindestens 2 auf Thorax-Sonografie spezialisierte Ärzte reanalysierten die sonografischen Aufnahmen im Hinblick auf interne Mamma-Adenopathien. Entsprechende Befunde wurden mit den CT-Daten verglichen.

Ergebnisse Die Thorax-Sonografie zeigte eine interne Mamma-Adenopathie ipsilateral zum Pleuraerguss bei 97 % der 29 Patienten mit diagnostizierter TP und bei 13 % der Patienten, die eine akute infektiöse Pleuritis hatten (p < 0,001). Die ROC-Analyse („receiver operator characteristic“) ergab für diese Methode eine Sensitivität von 97 % und eine Spezifität von 87 % für die Vorhersage einer TP („area under the curve“ 0,92 ± 0,04, p < 0,001). Die CT-Detektionsleistung und die Knotenmessungen waren signifikant ähnlich (p < 0,001).

Schlussfolgerung Die sonografische Darstellung der inneren Brustknoten ipsilateral zum Pleuraerguss kann zu einem Sentinelmarker für TP werden, der zur Frühdiagnose beiträgt oder bei fraglichen Fällen das diagnostische Management in Richtung invasiver Verfahren lenkt.

Key words

sentinel lymph node - granulomatous pleural diseases - pleural drainage
 

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