CLINICAL COURSE
Surgery was consulted and on December 8, 2000 she underwent a Thoracotomy and repeat Bronchoscopy and bronchoalveolar lavage.
Findings
at surgery were as follows:
– Removal of mediastinal nodes and pleura
– Inflamed nodes with central necrosis, narrowed (L) mainstem bronchus.
– Chest tube insertion
– Bronchoscopy –
repeat BAL.
She was taken to the PICU for 24 hours for monitoring.
She
also had other investigations:
– Mantoux 4-5mm induration, HIV negative, workup for neuroblastoma
negative
Further
history:
No TB contacts. Infectious Disease was consulted.
Pathology
results:
Frozen Section: Caseating granuloma –
BAL: (+) for acid fast bacilli on Ziehl-Neilsen stain. Biopsy tissue –
acid fast bacillus stain negative, but positive cultures in less than
10 days.
AN EXAMPLE IS SHOWN BELOW.
ENLARGE the slide above.
ENLARGE the slide above.
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