title: Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy.
abstract: Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting. Five cases of mediastinal lymphadenopathy are presented here in which lymph node anthracosis was identified as the primary diagnosis using EBUS-TBNA. They were female, non-smokers presenting with non-specific symptoms, who retrospectively reported cooking over wood fires. Four were from South Asia. Three were investigated by F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and increased signal was identified in the anthracotic nodes sampled. With expansion of PET/CT and EBUS-TBNA services it is likely that primary nodal anthracosis will be encountered more frequently and should be considered in the differential diagnosis of those with PET/CT positive lymphadenopathy. It may mimic pathologies including tuberculosis and malignancy, thus accurate sampling and follow-up are essential.
authors.affiliation: Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hewitt
authors.affiliation: Cytopathology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Corrina
authors.initials: C
authors.lastname: Wright
authors.affiliation: Respiratory Medicine, Central Middlesex Hospital, The North West London Hospitals NHS Trust, Acton Lane, London NW10 7NS, UK.
authors.forename: David
authors.initials: D
authors.lastname: Adeboyeku
authors.affiliation: Respiratory Medicine, Northwick Park Hospital, The North West London Hospitals NHS Trust, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Ornadel
authors.affiliation: Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Berry
authors.affiliation: Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wickremasinghe
authors.affiliation: Radiology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wright
authors.affiliation: Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK ; Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Sykes
authors.affiliation: Chest and Allergy Department, St. Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK ; Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, UK.
authors.forename: Onn Min
authors.initials: OM
authors.lastname: Kon
keywords: Anthracosis; EBUS-TBNA; FDG PET/CT; Mediastinal lymphapenopathy