Search

An accurate assessment of the mediastinal lymph node status is essential in the staging and treatment planning of potentially resectable non-small-cell lung cancer.We performed this meta-analysis to evaluate the role of endobronchial ultrasound-guided transbronchial needle aspiration in detecting occult mediastinal disease in non-small-cell lung cancer with no radiologic mediastinal involvement.The PubMed, Embase, and Cochrane libraries were searched for studies describing the role of endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer with radiologically negative mediastinum. The individual and pooled sensitivity, prevalence, negative predictive value, and diagnostic odds ratio were calculated using the random effects model. Meta-regression analysis, heterogeneity, and publication bias were also assessed.A total of 13 studies that met the inclusion criteria were included in the meta-analysis. The pooled effect sizes of the different diagnostic parameters were estimated as follows: prevalence, 12.8% (95% confidence interval, 10.4-15.7%); sensitivity, 49.5% (95% confidence interval, 36.4-62.6%); negative predictive value, 93.0% (95% confidence interval, 90.3-95.0%); and log diagnostic odds ratio, 5.069 (95% confidence interval, 4.212-5.925). Significant heterogeneity was noticeable for the sensitivity, disease prevalence, and negative predictive value, but not observed for log diagnostic odds ratio. Publication bias was detected for sensitivity, negative predictive value, and log diagnostic odds ratio but not for prevalence. Bivariate meta-regression analysis showed no significant association between the pooled calculated parameters and the type of anesthesia, imaging used to define negative mediastinum, rapid on-site test usage, and presence of bias by Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool. Interestingly, we observed a greater sensitivity, negative predictive value, and log diagnostic odds ratio for studies published before 2010 and for prospective multicenter studies.Among patients with non-small-cell lung cancer with a radiologically normal mediastinum, the prevalence of mediastinal disease is 12.8% and the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration is 49.5%. Despite the low sensitivity, the resulting negative predictive value of 93.0% for endobronchial ultrasound-guided transbronchial needle aspiration suggests that mediastinal metastasis is uncommon in such patients.

A 43-year-old man with a past medical history of HIV/AIDS presented with a cough, fever and night sweats. He was febrile, with normal heart rate and blood pressure. Initial laboratory testing included a mild leukocytosis. Chest X-ray demonstrated a right perihilar opacity and bilateral pleural effusions. He was admitted for treatment of pneumocystis pneumonia vs tuberculosis. He developed respiratory failure and was transferred to the ICU. He subsequently developed abdominal pain and severe lactic acidosis. CT scan demonstrated pneumatosis. Considering the clinical concern for mesenteric ischemia he was taken to the operating room, where it was noted that he had hepatomegaly and viable bowel. The mesentery demonstrated diffuse lymphadenopathy. Mesenteric lymph nodes were biopsied. He failed to improve clinically and his leukocytosis continued to increase to as high as 102,000, with a blood smear revealing atypical appearing lymphocytes. The patient continued to decline and ultimately died. Autopsy results demonstrated diffuse non-Hodgkin's lymphoma. Only 30 cases of non-Hodgkin's lymphoma have been reported in the literature as causing liver failure. This is the only case that included pneumatosis and lactic acidosis that mimicked mesenteric ischemia. How to cite this article Letourneau PA, Shah SK, Tchakarov A, Tanner AH, Hetz RA, Jani PP, Walker PA, Martinez EJ, Khan SA. Lactic Acidosis, Multiorgan Failure and Pneumatosis: A Rare Presentation of Lymphoma. Panam J Trauma Critical Care Emerg Surg 2013;2(2):94-96.