A toddler with a cough and wheeze refractory to treatment

• Published in: Thorax Vol. 72; no. 10; pp. 953 - 955
• Main Authors: Shanthikumar, Shivanthan, Lwin, Tommy, Chow, Chung W, Crameri, Joe, Harrison, Jo
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2017
• Subjects: Airway management; Asthma; Biopsy; Cryotherapy; Family medical history; Infections; Lymphoma; Medical imaging; Patients; Population; Tuberculosis; Ultrasonic imaging; Bronchoscopy; Atypical Mycobacterial Infection; Paediatric Physician
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thoraxjnl-2016-209915

Cryotherapy has multiple uses in adult pulmonology including removal of foreign bodies and transbronchial biopsy to diagnose granulomatous disease, infection, interstitial lung disease, lung cancer and post-transplant rejection. After a multidisciplinary discussion including an adult respiratory physician specialising in EBUS, a paediatric general surgeon and an anatomical pathologist, it was decided that although EBUS TBNA would be feasible, a needle aspirate might not provide a sample sufficient for diagnosis if the mass was due to a lymphoma such as Hodgkin's lymphoma which has a non-uniform population of tumour cells, and hence may be missed on an aspirate. [...]the patient was referred for a thoracoscopic biopsy. [...]in TST-positive cases, without risk factors for TB, who are clinically stable, withholding TB treatment while awaiting microbiological confirmation of the causative organism can be considered.