Anatomic considerations in TBNA of mediastinal lymph nodes

Station	Level	Best approach	Pitfalls
7	Subcarinal nodes	From a point 3-5 mm below on either side of the primary carina, with the needle pointed in an inferomedial direction.	Direct puncture of a normal looking carina should usually be avoided.
4R	Right paratracheal lymph nodes	From the second or third intercartilaginous space (or 2 cm) proximal to the carina at the 1-2 o'clock position.	The mediastinal reflection of the pleura and the azygos vein lie at the 3 o'clock position and should be avoided.
4L	Left paratracheal nodes	From the lateral wall of the left main bronchus at the level of the carina at the 9 o'clock position.
10R	Right hilar nodes	Through the bronchus intermedius at 3 o'clock position, just below the level of the right upper lobe bronchus or proximal to the origin of the superior segment of the right lower lobe bronchus.
10L	Left hilar nodes	At the origin of the left lower lobe bronchus at the nine o'clock position.

Approach_to_mediastinal_nod.htm

Adapted with permission from Minai, OA, Dasgupta, A, Mehta, AC. Transbronchial needle aspiration of central and peripheral lesions. In: Bolliger, CT, Mathur, PN (Eds), Progress in Respiratory Research - Interventional Bronchoscopy. Karger, Basel, Switzerland, 1999.

Graphic 59333 Version 1.0

خرید پکیج

Anatomic considerations in TBNA of mediastinal lymph nodes