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Endosc Ultrasound. 2015 Jul-Sep;4(3):225-8. doi: 10.4103/2303-9027.163004.

Starry sky sign: A prevalent sonographic finding in mediastinal tuberculous lymph nodes.

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1
Chest Physician, Lung Transplantation Center, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.

Abstract

BACKGROUND AND OBJECTIVES:

We report a prevalent finding in tuberculous lymphadenitis (TL): Starry sky sign, hyperechoic foci without acoustic shadows over a hypoechoic background.

MATERIALS AND METHODS:

We retrospectively searched the database for a possible relationship of starry sky sign with a specific diagnosis and also the prevalence and accuracy of the finding.

RESULTS:

Starry sky sign was found in 16 of 31 tuberculous lymph nodes, while none of other lymph nodes (1,015 lymph nodes) exhibited this finding; giving a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 51.6%, 100%, 100%, 98.5%, and 98.5%, respectively.

CONCLUSION:

Bacteriologic and histologic findings are gold standard in the diagnosis of tuberculosis, but this finding may guide the bronchoscopist in choosing the more pathologic node within a station and increase the diagnostic yield as it may relate to actively dividing mycobacteria.

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