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• W2980355025 abstract "SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Acute mediastinitis is a rare but serious complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), occurring in approximately 0.07% of patients.(1) We present a case of acute mediastinitis following EBUS-TBNA. CASE PRESENTATION: A 68-year-old male presented with a left upper lobe mass, an EBUS-TBNA was performed for diagnosis and mediastinal staging. The procedure was complicated by a difficult intubation requiring three attempts, video laryngoscopy, and significant manipulation of the endotracheal tube. Two days after the procedure he developed non-radiating chest pain and was admitted to the hospital with sepsis and acute respiratory failure requiring noninvasive positive pressure ventilation. Computed tomography scan of the chest demonstrated anterior mediastinitis. His condition rapidly deteriorated into septic shock with acute respiratory distress syndrome and multiorgan failure. During the initial thoracotomy on hospital day 7, a large amount of turbid fluid was encountered in the right chest. The anterior mediastinum was bulging superiorly and with only blunt finger dissection the mediastinum was easily freed from the posterior sternum as multiple purulent pockets were encountered. Blood and intraoperative cultures did not yield a causative organism and the patient was treated with broad spectrum antibiotics for necrotizing mediastinitis for a total of four weeks. After a prolonged hospital course, he was discharged to a rehabilitation facility and started on systemic chemotherapy for non-small cell lung cancer as an outpatient. DISCUSSION: Literature review suggests that mediastinitis is not related to bronchoscopy alone.(1,2,3) TBNA, the number of needle passes required for sampling, contamination, site necrosis and bronchoscopist experience can also increase the risk of infection.(3) Severity can range from mild illness and fevers to severe infections requiring thoracotomy.(3) As pharyngeal and retropharyngeal infection are also known causes of mediastinitis, difficult intubation and underlying cancer must be considered as possible causative factors in our case. The multiple intubation attempts required in this case may have caused traumatic injury to the trachea, thus predisposing the patient to development of mediastinitis. CONCLUSIONS: Rapid recognition is imperative to reduce morbidity and mortality with suspected mediastinitis and to clearly identify at risk patients. Although antibiotic prophylaxis is not routinely recommended for flexible bronchoscopy with EBUS-TBNA, there may be some benefit in cases with a challenging intubation or intraoperative complications. Reference #1: 1. Von Bartheld MB, van Breda A, Annema JT. Complication rate of endosonography (endobronchial and endoscopic ultrasound). a systematic review. Respiration. 2014;87:343-351. https://doi.org/10.1159/000357066. Reference #2: 2. Jahoor A, Ghamande S, Jones S, Boethel C, White HD. Mediastinitis following endobronchial ultrasound-guided transbronchial needle aspiration. Journal of Bronchology & Interventional Pulmonology. 2017;24(4):323-329. https://doi.org/10.1097/LBR.0000000000000370. Reference #3: 3. Voldby N, Folkersen BH, Rasmussen TR. Mediastinitis. Journal of Bronchology & Interventional Pulmonology. 2017;24(1):75–79. https://doi.org/10.1097/LBR.0000000000000231. DISCLOSURES: No relevant relationships by Marshall Beckman, source=Web Response No relevant relationships by Thomas Carver, source=Web Response No relevant relationships by Christopher Davis, source=Web Response No relevant relationships by Marc de Moya, source=Web Response No relevant relationships by Javeria Haque, source=Web Response No relevant relationships by Jeremy Juern, source=Web Response course relationship with Pinnacle Biologic Please note: $1001 - $5000 Added 03/13/2019 by Jonathan Kurman, source=Web Response, value=Travel Speaker/Speaker's Bureau relationship with Biodesix Please note: $5001 - $20000 Added 03/18/2019 by Jonathan Kurman, source=Web Response, value=Honoraria Consultant relationship with Medtronic Please note: $1001 - $5000 Added 03/18/2019 by Jonathan Kurman, source=Web Response, value=Consulting fee Consultant relationship with Level EX Please note: $1001 - $5000 Added 03/18/2019 by Jonathan Kurman, source=Web Response, value=Consulting fee educational course relationship with Pinnacle Biologics Please note: $1001 - $5000 Added 03/18/2019 by Jonathan Kurman, source=Web Response, value=Travel<br Speaker/Speaker's Bureau relationship with American Medical Forum Please note: $1001 - $5000 Added 03/18/2019 by Jonathan Kurman, source=Web Response, value=Honoraria No relevant relationships by Paul Linsky, source=Web Response No relevant relationships by Joseph Losh, source=Web Response No relevant relationships by Pamela Souders, source=Web Response" @default.
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• W2980355025 date "2019-10-01" @default.
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• W2980355025 title "ACUTE MEDIASTINITIS WITH MULTIORGAN FAILURE AFTER ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION" @default.
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