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• W3093278464 abstract "SESSION TITLE: Fellows Procedures Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive diagnostic tool for the evaluation of mediastinal and hilar lymphadenopathy. There is a paucity of data on its complications that usually include self-limiting bleeding, infections, and rarely pneumothorax/pneumomediastinum. CASE PRESENTATION: A 71-year-old male with a past medical history of cirrhosis, COPD with 45 pack-year smoking history, chronic hypoxic respiratory failure on 2 L/min home oxygen, OSA on BiPAP, was evaluated in pulmonary clinic for mediastinal and right hilar adenopathy. He underwent bronchoscopy with EBUS guided 21-gauge TBNA of station 7 lymph node. A chest x-ray post bronchoscopy was unremarkable. The patient was discharged with outpatient follow-up. He presented two days later with bilateral chest pain. A chest x-ray showed bilateral pleural effusions, and CTchest showed a 6.5 x 4.6 cm mass with partial cavitation in the subcarinal region of the mediastinum with intrinsic soft tissue gas. The patient was intubated due to worsening hypoxemic hypercapnic respiratory failure and started on broad-spectrum antibiotics. Repeat bronchoscopy did not show any bronco-mediastinal fistula but the narrowing of right lower lobe (RLL) medial segment with endobronchial tumor invasion. Endobronchial biopsies were obtained. EGD did not show esophago-mediastinal fistula. Hospital course was complicated by Strep mitis/oralis and Strep salivarius bacteremia followed by endocarditis. The pathology from both bronchoscopies was consistent with high-grade large B-cell lymphoma eroding into RLL parenchyma. DISCUSSION: EBUS-TBNA complications remain relatively rare. Asano et al. reported only 2 cases of pneumothorax (0.03%), out of 7000 patients surveyed in National Japanese study [1]. The results of the AQuIRE registry showed pneumothorax in 0.53% [2] of 1317 enrolled patients in the USA. In a systematic review of EBUS complications, including the case reports, Vaidya et al. revealed 4% estimated rate for pneumothorax [3]. Pneumomediastinum is a rare complication associated with EBUS with a few case reports worldwide [4]. There was no obvious evidence of a fistula on follow up bronchoscopy though this does not negate the possibility of a procedure-related pneumomediastinum, particularly in the absence of mediastinal air on initial CT and post EBUS CXR. Alternatively, the findings could be consistent with necrosis of a rapidly enlarging mass with the eventual invasion of the airway and development of an abscess. CONCLUSIONS: With the growing interest in the use of EBUS for evaluation of mediastinal lymphadenopathy, awareness of possible complications is vital for optimal patient care. Reference #1: F. Asano et al., “Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy,” Respiratory Research, vol. 14, no. 1, p. 50, May 2013, doi: 10.1186/1465-9921-14-50. Reference #2: G. A. Eapen et al., “Complications, Consequences, and Practice Patterns of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Results of the AQuIRE Registry,” Chest, vol. 143, no. 4, pp. 1044–1053, Apr. 2013, doi: 10.1378/chest.12-0350. Reference #3: P. J. Vaidya, M. Munavvar, J. D. Leuppi, A. C. Mehta, and P. N. Chhajed, “Endobronchial ultrasound-guided transbronchial needle aspiration: Safe as it sounds,” Respirology, vol. 22, no. 6, pp. 1093–1101, 2017, doi: 10.1111/resp.13094. DISCLOSURES: No relevant relationships by Nathalie Abi Hatem, source=Web Response No relevant relationships by Mahtab Foroozesh, source=Web Response No relevant relationships by Sara Khademolhosseini, source=Web Response No relevant relationships by Seyedmohammad Pourshahid, source=Web Response" @default.
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• W3093278464 date "2020-10-01" @default.
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• W3093278464 title "PNEUMOMEDIASTINUM AFTER ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL BIOPSY" @default.
• W3093278464 doi "https://doi.org/10.1016/j.chest.2020.08.1638" @default.
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