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Torre De León AJ, Valles Bastidas H, Grosu HB. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration Leading to Mediastinitis Causing Critical Airway Obstruction. J Bronchology Interv Pulmonol 2024; 31:e0967. [PMID: 38775276 DOI: 10.1097/lbr.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
| | | | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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2
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Hartert M, Wolf M, Huertgen M. Pyopericardium and extensive mediastinal abscess following EBUS-TBNA for mediastinal staging of NSCLC: a case report. MEDIASTINUM (HONG KONG, CHINA) 2023; 7:4. [PMID: 36926285 PMCID: PMC10011863 DOI: 10.21037/med-22-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
Abstract
Background Based on the algorithm on preoperative mediastinal staging in patients with non-small cell lung cancer (NSCLC), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes. It represents both a safe minimal invasive procedure with complication rates of less than 1.5% and a valid tool with a high sensitivity defining mediastinal nodal disease. However, infectious complications like mediastinitis or pyopericardium are most feared. Case Description A 54-year-old woman was admitted to our hospital for further investigation of a suspected NSCLC of the right upper lobe. EBUS-TBNA was performed to receive both diagnosis and samples of the mediastinal lymph nodes. Two weeks after EBUS-TBNA, the patient presented with symptoms of cardiogenic/septic shock: hypotension, tachycardia, chest pain and fever. Prompt diagnosis of concomitant infectious mediastinitis and extensive pyopericardium in consequence of EBUS-TBNA was obvious. Besides systemic antibiotics, bilateral thoracoscopic interventions finally made the breakthrough. The patient could be discharged roughly three weeks after emergent re-admittance. As being finally diagnosed with NSCLC (stage IIIA squamous cell carcinoma), the patient underwent-subsequent to induction chemotherapy-a definitive sequential chemoradiotherapy. Twelve-month follow-up confirmed stable disease. Conclusions It is to be expected that with increasing application of EBUS-TBNA as mediastinal staging tool, the number of serious infection-related complications will rise accordingly. The efficacy of antibiotic prophylaxis after EBUS-TBNA has not yet been proved and is therefore not included in any guideline. Our case gives an impression on the severity of delayed infectious complications after EBUS-TBNA and outlines up-front surgery as primary objective to broadly debride all contagious abscess-/empyema sites. With increased use of EBUS-TBNA as mediastinal staging tool, clinicians should be aware of this rare but highly critical peri-interventional complication in order to closely monitor endangered patients.
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Affiliation(s)
- Marc Hartert
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Michael Wolf
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
| | - Martin Huertgen
- Department of Thoracic Surgery, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany
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3
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Stirpe E, Bardaro F, Köhl J. Unusual lymphadenopathy diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Monaldi Arch Chest Dis 2022; 93. [PMID: 35608519 DOI: 10.4081/monaldi.2022.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 01/21/2023] Open
Abstract
Oxidized cellulose, used as hemostatic in thoracic surgery, may cause in some cases foreign body reactions, and simulate other diseases. We report the case of a 39-year-old man operated on a middle lobe lobectomy for atypical carcinoid. The follow up chest-CT showed enlarged mediastinal lymph nodes, so endobronchial ultrasound-guided transbronchial needle aspiration was performed suspecting recurrence of the tumor. The cytology results showed amorphous fragments such as foreign body reaction secondary to Pahacel®, used as hemostatic during the surgery. A few days later, the patient was re-operated on suspicion of mediastinitis induced by the endoscopic procedure. The aim of this case is to consider the foreign body reaction to Pahacel®, in patients with postoperative thoracic lymphadenopathy. It is also important to remember that in these patients the endoscopic procedures allow the diagnosis but may cause mediastinitis.
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Affiliation(s)
| | | | - Johanna Köhl
- Department of Respiratory Diseases, Bolzano Hospital.
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4
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Koh JS, Kim YJ, Kang DH, Lee JE, Lee SI. Severe mediastinitis and pericarditis after endobronchial ultrasound-guided transbronchial needle aspiration: A case report. World J Clin Cases 2021; 9:10723-10727. [PMID: 35005007 PMCID: PMC8686124 DOI: 10.12998/wjcc.v9.i34.10723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/07/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive diagnostic tool for mediastinal and hilum evaluation. However, infectious complications may occur after EBUS-TBNA. Among these, mediastinitis and pericarditis are rare.
CASE SUMMARY A 67-year-old woman was referred to our hospital due to paratracheal lymph node enlargement on chest computed tomography (CT). EBUS-TBNA was performed on the lymph node lesions, and prophylactic oral antibiotics were administered. Seven days after EBUS-TBNA, the patient visited the emergency room with a high fever and chest pain. Laboratory test results revealed leukocytosis with a left shift and elevated C-reactive protein level (25.7 mg/dL). Chest CT revealed the formation of a mediastinal abscess in the right paratracheal lymph node and pericardial and bilateral pleural effusions. The patient received intravenous antibiotic treatment, cardiac drainage through pericardiocentesis, and surgical management. The patient recovered favorably and was discharged 31 d after the operation.
CONCLUSION Mediastinitis and pericarditis after EBUS-TBNA are rare but should be considered even after the use of prophylactic antibiotics.
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Affiliation(s)
- Jeong Suk Koh
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Yoon Joo Kim
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Da Hyun Kang
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Jeong Eun Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
| | - Song-I Lee
- Department of Pulmonary and Critical Care Medicine, Chungnam National University Hospital, Daejeon 35015, South Korea
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Hashimoto T, Ando M, Watanabe E, Kadota JI. Mediastinal cyst infection followed by bacteremia due to Streptococcus anginosus after endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Med 2020; 15:95-97. [PMID: 32489445 PMCID: PMC7259389 DOI: 10.4103/atm.atm_42_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022] Open
Abstract
We herein report a case of recurrent mediastinal cyst infection followed by bacteremia after endobronchial ultrasound-guide transbronchial needle aspiration (EBUS-TBNA). A 65-year-old Japanese male with sarcoidosis presented with 4 L progressive lymph node adenopathy and was diagnosed with mediastinal cyst by EBUS-TBNA. After bronchoscopy, he suffered from a high fever. Chest computed tomography showed enlargement of the 4 L lymph node with low attenuation areas, the elevation of mediastinal fat concentration. Blood cultures were positive for Streptococcus anginosus. Antimicrobial agents were administered for a total of 12 weeks, at which point the size of the lymph node was reduced. However, at 5 months after the discontinuation of antimicrobial agents, the mediastinal cyst infection recurred. It is important to conduct careful follow-up because mediastinal cyst infection following ebus-tbna may relapse with conservative treatment without invasive surgery.
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Affiliation(s)
- Takehiko Hashimoto
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, Japan
| | - Masaru Ando
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, Japan
| | - Erina Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, Japan
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Faculty of Medicine, Oita University, Oita, Japan
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Kurokawa K, Asao T, Ko R, Nagaoka T, Suzuki K, Takahashi K. Severe mediastinitis over a month after endobronchial ultrasound-guided transbronchial needle aspiration. Respirol Case Rep 2019; 7:e00426. [PMID: 31007930 PMCID: PMC6454807 DOI: 10.1002/rcr2.426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Abstract
Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to be a minimally invasive and relatively safe procedure, mediastinitis is a serious complication related to the procedure. The median time of mediastinitis onset is approximately 12 days after EBUS-TBNA. Here we report two rare cases with mediastinitis onset 40 and 53 days after EBUS-TBNA. Surgical drainage was performed since systemic treatment with antibiotics was insufficient in both cases. Eikenella corrodens, which is a slow-growing microorganism, was identified as the causative pathogen in one case. To our knowledge, this is the first report of mediastinitis occurring over a month after EBUS-TBNA. Clinicians should consider the diagnosis of mediastinitis even if symptoms appear over a month after EBUS-TBNA.
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Affiliation(s)
- Kana Kurokawa
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Tetsuhiko Asao
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Ryo Ko
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Tetsutaro Nagaoka
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Kenji Suzuki
- Department of General Thoracic SurgeryJuntendo University School of MedicineTokyoJapan
| | - Kazuhisa Takahashi
- Department of Respiratory MedicineJuntendo University Graduate School of MedicineTokyoJapan
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7
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Nakagomi T, Hirotsu Y, Goto T, Shikata D, Yokoyama Y, Higuchi R, Otake S, Amemiya K, Oyama T, Mochizuki H, Omata M. Clinical Implications of Noncoding Indels in the Surfactant-Encoding Genes in Lung Cancer. Cancers (Basel) 2019; 11:cancers11040552. [PMID: 30999697 PMCID: PMC6520783 DOI: 10.3390/cancers11040552] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 02/06/2023] Open
Abstract
Lung cancer arises from the accumulation of genetic mutations, usually in exons. A recent study identified indel mutations in the noncoding region of surfactant-encoding genes in lung adenocarcinoma cases. In this study, we recruited 94 patients with 113 lung cancers (88 adenocarcinomas, 16 squamous cell carcinomas, and nine other histologies) who had undergone surgery in our department. A cancer panel was designed in-house for analyzing the noncoding regions, and targeted sequencing was performed. Indels in the noncoding region of surfactant-encoding genes were identified in 29/113 (25.7%) cases and represent the precise cell of origin for the lung cancer, irrespective of histological type and/or disease stage. In clinical practice, these indels may be used as clonal markers in patients with multiple cancers and to determine the origin of cancer of unknown primary site.
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Affiliation(s)
- Takahiro Nakagomi
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan.
| | - Yosuke Hirotsu
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
- Department of Surgery, School of Medicine, Keio University, Tokyo 160-8582, Japan.
| | - Daichi Shikata
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Yujiro Yokoyama
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Rumi Higuchi
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Sotaro Otake
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Kenji Amemiya
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Toshio Oyama
- Department of Pathology, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Hitoshi Mochizuki
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
| | - Masao Omata
- Genome Analysis Center, Yamanashi Central Hospital, Yamanashi 400-8506, Japan.
- Department of Gastroenterology, The University of Tokyo Hospital, Tokyo 113-8655, Japan.
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Propionibacterium acnes Causing Mediastinal Infection following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration. Case Rep Med 2019; 2019:3920868. [PMID: 31089327 PMCID: PMC6476028 DOI: 10.1155/2019/3920868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is now a standard of care to sample mediastinal lymph nodes and masses with high diagnostic accuracy and low complication rates. However, the procedure has potential complications that might be life-threatening. Here, we present the first case of Propionobacterium acnes (P. acnes) causing mediastinitis following EBUS-TBNA of a subcarinal lymph node.
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Shimada S, Furusawa H, Ishikawa T, Kamakura E, Suzuki T, Watanabe Y, Fujiwara T, Tominaga S, Komatsuzaki KM, Natsume I. Development of mediastinal adenitis six weeks after endobronchial ultrasound-guided transbronchial needle aspiration. Respir Med Case Rep 2018; 25:161-164. [PMID: 30175038 PMCID: PMC6115609 DOI: 10.1016/j.rmcr.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022] Open
Abstract
A 60-year-old man visited our hospital for further examination of an abnormal chest radiograph. Computed tomography (CT) images revealed enlarged mediastinal lymph nodes and multiple pulmonary nodules. Further evaluation by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed and he was diagnosed with sarcoidosis. Six weeks after EBUS-TBNA, he presented to the emergency department with a high-grade fever. CT scan revealed an enlarged mediastinal lymph node. He was diagnosed with mediastinal adenitis and treated successfully with antibiotics. EBUS-TBNA is a highly accurate diagnostic tool, but clinicians should be aware of mediastinal infectious complication that could be asymptomatic for long period of time.
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Affiliation(s)
- Sho Shimada
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan.,Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Haruhiko Furusawa
- Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Toshihisa Ishikawa
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Eisaku Kamakura
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Takafumi Suzuki
- Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Yuta Watanabe
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Takasato Fujiwara
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Shinichiro Tominaga
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Keiko Mitaka Komatsuzaki
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Ichiro Natsume
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama dori, Yokosuka, Kanagawa, 238-8558, Japan
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Dai JH, Chen LL, Li H, Miao LY, Li R, Gao L, Meng FQ, Cai HR. Severe Mediastinal Abscess after Endobronchial Ultrasound with Transbronchial Needle Aspiration. Chin Med J (Engl) 2018; 131:357-358. [PMID: 29363654 PMCID: PMC5798060 DOI: 10.4103/0366-6999.223848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jing-Hong Dai
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Lu-Lu Chen
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Hui Li
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Li-Yun Miao
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Rui Li
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Li Gao
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Fan-Qing Meng
- Department of Pathology, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
| | - Hou-Rong Cai
- Department of Respiratory Medicine, Nanjing Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, Jiangsu 210008, China
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