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Gross DJ, Briski LM, Wherley EM, Nguyen DM. Bronchogenic cysts: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2023; 7:26. [PMID: 37701638 PMCID: PMC10493618 DOI: 10.21037/med-22-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/07/2023] [Indexed: 09/14/2023]
Abstract
Background and Objective Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed to the thoracic cavity if arising later in development. However, they can arise from any site along the foregut. They exhibit a variety of clinical and radiologic presentations, representing a diagnostic challenge, especially in areas with endemic hydatid disease. Endoscopic drainage has emerged as a diagnostic and potentially therapeutic option but has been complicated by reports of infection. Surgical excision remains the standard of care allowing for symptomatic resolution and definitive diagnosis via pathologic examination; minimally invasive approaches such as robotic and thoracoscopic approaches aiding treatment. Following complete resection, prognosis is excellent with essentially no recurrence. Methods A review of the available electronic literature was performed from 1975 through 2022, using PubMed and Google Scholar, with an emphasis on more recent series. We included all retrospective series and case reports. A single author identified the studies, and all authors reviewed the selection until there was a consensus on which studies to include. Key Content and Findings The literature consisted of relatively small series, mixed between adult and pediatric patients, and the consensus remains that all symptomatic lesions should be excised via minimally invasive approach where feasible. Conclusions Surgical excision of symptomatic bronchogenic cysts remains the gold standard, with endoscopic drainage being reserved for diagnosis or as a temporizing measure in clinically unstable patients.
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Affiliation(s)
- Daniel J. Gross
- Thoracic Surgery Section, Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Eric M. Wherley
- Thoracic Surgery Section, Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Dao M. Nguyen
- Thoracic Surgery Section, Division of Cardiothoracic Surgery, The DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
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Serra Mitjà P, Gonçalves Dos Santos Carvalho F, Garcia Olivé I, Sanz Santos J, Jiménez López J, Núñez Ares A, Tomás López L, Centeno Clemente C, Tazi R, Castellà E, Abad Capa J, Rosell Gratacós A, Andreo Garcia F. Incidence and Risk Factors for Infectious Complications of EBUS-TBNA: Prospective Multicenter Study. Arch Bronconeumol 2023; 59:84-89. [PMID: 36446657 DOI: 10.1016/j.arbres.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/29/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022]
Abstract
The aim of our study was to describe the incidence of infectious complications of endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and to analyze the potential risk factors in a prospective cohort of patients. METHODS We conducted a prospective multicenter study, with all consecutive patients referred for an EBUS-TBNA with patients at risk of developing an infectious complication (considering>10 nodal samplings, known immunosuppression, bronchial colonization and cavitated or necrotic lesions) and a second group without any risk factor. RESULTS Three hundred seventy patients were included: 245 with risk factors and 125 without risk factors (as the control group). Overall, 15 patients (4.05%) presented an acute infectious complication: fourteen in cases (5.7%) and 1 in controls (0.8%). Of these, 4 patients presented pneumonia, 1 mediastinitis, 4 obstructive pneumonitis and 6 mild complications (respiratory tract infection that resolved with antibiotic). Also 7 (1.9%) patients had self-limited fever. One-month follow-up showed 1 mediastinitis at sixteenth day post-EBUS, which required surgical treatment, and 3 pneumonias and 3 respiratory tract infections at nineteenth day (1.9%). All patients had a good evolution and there were no deaths related with infectious complication. We observed an increased risk of complication in patients with risk factors and in patients with necrosis (p=0.018). CONCLUSIONS The incidence of infectious complications in a subgroup of patients with risk factors was higher than in patients without risk factors. Nevertheless, it remains low, and no fatal complication occurred, which reinforces the idea that EBUS-TBNA is a safe technique for the assessment of the mediastinum. Necrotic lesions are a risk factor of post-EBUS infection, and their puncture should be avoided.
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Affiliation(s)
- Pere Serra Mitjà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain.
| | | | - Ignasi Garcia Olivé
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | | | | | | | | | - Carmen Centeno Clemente
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | - Rachid Tazi
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain
| | - Eva Castellà
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jorge Abad Capa
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
| | - Antoni Rosell Gratacós
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
| | - Felipe Andreo Garcia
- Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Institut Investigació Germans Trias i Pujol, IGTP, Spain; Universitat Autònoma de Barcelona, UAB, Spain
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Marcuse F, Rutten M, Schreurs R, Gietema HA, Theunissen P, Maessen JG. Symptomatic mediastinal mass in a 32-year-old male. Breathe (Sheff) 2021; 17:210029. [PMID: 34295427 PMCID: PMC8291925 DOI: 10.1183/20734735.0029-2021] [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: 02/12/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022] Open
Abstract
A 32-year-old male, known to have atopic eczema, presented with a 3-day history of acute pleuritic chest pain and shortness of breath. No traumatic event had occurred. The pain was described as sharp and posture dependent, and was worse when leaning backwards. The patient had no palpitations, oedema or radiated pain. Dyspnoea was present both at rest and during exercise, without the presence of wheezing, haemoptysis or purulent sputum. He had no history of fever, cold shivers, weight loss or perspiration. His nutritional state was normal and he had no symptoms of nausea, vomiting or diarrhoea. For 3 days he had experienced dysphagia during meals. The patient was working full-time as a national courier and did not visit foreign countries for his work and did not travel outside Europe. The patient owned a dog but he had no specific contact with (farm) animals. He never smoked and never consumed alcohol. His physical condition, before the start of the present symptoms, was excellent due to daily exercises. On clinical examination our patient was conscious and orientated. He had a normal temperature of 36.9 °C, a respiratory rate of 16 breaths·min−1, blood pressure of 115/75 mmHg, heart rate of 68 beats·min−1 and an oxygen saturation of 95% on room air. Both percussion and respiratory sounds were reduced over the right hemithorax, without crackles or rhonchi. He had no pitting oedema around the ankles. A chest radiograph was performed (figure 1). Most bronchogenic cysts are found incidentally and clinicians should be aware of an atypical case presentation. Total surgical resection is the treatment of choice of a bronchogenic cyst, especially in symptomatic patients.https://bit.ly/3uQrFXo
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Affiliation(s)
- Florit Marcuse
- Dept of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marijke Rutten
- Dept of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rick Schreurs
- Dept of Cardiothoracic surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hester A Gietema
- Dept of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Prisca Theunissen
- Dept of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Dept of Cardiothoracic surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
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Role of Interventional Pulmonology in Miscellaneous Conditions. Respir Med 2021. [DOI: 10.1007/978-3-030-80298-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lat T, Hayek SA, Sikka P, Bhat U. Infected Bronchogenic Cyst With Left Atrial, Pulmonary Artery, and Esophageal Compression. Fed Pract 2020; 37:190-193. [PMID: 32322151 PMCID: PMC7173636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ultrasound-guided transbronchial needle aspiration was used successfully for both diagnosis and treatment of a rare bronchogenic cyst caused by an Actinomyces infection that was compressing mediastinal structures.
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Affiliation(s)
- Tasnim Lat
- is a Pulmonary/Critical Care Fellow, is Associate Chief of Staff of Education, and is Chief of the Division of Pulmonary/Critical Care, all at Central Texas Veterans Health Care System in Temple Texas. is a Staff Physician at the Baylor University Medical Center in Dallas, Texas. Tasnim Lat is a Pulmonary/Critical Care Fellow, Pawan Sikka previously was a Pulmonary/Critical Care Fellow, and Udaya Bhat is Associate Program Director for the Pulmonary/Critical Care Fellowship at Baylor Scott and White in Temple
| | - Sgt Adam Hayek
- is a Pulmonary/Critical Care Fellow, is Associate Chief of Staff of Education, and is Chief of the Division of Pulmonary/Critical Care, all at Central Texas Veterans Health Care System in Temple Texas. is a Staff Physician at the Baylor University Medical Center in Dallas, Texas. Tasnim Lat is a Pulmonary/Critical Care Fellow, Pawan Sikka previously was a Pulmonary/Critical Care Fellow, and Udaya Bhat is Associate Program Director for the Pulmonary/Critical Care Fellowship at Baylor Scott and White in Temple
| | - Pawan Sikka
- is a Pulmonary/Critical Care Fellow, is Associate Chief of Staff of Education, and is Chief of the Division of Pulmonary/Critical Care, all at Central Texas Veterans Health Care System in Temple Texas. is a Staff Physician at the Baylor University Medical Center in Dallas, Texas. Tasnim Lat is a Pulmonary/Critical Care Fellow, Pawan Sikka previously was a Pulmonary/Critical Care Fellow, and Udaya Bhat is Associate Program Director for the Pulmonary/Critical Care Fellowship at Baylor Scott and White in Temple
| | - Udaya Bhat
- is a Pulmonary/Critical Care Fellow, is Associate Chief of Staff of Education, and is Chief of the Division of Pulmonary/Critical Care, all at Central Texas Veterans Health Care System in Temple Texas. is a Staff Physician at the Baylor University Medical Center in Dallas, Texas. Tasnim Lat is a Pulmonary/Critical Care Fellow, Pawan Sikka previously was a Pulmonary/Critical Care Fellow, and Udaya Bhat is Associate Program Director for the Pulmonary/Critical Care Fellowship at Baylor Scott and White in Temple
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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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Mediastinitis Following Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. J Bronchology Interv Pulmonol 2018; 24:323-329. [PMID: 28195963 DOI: 10.1097/lbr.0000000000000370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mediastinitis is a rare complication of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Recent reports of infectious complications following EBUS-TBNA involved oropharyngeal bacteria. Here, we report 2 unusual cases of post-EBUS-TBNA mediastinitis involving Streptococcus pneumoniae and Pseudomonas aeruginosa, which were likely the result of direct inoculation of the organisms at the time of transbronchial needle aspiration. The first case was successfully treated with computed tomography-guided drainage and antibiotics, whereas the second case had >50% distal tracheal obstruction and near total occlusion of the left main stem bronchus, requiring rigid bronchoscopy, stent placement, debulking, and antibiotics. Review of literature suggests that the isolated pathogens are rare in this setting and are most likely not related to oropharyngeal contamination during bronchoscope insertion. Active bronchitis should be considered an additional risk factor for EBUS-TBNA-induced mediastinitis. We suggest possible methods to decrease the risk of this serious postprocedure complication. It is important to be vigilant about the possibility of mediastinitis in patients that undergo EBUS-TBNA. Fever and respiratory symptoms should lower the threshold for ordering a computed tomography chest for early detection and management. Our patients did not require thoracic surgery for the management of the mediastinitis.
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Bukamur HS, Alkhankan E, Mezughi HM, Munn NJ, Shweihat YR. The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults. Respir Med Case Rep 2018; 24:46-49. [PMID: 29977757 PMCID: PMC6010617 DOI: 10.1016/j.rmcr.2018.04.002] [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: 03/16/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 11/26/2022] Open
Abstract
Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such an approach and its potential complications and add recommendations based on our experience in managing these anomalies.
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Affiliation(s)
- Hazim S Bukamur
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
| | - Emad Alkhankan
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
| | - Haitem M Mezughi
- Department of Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| | - Nancy J Munn
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
| | - Yousef R Shweihat
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
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A Young Woman With Severe Chest Pain After Undergoing Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for a Large Mediastinal Mass. J Bronchology Interv Pulmonol 2017; 23:236-8. [PMID: 27070336 DOI: 10.1097/lbr.0000000000000224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 33-year-old woman with chest pain and hemoptysis was found to have a large mediastinal mass. As the radiology imagings were inconclusive, she underwent diagnostic endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). After the procedure she developed mediastinitis, which required video-assisted thoracoscopic surgery excision and intravenous antibiotics. Bronchogenic cysts are rare congenital anomalies. Traditionally, surgical resection has been recommended as the first-line treatment option for both symptomatic and asymptomatic bronchogenic cysts due to concerns of late complications, including malignant transformation. Recently, there have been a number of case reports of bronchogenic cysts been diagnosed and treated successfully using EBUS-TBNA. We present a case in which EBUS-TBNA was performed for a definitive diagnosis of cystic lesion in the mediastinum.
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Efficacy and Safety of Transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol 2016; 22:195-203. [PMID: 26165889 DOI: 10.1097/lbr.0000000000000174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although surgical resection of mediastinal bronchogenic cysts is considered the treatment of choice, there is increasing interest in minimally invasive approaches of management. The purpose of this study was to review the literature on the role of transbronchial needle aspiration (TBNA), either conventional or endobronchial ultrasound (EBUS)-guided, in the diagnosis and management of bronchogenic cysts. METHODS We systematically searched the PubMed and EmBase databases for studies (until July 2014) reporting TBNA of bronchogenic cysts. Data were recorded on a standard data extraction form and is presented in a descriptive manner. RESULTS Our search yielded 26 studies (32 patients). The median age of the patients was 43 years. Most were men (n=15), symptomatic at presentation (n=19), and had cysts in the paratracheal location (n=14). Endosonography was performed on 16 patients. The EBUS appearance of the lesion was hypoechoic and anechoic in 11 and 5 patients, respectively. Thirty-one patients underwent TBNA (conventional: 16; EBUS-guided: 15). The intent of TBNA was therapeutic in 19 patients and diagnostic or symptomatic palliation in the others. Complications were reported in 5 (16.1%) patients [infective (n=4), bradycardia (n=1)] after TBNA; there were no deaths. The median duration of follow-up was 14 months and no recurrences were detected during the follow-up period. CONCLUSIONS Bronchoscopy is a useful tool in the diagnosis of bronchogenic cysts, both for confirmation of the cystic nature of the lesion by EBUS and diagnosis by TBNA (preferably EBUS-guided) of the cyst fluid. Therapeutic aspiration of the cyst may be an alternative to surgery in adults with mediastinal bronchogenic cysts.
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