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Salwen B, Frechtling D, Chahine W, Palomino J. Bacterial pericardial effusion secondary to endobronchial ultrasound guided needle aspiration. Respirol Case Rep 2024; 12:e01290. [PMID: 38318116 PMCID: PMC10839624 DOI: 10.1002/rcr2.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely used procedure in lung cancer diagnosis with few serious complications. We present a rare case of pericardial effusion secondary to EBUS-TBNA. An 80-year-old male with interstitial lung disease, developed a pericardial effusion composed exclusively of oropharyngeal flora following EBUS-TBNA. Bacterial pericardial effusion following EBUS-TBNA has only been reported in the literature seven previous times. The majority of these cases reported a biopsy of the 4R lymph node. This case highlights the potential risk of pericardial effusion when sampling lymph nodes, particularly station 4R, in patients with a high-riding superior pericardial recess.
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Affiliation(s)
- Benjamin Salwen
- Department of MedicineTulane University School of MedicineNew OrleansLouisianaUSA
| | - Dan Frechtling
- Department of MedicineTulane University School of MedicineNew OrleansLouisianaUSA
| | - Wadih Chahine
- Department of RadiologyTulane University School of MedicineNew OrleansLouisianaUSA
| | - Jaime Palomino
- Division of Pulmonary, Critical Care and Environmental MedicineTulane University School of MedicineNew OrleansLouisianaUSA
- Department of Pulmonary and Critical Care Medicine, Southeast Louisiana Veterans Healthcare SystemNew OrleansLouisianaUSA
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Alfaiate J, Brito A, Matos AL. EBUS-TBNA-INDUCED PURULENT PERICARDITIS: A RARE COMPLICATION OF A COMMON PROCEDURE. Eur J Case Rep Intern Med 2023; 10:003738. [PMID: 36969517 PMCID: PMC10035615 DOI: 10.12890/2023_003738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 03/29/2023] Open
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic tool used to investigate mediastinal lesions. It has a good safety profile, but there are rare accounts of potentially deadly complications. The present article describes one such complication: pericardial empyema. A 70-year-old man underwent EBUS-TBNA for the differential diagnosis of a pulmonary mass with multiple mediastinal adenopathies. Two weeks after the procedure he developed chest pain, shortness of breath and fever, with rapid progression to hypotension, tachycardia and low peripheral saturation. He was diagnosed with purulent pericarditis with cardiac tamponade. Pericardial drainage and antibiotic therapy were employed with successful recovery from obstructive disease and septic shock. LEARNING POINTS Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a good safety profile and is used to investigate peritracheal and peribronchial lesions, but severe complications have occurred so prophylactic measures should be implemented.Risk factors for infections due to EBUS-TBNA have not been properly established, but the presence of necrotic or cystic lesions and an elevated number of punctures during TBNA seem to be relevant.Although severe complications are rare, awareness of their existence may allow faster diagnosis and, consequently, a better prognosis.
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Affiliation(s)
- Joana Alfaiate
- Serviço Medicina Interna - Centro Hospitalar do Médio Tejo, EPE, Abrantes, Portugal
| | - Andreia Brito
- Serviço Medicina Interna - Centro Hospitalar do Médio Tejo, EPE, Abrantes, Portugal
| | - Ana Luisa Matos
- Serviço Medicina Interna - Centro Hospitalar do Médio Tejo, EPE, Abrantes, Portugal
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Kim NY, Park JH, Park J, Kwak N, Choi SM, Park YS, Lee CH, Cho J. Effect of chlorhexidine Mouthrinse on prevention of microbial contamination during EBUS-TBNA: a randomized controlled trial. BMC Cancer 2022; 22:1334. [PMID: 36539736 PMCID: PMC9764697 DOI: 10.1186/s12885-022-10442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure, fatal infectious complications have been reported. However, adequate preventive strategies have not been determined. We aimed to investigate the effect of chlorhexidine mouthrinse on the prevention of microbial contamination during EBUS-TBNA. METHODS In this single-center, assessor-blinded, parallel-group randomized controlled trial, we randomly assigned adult participants undergoing EBUS-TBNA using a convex probe to gargle for 1 minute with 100 mL of 0.12% chlorhexidine gluconate before EBUS-TBNA or to receive usual care (no chlorhexidine mouthrinse). Aspiration needle wash samples were collected immediately after completion of EBUS-TBNA by instilling sterile saline into the used needle. The primary outcome was colony forming unit (CFU) counts per mL of needle wash samples in aerobic cultures. Secondary outcomes were CFU counts per mL of needle wash samples in anaerobic cultures, fever within 24 hours after EBUS-TBNA, and infectious complications within 4 weeks after EBUS-TBNA. RESULTS From January 2021 to June 2021, 106 patients received either chlorhexidine mouthrinse (n = 51) or usual care (n = 55). The median CFU counts of needle wash samples in aerobic cultures were not significantly different in the two groups (10 CFU/mL vs 20 CFU/mL; P = 0.70). There were no significant differences between the groups regarding secondary outcomes, including median CFU counts in anaerobic cultures (P = 0.41) and fever within 24 hours after EBUS-TBNA (11.8% vs 5.6%, P = 0.31). There were no infectious complications within 4 weeks in both groups. CONCLUSIONS Chlorhexidine mouthrinse did not reduce CFU counts in needle wash samples of EBUS-TBNA. TRIAL REGISTRATION ClinicalTrials.gov, NCT04718922 . Registered on 22/01/2021.
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Affiliation(s)
- Na Young Kim
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hyeon Park
- grid.412484.f0000 0001 0302 820XDepartment of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jimyung Park
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nakwon Kwak
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Sun Mi Choi
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
| | - Young Sik Park
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jaeyoung Cho
- grid.412484.f0000 0001 0302 820XDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea ,grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080 Republic of Korea
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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: 1] [Impact Index Per Article: 0.3] [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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Vallabhaneni S, Kichloo A, Rawan A, Aljadah M, Albosta M, Singh J, Cutitta C. Transbronchial Needle Aspiration Cytology and Purulent Pericarditis. J Investig Med High Impact Case Rep 2021; 8:2324709620951345. [PMID: 32840131 PMCID: PMC7450287 DOI: 10.1177/2324709620951345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endobronchial ultrasound with transbronchial needle aspiration (TBNA) is commonly performed for the evaluation of mediastinal lymphadenopathy. Purulent pericarditis is a rare, yet potentially fatal complication of TBNA. It commonly presents with nonspecific symptoms such as chest pain, shortness of breath, palpitations, or vague abdominal discomfort. Additionally, more severe symptoms such as cardiac tamponade and even death have been reported. In this article, we present the case of a 58-year-old male who developed purulent pericardial effusion with tamponade thought to be caused by TBNA cytology. This case raises an important question regarding the current guidelines for prophylactic antibiotic treatment for patients at high risk of developing purulent pericarditis as a complication of TBNA.
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Affiliation(s)
| | | | - Amir Rawan
- Central Michigan University, Saginaw, MI, USA
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