Endotracheal tuberculous granuloma formation following endobronchial ultrasound transbronchial needle aspiration

Airway stenosis complicated by endobronchial ultrasound-guided tissue acquisition: A case report

Endobronchial ultrasound (EBUS)‐guided tissue acquisition (TA) performed by transbronchial needle aspiration (TBNA) is the main diagnostic procedure in mediastinal and hilar lymph node (LN) biopsy. EBUS‐guided intranodal forceps biopsy (EBUS‐IFB) and EBUS‐guided cryobiopsy can achieve higher diagnostic yield of lymphomas, uncommon tumors, and benign diseases. However, these techniques require the creation of a tract to insert biopsy devices, which may result in critical complications. Here, we report a rare case of airway stenosis (AS) that occurred after EBUS‐TA for mediastinal LN biopsy. An 80‐year‐old man had multiple pulmonary nodules and an enlarged mediastinal LN. EBUS‐TBNA and EBUS‐IFB were performed for histological diagnosis. Cutaneous adnexal carcinoma (CAC) was diagnosed. The patient underwent chemotherapy. Four months later, he was hospitalized for AS due to a tracheal tumor with dyspnea. Chest computed tomography and bronchoscopy revealed that the tracheal tumor was caused by invasion from the biopsied LN into the tracheal lumen by tract seeding (TS) caused by EBUS‐TA. Cryotherapy was performed. The tracheal tumor was pathologically consistent with CAC and is currently under control with radiotherapy. TS‐associated EBUS‐TA is rare but may increase in frequency with aggressive tissue sampling techniques. Bronchoscopists should perform EBUS‐TA with awareness of the potentially serious complications.

Tracheobronchial puncture-site nodular reaction (TPNR) following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA): Systematic review of case reports

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and efficacious diagnostic modality for lung cancer staging and evaluation of undiagnosed mediastinal lymphadenopathy. Procedure-related complications are uncommon. We herein report an infrequently described phenomenon following EBUS-TBNA in which two patients developed nodular granulation tissue at the tracheobronchial puncture site. On systematic review, we found description of such phenomena by terminologies such as endobronchial inflammatory polyp, granuloma, and endobronchial mass. The endobronchial inflammatory polyp has been one of the most commonly used terminologies for these; but in most cases, the classical features of an inflammatory polyp are lacking. We propose the term, tracheobronchial puncture-site nodular reaction (TPNR) with further classification into granulomatous and nongranulomatous subtypes, for standardized reporting of such reactions following transbronchial needle aspiration procedures. Knowledge of this entity and standardized nomenclature shall help in better characterization of the outcomes and risk factors for the occurrence of these reactions.

Endobronchial mass formation after endobronchial ultrasound-transbronchial needle aspiration mimicking implantation metastasis

Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has been widely used for diagnosing intrathoracic lymphadenopathy. Here, we present two cases of endobronchial polyp formation after an EBUS‐TBNA for suspicious malignant lymph nodes. An inflammatory polyp should be considered as a possible differential diagnosis for a newly developed mass after an EBUS‐TBNA.

New-onset malignant pleural effusion after abscess formation of a subcarinal lymph node associated with endobronchial ultrasound-guided transbronchial needle aspiration

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.