Loading...
Please wait, while we are loading the content...
Similar Documents
Pyopericardium and extensive mediastinal abscess following EBUS-TBNA for mediastinal staging of NSCLC: a case report.
| Content Provider | Europe PMC |
|---|---|
| Author | Hartert, Marc Wolf, Michael Huertgen, Martin |
| Copyright Year | 2023 |
| Abstract | BackgroundBased 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 DescriptionA 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.ConclusionsIt 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. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC10011863&blobtype=pdf |
| Journal | Mediastinum |
| Volume Number | 7 |
| DOI | 10.21037/med-22-13 |
| PubMed Central reference number | PMC10011863 |
| PubMed reference number | 36926285 |
| e-ISSN | 25226711 |
| Language | English |
| Publisher | AME Publishing Company |
| Publisher Date | 2022-10-28 |
| Access Restriction | Open |
| Rights License | Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0. 2023 Mediastinum. All rights reserved. |
| Subject Keyword | Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) mediastinitis pyopericardium mediastinal lymph nodes case report |
| Content Type | Text |
| Resource Type | Article |
| Subject | Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine Endocrinology, Diabetes and Metabolism Pulmonary and Respiratory Medicine Medicine Oncology |
