Rationale: Endo-bronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) has been widely accepted as a safe and efficient technique for diagnosing patients with mediastinal/hilar lymphadenopathy and suspected cases of lung cancer. An effective anesthetic technique should provide comfort and quick recovery of patients while allowing the clinicians to obtain adequate tissue sample. Therefore we combined mask ventilation support (SIMV), BIS monitoring, and short-acting medication to achieve the effect mentioned above. Patient concerns: In this report, both patients had lung mass accompanied by cough that lasted for >2 weeks, and were admitted to hospital for further diagnosis and treatment to clarify the nature of the mass. To make a definite diagnosis, EBUS-TBNA examination was performed under general anesthesia. Both patients had no salient past history. Diagnosis: Case 1 was diagnosed as tumor or pneumonia based on the right lung shadow. Case 2 was diagnosed with squamous cell carcinoma of the right lung with right hilar lymph node metastasis. The diagnostic results of both patients were based on pathological examination of tissues obtained by EBUS-TBNA, of which case 1 required further confirmation by lung biopsy. Intervention: Both the patients received antibiotic treatment before EBUS-TBNA. We used the mask ventilation supported by SIMV mode without using muscle relaxant, thus providing a guarantee for rapid and high-quality recovery of patients. Outcomes: During EBUS-TBNA, the vital signs of the 2 patients were stable. Both patients recovered within 5 minutes after we stopped pumping general anesthetics. None of the patient complained of any discomfort and felt comfortable. No complications occurred during and 3 months after EBUS-TBNA examination. Lessons: The obtained results showed that this anesthesia scheme can provide appropriate depth of anesthesia for patients undergoing EBUS-TBNA examination, while ensuring rapid and high-quality recovery of patients.
Castleman's Disease is a rare lymphoproliferative disorder of idiopathic etio-pathogenesis and was first described by Dr Benjamin Castleman in 1954. It is a rather rare disease entity in clinical practice. However, the incidence cannot be ignored. It may affect a single lymph node (Unicentric CD) or multiple lymph nodes throughout the body (Multicentric CD). Management depends upon the type and severity of the disease and early recognition of the condition. Our case report is that of a 60-year-old female patient with underlying comorbidities including type 2 diabetes mellitus, hypothyroidism who presented with complaints of generalized weakness, weight loss, hair loss, non-resolving muco-purulent rhinorrhea, bilateral pedal edema and multiple, non-tender, firm and mobile left sided Level I and II 'AJCC' cervical lymphadenopathy of >2cm which was later biopsied and diagnosed to be Castleman's disease associated POEMS syndrome. The aim of this report is to consider CD as a differential diagnosis in patients presenting with similar clinical picture and early identification and treatment may provide a better prognosis. We would also like to highlight 3 take home points: 1) The significance of histology in differentiating it from other lymph proliferative conditions. 2) LN excision of the bothersome LN can be diagnostic and may be considered therapeutic to some extend even in MCD. 3) Steroid therapy has beneficial effects to control progression of the disease.
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