Introduction Lower respiratory tract anomalies are not commonly encountered in clinical practice, specifically with regards to adult medicine. Bronchogenic cysts, in particular, are rare anomalies that may present as a diagnostic challenge for most clinicians, especially if the patient is asymptomatic. Furthermore, presenting symptoms are often non-specific, and imaging may be misleading. Historically, gold standard for diagnosis requires surgical resection and pathological evaluation. However, there may be a role for bronchoscopy and endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) in the diagnosis and, potentially, treatment of bronchogenic cysts. Case Description The patient was referred to pulmonary for abnormal imaging. A computed tomography scan of the chest revealed a mediastinal mass that was initially concerning for malignancy. After undergoing bronchoscopy with EBUS, it was determined based on ultrasound that the lesion in question was in fact cystic in nature. Furthermore, TBNA of the lesion yielded serous fluid and resulted in shrinkage of the lesion. Discussion There are several peer-reviewed, published case reports detailing the use of bronchoscopy with EBUS-TBNA to aid in diagnosis of bronchogenic cysts. The obvious advantage of this method is potentially avoiding unnecessary surgery. However, there are also case reports detailing potentially fatal adverse events from performing needle aspiration of bronchogenic cysts, the most devastating being mediastinitis. Further data is needed regarding the utility and safety of bronchoscopy with EBUS-TBNA in diagnosing and managing bronchogenic cysts.
Pneumocystis jirovecii is an opportunistic fungus that is classically associated with pneumonia in immunocompromised patients, particularly those with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). However, this infection is now more commonly seen in those with malignancy, particularly lymphoproliferative disorders. Classic image findings with Pneumocystis jirovecii pneumonia (PJP) include bilateral ground-glass opacities with or without cyst formation. Up to 5% of patients with PJP may present with atypical image findings, specifically nodular opacities or masses thought to represent granulomatous inflammation. The differential diagnosis for a new solitary pulmonary nodule in an immunocompromised patient is broad. One must first rule out a recurrence of malignancy or new primary malignancy. In our patient’s case, two nondiagnostic bronchoscopies with EBUS-TBNA eventually led to a surgical resection, which revealed a diagnosis of nodular necrotizing granulomatous Pneumocystis jirovecii. The diagnostic yield from EBUS is not well established, and most cases require surgical biopsy for definitive diagnosis. Further data regarding the use of EBUS-TBNA in diagnosing granulomatous PJP is needed.
With the advent of bronchoscopic lung-volume reduction (BLVR), this minimally invasive technique represents a new and effective way of managing the debilitating symptoms associated with severe centrilobular emphysema. Despite its vast potential in the management of this disease, there are still several potential risk factors associated with the procedure that may predispose the patient to increased morbidity. Our patient received four endobronchial valves in the right-upper lobe (RUL) and right-middle lobe (RML). Although her immediate post-procedure course was uncomplicated, she returned shortly after discharge with a right-sided pneumothorax and right-lower lobar pneumonia with sputum culture growing methicillin-sensitive Staphylococcus aureus (S. aureus). She was managed with tube thoracostomy and two weeks of cefazolin with clinical improvement. Despite the abundance of literature detailing the risk of pneumonia following BLVR, very little data exists discussing common causative organisms, choice of treatment, duration of treatment, and potential risk factors that may predispose these patients to infection.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.