A 44-Year-Old Man With Nonproductive Cough and Sensation of Heaviness Over the Upper Chest

Abstract

A 44-year-old man presented with progressively increasing nonproductive cough associated with a sensation of heaviness over the upper chest for 7 months. He had no dyspnea, fever, hemoptysis, chest pain, headache, or weight loss. His clinical examination was unremarkable. Complete blood hemogram, coagulation profile, blood sugar, and results of renal and liver function tests were normal; ECG and spirometry results were also normal. A posteroanterior view on chest radiograph showed a right paratracheal stripe. A contrast-enhanced CT scan of the chest revealed a right paratracheal mass extending to the precarinal area, measuring 33 Â 54 mm with internal hypoattenuation (0 Hounsfield unit) surrounded by an imperceptible wall, associated with narrowing of the superior vena cava (SVC) (Fig 1).Endobronchial ultrasonography (EBUS) was performed in the semi-recumbent position with the BF-UC180F convex probe echo-bronchoscope (Olympus America) via the oral route. The procedure was performed under IV conscious sedation (combination of IV midazolam and fentanyl), augmented with topical anesthesia with 2% lidocaine solution, along with continuous low-flow nasal oxygen and hemodynamic monitoring. Sequential scanning at a frequency of 7.5 MHz along the tracheal wall enabled the identification of an anechoic structure extending along the right paratracheal area, measuring w40 Â 70 mm distally and extending anteriorly over the precarinal area. EBUS-guided transbronchial needle aspiration (EBUS-TBNA) was performed at its most dependent distal end with a 21-gauge EBUS-TBNA needle (ViziShot single-use aspiration needle; Olympus America) (Fig 2, Video 1). Following puncture, suction was applied by using the VacLok negative pressure syringe (Merit Medical Systems) with a suction pressure of 20 cm H 2 O of air (Video 2). A total of 35 mL of clear straw-colored fluid was aspirated (Fig 2).

Mediastinal Bronchogenic Cyst With Superior Vena Cava Syndrome: A Case Report

“…Bronchogenic cysts can manifest at any age but are rare in adults. While 75% of patients remain asymptomatic [ 7 ] and cysts are usually detected incidentally on chest radiographs [ 8 ], significant growth can compress the surrounding structures, including the airways and blood vessels, such as the SVC. This can lead to symptomatic presentations.…”