Accidental breakage of needle tip during endobronchial ultrasound-guided transbronchial needle aspiration

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly recommended for the diagnosis of mediastinal lymphadenopathy with malignant and nonmalignant etiology. EBUS-TBNA has been preferred over mediastinoscopy because of several advantages such as comparable diagnostic accuracy, safety, cost-effectiveness, and less invasiveness. Hemorrhage, mediastinitis, pneumonia, mediastinal abscess, empyema, lung abscess, pericarditis, and pneumothorax have been reported as major complications of EBUS-TBNA. Equipment malfunction has been observed mostly in the form of breakage of EBUS scope parts such as working channel, optical fibers, and ultrasound probe. Needle malfunction either involving assembly leading to inability to retract the needle within the sheath or accidental breakage of the needle tip has also been reported but the evidence is still limited. We encountered an accidental breakage of needle tip while performing EBUS-TBNA procedure in a 58-year-old male having subcarinal lymphadenopathy suspected to have lung cancer. We were able to successfully retrieve the broken fragment bronchoscopically without any complications.

Successful Retrieval of a Broken Aspiration Needle Penetrated into the Right Pulmonary Artery: A Case Report with Experience Sharing

“…Patients should also be placed under general anesthesia to avoid coughs that could interfere with needle retrieval. (4) Previous cases of needle fracture reported the possible causes might be inappropriate handling or misassembly of the bronchoscope or needle [4]. When our patient received the EBUS-TBNA at the outside hospital, the bronchoscopist might target the lymph nodes in the mediastinum for biopsy.…”

“…Previous case reports described the accidental needle fracture or malfunction during the EBUS-TBNA [4]. Most broken needles were found at the main bronchus, carina, or surrounding lymph nodes, retrieved under direct visualization on the bronchoscopy [4]. Ozgul et al [6] reported an accidental needle fracture, with the broken needle finally localized in the transverse colon.…”

“…Very rarely, iatrogenic complications, such as equipment failure with needle fracture, were described in case reports [4]. The broken needle was located at the main bronchus, carina, surrounding lymph nodes, or even in the transverse colon [4]. Here, we report a patient with a broken needle during the EBUS-TBNA.…”

“…EBUS-TBNA is a safe procedure with fewer complications, such as bleeding, infection, pneumothorax, and hypoxia [3]. Very rarely, iatrogenic complications, such as equipment failure with needle fracture, were described in case reports [4]. The broken needle was located at the main bronchus, carina, surrounding lymph nodes, or even in the transverse colon [4].…”