Mediastinitis and pericarditis after endobronchial ultrasound‐guided transbronchial needle aspiration

Abstract

A 73-year-old man was admitted to our hospital for further investigation of multiple lung nodules and lymphadenopathy that were observed on chest radiography. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed to sample the lower paratracheal lymph node (4R), leading to a definitive diagnosis of squamous cell carcinoma of the lung. About 2 weeks after EBUS-TBNA, the patient had a high temperature, anterior chest pain, tachycardia, and hypotension. The diagnosis of infectious mediastinitis and pericarditis as complications of EBUS-TBNA, which were successfully treated with systemic antibiotics, was made after examinations. EBUS-TBNA is minimally invasive and useful for the diagnosis of hilar and mediastinum lesions particularly in determining the extent of lung cancer. With the increased employment of this method, critical complications may also increase. Clinicians should be aware of the rare but critical complications associated with EBUS-TBNA.

Incidence of Fever Following Endobronchial Ultrasound–Guided Transbronchial Needle Aspiration

“…Similarly, a recent study in Turkey showed an infectious complication rate of 0.16% (fever lasting longer that 24 hours, 0.03%; infection of bronchogenic cyst, 0.03%; mediastinal abscess, 0.03%; pericarditis, 0.03%; pneumomediastinitis with empyema, 0.03%)5. Several cases with infectious complications caused by EBUS-TBNA have been reported678181920212223, and we reviewed fifteen of these. Most patients usually developed fever at 4–10 days after EBUS-TBNA.…”

Endobronchial ultrasound‐guided transbronchial needle aspiration: Safe as it sounds

“…The causative organisms could be isolated in three patients, and were alpha streptococcus, diphtheroids and Klebsiella pneumoniae . Six cases of infective pericarditis post‐EBUS‐TBNA have also been reported . One patient died despite timely therapy and two of these patients were treated with surgical pericardial window .…”

“…Six cases of infective pericarditis post‐EBUS‐TBNA have also been reported . One patient died despite timely therapy and two of these patients were treated with surgical pericardial window . Stather et al .…”

“…Al Qadi and Maldonado 25 2014 Case report Tracheal stenosis 1 12 Jang et al 26 2014 Case report Malignant pleural effusion 1 13 Hata et al 27 2013 Case report Intrabronchial polyp; sputum positive for tuberculosis post-EBUS-TBNA 2 14 Lee et al 28 2013 Case report Endotracheal granuloma 1 15 Miller et al 29 2013 Letter to editor Fatal haemorrhage 1 16 Hong et al 30 2013 Case report Cyst rupture; pneumonia 1 17 Gochi et al 31 2013 Case report Mediastinitis 1 18 Dhillon and Yendamuri 32 2013 Case report Needle assembly malfunction 2 19 Huang et al 33 2011 Case report Mediastinitis, empyema, lung abscess 1 20 Gomez et al 34 2010 Case report Sputum positive for tuberculosis post-EBUS-TBNA 1 21 Gupta et al 35 2010 Case report Endobronchial polyp 1 22…”

“…36,38 Six cases of infective pericarditis post-EBUS-TBNA have also been reported. 17,18,20,39 One patient died despite timely therapy and two of these patients were treated with surgical pericardial window. 17,18,20 Stather et al reported two patients manifesting lymphadenitis following EBUS-TBNA.…”