A case report of an expensive yet necessary thoracentesis

Abstract

Rationale:Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS).Patient concerns:52-year-old women with dyspnea, fever and a new loculated pleural effusion that was suspected to be the source of the fever but was not accessible through traditional thoracentesis.Diagnosis:Malignant pleural effusion.Interventions:Sampling and drainage of the loculated pleural fluid collection using EBUS scope introduced via the esophagus.Outcomes:Infection excluded. Resolution of fever and improved dyspnea after drainage of effusion.Lessons:The convex curvilinear ultrasound bronchoscope allows unprecedented access to thoracic structures. The reach is not limited to mediastinal lymph nodes and parenchymal masses adjacent to the airways, and pleural space and pleural fluid are at times accessible, particularly when one considers the esophageal approach.

A case report on expanding horizon of endobronchial ultrasound through esophagus

“…The EUS-guided diagnostic thoracocentesis is a safe and effective alternative method for evaluating patients with minimal pleural effusion [9]. The EUS combined with EUSguided FNA can be used for the diagnosis of malignant pleural or ascitic fluid in patients with gastrointestinal malignancies and might further extend the staging capabilities of EUS [10].…”

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities

“…In nine cases, the EBUS scope was introduced in the esophagus and was successfully applied to drain pleural effusion, thus providing adequate samples for cytological analysis without significant complications. Similarly, Cocciardi et al drained a loculated pleural effusion not accessible through traditional thoracentesis [93].…”

The evolution of endobronchial ultrasound usage in modern era

“…This procedure yielded sufficient samples for cytological investigation, demonstrating its efficacy without notable problems ( 51 ). Similarly, Cocciardi et al conducted drainage of a loculated pleural effusion that could not be addressed through conventional thoracentesis ( 52 ). Additionally, aspiration of posteriorly loculated pericardial effusion via endobronchial ultrasound-guided approach was described in different case reports ( 53 , 54 ).…”