A Case report on the Diagnosis of a Rare Pleural Tumor With Endobronchial Ultrasound

Abstract

Convex endobronchial ultrasound (C-EBUS)–guided transbronchial needle aspiration (TBNA) is an effective tool for the diagnosis of hilar, mediastinal, and central parenchymal lung lesions. However, it has a limited utility for pleural-based masses. We report a unique case of a pleural synovial sarcoma recurrence that was diagnosed by C-EBUS.The patient had a history of inguinal synovial sarcoma. He presented with cough and chest pain. Imaging of chest revealed large right pleural mass. Bronchoscopy with EBUS-TBNA diagnosed pleural recurrence of synovial sarcoma. He underwent radical resection and pathological examination confirmed the diagnosis of pleural synovial sarcoma. He experienced complete recovery and resolution of symptoms.Synovial sarcoma should be included in the differential diagnosis of pleural masses. Convex EBUS-guided biopsies can provide adequate diagnosis of large pleural tumors adjacent to the central airways without need for more invasive diagnostic procedures.

When Less Is More: EBUS-TBNA for the Diagnosis of Pleural Lesions

“…There are few reports in the literature about the use of EBUS-TBNA as the first-choice approach to pleural lesions, 2,6,7 the common link between those cases being the presence of paratracheal pleural thickenings or nodules, an easy to reach and therefore suitable location for this technique. EBUS-TBNA is safe, effective and has a low complication rate.…”

A case report of an expensive yet necessary thoracentesis

“…[5] The reach of the EBUS scope has even extended beyond these structures and cases of pleural lesion biopsies and transvascular biopsies have been described. [2,3,4] The applications of this scope are not; however, limited to a bronchial approach, and the EBUS scope has been used via the esophagus for the diagnosis of nodal and non-nodal thoracic abnormalities. It is particularly effective for left para-aortic, para-esophageal, and sometimes aortopulmonary window lymph node stations.…”

“…Since its introduction in 2004, endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) has become one of the most important tools available to chest physicians for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. [1] The reach of this technique is not limited to these structures, and cases of pleural lesion biopsies and transvascular biopsies have been reported [2,3,4] To our knowledge, pleural fluid collections has not been accessed with EBUS. We present a case of a loculated fluid collection that was suspected to cause fever and dyspnea and was not amenable to traditional thoracentesis, but was successfully sampled and drained using the EBUS scope via the esophagus.…”

Sampling pleural nodules with an EBUS scope: A novel application

“…This is due to the thickness of the C-EBUS scope which precludes its' ability to reach the lung periphery. As such, only the pleura in the vicinity of the large airways are accessible [ 5 , 6 , 12 , 14 ].…”

“…Successful sampling of pleural lesions via EBUS is described only for central pleural lesions with close proximity to the mediastinum and central air ways, and not for peripheral lesions [ [4] , [5] , [6] ].…”