Endotracheal Tuberculous Granuloma Formation Following Endobronchial Ultrasound Transbronchial Needle Aspiration

Abstract

Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) is a useful and safe diagnostic test. We herein report a case of endotracheal granuloma formation that occurred after EBUS-TBNA in a 73-year-old woman. The patient was admitted due to coughing and dyspnea after 70 days of antituberculous therapy for mediastinal lymphadenitis. Computed tomography revealed decreases in the size of the lymph nodes with a new mass protruding into the tracheal lumen. The mass originated from the right paratracheal area, which was a previous puncture site. This case suggests that clinicians should pay attention to complications because tuberculosis can produce new granulomas via the sinus tract after EBUS-TBNA.

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

“…Three cases of airway tuberculous granulomas (one endotracheal and two endobronchial) have been reported post‐EBUS‐TBNA sampling of tuberculous mediastinal lymphadenopathy . The clinical presentation leading to diagnosis was cough and dyspnoea 2 months after the procedure and in one patient the lesion was revealed on a follow‐up CT scan of the thorax . In all patients, the lymph node station 4R was sampled and the complications were diagnosed 2 months post‐procedure .…”

“…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…”

“…27,35 The clinical presentation leading to diagnosis was cough and dyspnoea 2 months after the procedure and in one patient the lesion was revealed on a followup CT scan of the thorax. 27,28,35 In all patients, the lymph node station 4R was sampled and the complications were diagnosed 2 months post-procedure. 27,28,35 The endotracheal granuloma was removed with rigid bronchoscopy and argon plasma coagulation.…”

“…27,28,35 In all patients, the lymph node station 4R was sampled and the complications were diagnosed 2 months post-procedure. 27,28,35 The endotracheal granuloma was removed with rigid bronchoscopy and argon plasma coagulation. 28 One endobronchial granuloma was debulked piecemeal with the biopsy forceps and the other was treated conservatively with inhaled corticosteroids.…”

New-Onset Malignant Pleural Effusion after Abscess Formation of a Subcarinal Lymph Node Associated with Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

“…EBUS-TBNA is an accurate and minimally invasive technique for evaluating mediastinal lesions; however, serious complications have been reported occasionally due to its increased use4,6,7. Reported infectious complications include mediastinitis, pneumonia, pericarditis, cyst infection and sepsis, with a 0.19% incidence.…”