Infected mediastinal cysts following endobronchial ultrasound guided biopsy—a case series

Abstract

Mediastinal cysts are commonly an incidental finding simulating a benign or malignant diagnosis. Infection is a recognised complication of mediastinal cyst and therefore early surgical management is essential. Endobronchial ultrasound guided biopsy (EBUS) has been used to diagnose and manage mediastinal cyst. We present a case series of three patients who presented with sepsis following diagnostic EBUS of mediastinal cyst. We would recommend that EBUS guided biopsy be applied cautiously if there is a high suspicion of mediastinal cyst to avoid post procedural infection, which can thus complicate any future therapeutic options.

Mediastinal thymic cysts: a narrative review

“…Incorrect diagnosis was especially common with masses less than 3 cm and Hounsfield units greater than 20 on imaging ( 35 ). Tissue sampling before surgical excision should not be undertaken, as biopsy of cysts results are often unrevealing ( 39 , 49 ) and risk bacterial seeding, subsequent sepsis and death ( 41 , 42 , 50 ). Given preoperative diagnostic uncertainty, and overall rarity of this pathology, workup requires a broad differential.…”

“…Endoscopic ultrasound is a newer technology that can potentially aid in diagnosis of thymic cysts ( 56 - 58 ). As previously discussed, caution should be taken with endoscopic aspiration of cyst contents when diagnosis of thymic or mediastinal cyst is suspected, as analysis of fine needle aspiration is usually non-diagnostic 73% of the time, with risk of infection, sepsis, and death ( 41 , 42 , 50 , 58 ).…”