Localized Subcarinal Adenitis following Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure for the diagnosis of mediastinal lymph nodes and masses. Its complications are rare and include hemorrhage, pneumothorax and infections such as mediastinitis. We report the case of a 51-year-old patient who presented with a localized subcarinal adenitis after EBUS-TBNA. Germs colonizing the oropharynx may have been dragged along by the echobronchoscope, inoculating the punctured mediastinal lymph node.

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

“…Lymphadenitis was defined as fever >38.5°C and feeling unwell 24–48 h post‐EBUS‐TBNA procedure, with an absence of new infiltrates on chest radiograph, requiring broad spectrum antibiotic therapy . Another localized lymphadenitis of the subcarinal lymph node has been reported . The Turkish survey reported fever lasting more than 24 h after EBUS‐TBNA with negative culture growth in blood, urine and sputum for one patient .…”

“…10 Another localized lymphadenitis of the subcarinal lymph node has been reported. 22 The Turkish survey reported fever lasting more than 24 h after EBUS-TBNA with negative culture growth in blood, urine and sputum for one patient. 7 One patient manifesting a triad of empyema, lung abscess and mediastinal abscess due to Streptococcus viridans was attributed to EBUS-TBNA 2 months post-procedure.…”

Severe mediastinitis over a month after endobronchial ultrasound‐guided transbronchial needle aspiration

“…Some of these complications can be serious, with mediastinitis presenting as an important acute or sub-acute complication requiring precise diagnosis and treatment [4][5][6]. The median time of mediastinitis onset after EBUS-TBNA, estimated by these previous reports, was 12.5 days (interquartile range: 2.75-14.5 days) [4,[7][8][9][10][11][12][13]. Here we describe two rare cases in which severe mediastinitis occurred over a month after EBUS-TBNA.…”

“…We searched the PubMed database for reported cases of mediastinitis after EBUS-TBNA and retrieved a total of 13 cases [4,[7][8][9][10][11][12][13]. In addition to the two cases reported here, the patient characteristics, clinical courses, pathogens, and treatments for these 13 cases and a case treated at our hospital are shown in Table 1 (n = 16).…”

“…In addition to the two cases reported here, the patient characteristics, clinical courses, pathogens, and treatments for these 13 cases and a case treated at our hospital are shown in Table 1 (n = 16). The median time of mediastinitis onset after EBUS-TBNA, estimated by these previous reports, was 12.5 days (interquartile range: 2.75-14.5 days) [4,[7][8][9][10][11][12][13]. The most common pathogens were Streptococcus spp.…”