Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis and Management of Mediastinal Cyst

Aravena, Carlos; Patel, Jinesh; Goyal, Abha; Jaber, Wissam; Khemasuwan, Danai; Machuzak, Michael; Cicenia, Joseph; Gildea, Thomas R.; Sethi, Sonali; Mehta, Atul C.; Almeida, Francisco A.

doi:10.1097/lbr.0000000000000640

Cited by 9 publications

(20 citation statements)

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“…The accuracy of CT in the diagnosis of mediastinal cysts was reported by Aravena et al to be only 53.8%, [ 11 ] about 43% of cysts could be misdiagnosed as solid mediastinal tumors. [ 11 ] An MRI is also helpful in the diagnosis of mediastinal cysts, and serous fluid has a low T1-weighed signal and high T2-weighted signal images. [ 27 ] For some proteinaceous, hemorrhagic or infected cysts, MRI images are atypical and may show higher T1-weighed signal images.…”

Section: Discussionmentioning

confidence: 99%

“…However, for patients who are unfit or reluctant for surgery, transcutaneous, transesophageal or transbronchial aspiration of the cystic fluid and analysis of its cellular composition can help to identify the origin of the cyst. [ 11 ] The origin of the cyst is determined based on its cell components on the cytology specimen: bronchogenic cyst if bronchial epithelium were present, thoracic duct cyst or lymphangioma if lymphocytes were present, pleural or pericardial cyst if mesothelial cells were present, hydatid cyst if hydatid scolices were present, tuberculosis if acid-fast bacilli were present and cystic neoplasm if malignant cells were present. [ 9 , 11 ] However, the sensitivity of cyst composition analysis to determine the origin of cysts is undesirable, a study by Aravena C [ 11 ] showed that only 27% of cysts were able to identify the origin by an analysis of the cysts composition.…”

Section: Discussionmentioning

confidence: 99%

“…[ 11 ] The origin of the cyst is determined based on its cell components on the cytology specimen: bronchogenic cyst if bronchial epithelium were present, thoracic duct cyst or lymphangioma if lymphocytes were present, pleural or pericardial cyst if mesothelial cells were present, hydatid cyst if hydatid scolices were present, tuberculosis if acid-fast bacilli were present and cystic neoplasm if malignant cells were present. [ 9 , 11 ] However, the sensitivity of cyst composition analysis to determine the origin of cysts is undesirable, a study by Aravena C [ 11 ] showed that only 27% of cysts were able to identify the origin by an analysis of the cysts composition. Nevertheless, from a therapeutic point of view, this does not affect the application of EBUS-TBNA in mediastinal cystic lesions, as patients usually presented with symptoms of compression of adjacent organs by oversized cysts or infection, independent of the cyst origin.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, from a therapeutic point of view, this does not affect the application of EBUS-TBNA in mediastinal cystic lesions, as patients usually presented with symptoms of compression of adjacent organs by oversized cysts or infection, independent of the cyst origin. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 – 3 ] In particular, its application in mediastinal cystic lesions has been reported less frequently, mostly in case reports, [ 4 – 8 ] with only a few cohort studies and systematic review of case reports. [ 9 – 11 ] It shows that EBUS-TBNA is a reassuringly safe procedure with an overall complication rate of less than 2%, [ 12 – 15 ] and serious adverse event rate of 0.14% to 0.16%. [ 13 , 16 ] The most common complications are fever, infection (mediastinitis, pneumonia, mediastinal cyst infection, etc.…”

Section: Introductionmentioning

confidence: 99%

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Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration

et al. 2021

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen). Patient concerns: A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed. Diagnosis: The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid. Interventions: Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed. Outcomes: Seven days after the treatments, the patient's symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic. Conclusions: EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.

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Section: Discussionmentioning

confidence: 99%