ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION OF A BRONCHOGENIC CYST

Abstract

SESSION TITLE: Case Report Semifinalists 12 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Bronchogenic cysts are rare congenital malformations that can occur in various parts of the tracheobronchial tree and if symptomatic, can lead to a range of symptoms depending on location [1-2]. Historically, diagnostic confirmation and treatment was achieved via surgical means [1-2]; however, a growing body of evidence exists for the safety and efficacy of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of bronchogenic cysts [3]. CASE PRESENTATION: A 63-year-old female with a known asymptomatic non-FDG avid mediastinal lesion since 2008 presented for a chronic cough. She had previously presented with a right lower lobe pneumonia in early 2017.Physical exam was notable for an oxygen saturation of 97%, comfortably breathing ambient air with clear lung sounds bilaterally. Computed tomography (CT) imaging in late 2017 revealed significant interval increase in the mediastinal lesion which grew from 1.6x2.3cm to 3.0x2.5cm with associated luminal narrowing of the right bronchus intermedius. The mass was noted to be smoothly marginated, 30-40 Hounsfield units in density, and without associated lymphadenopathy or contrast enhancement, most consistent with an enteric duplication or other mediastinal cyst. Additionally, right lower lobe bronchiectasis and associated bronchial mucous plugging with air trapping was noted. The patient underwent flexible EBUS bronchoscopy. The bronchus intermedius was extrinsically obstructed by 75%. EBUS revealed a well demarcated hypoechoic fluid collection most consisted with a cyst. Transbronchial needle aspiration was performed removing 35mL of fluid. Complete resolution of bronchial luminal narrowing was achieved post-aspiration. The patient recovered without complications. Cystic fluid was sent for analysis. Microbiologic stains and cultures were negative. Cytology was notable for rare bland degenerative epithelial cells in a background of mucoid debris. No malignant cells were identified. DISCUSSION: Bronchogenic cysts are rare and may be associated with symptoms ranging from chronic cough to bronchial obstruction with recurrent infections [1-2]. CT imaging has known limitations in establishing the benign cystic characteristics of bronchogenic cysts [1]. They may be diagnosed and treated via surgical resection, which is invasive and has been associated with increased postoperative complications in symptomatic patients [1]. CONCLUSIONS: EBUS-TBNA is a safe and effective alternative to diagnosis and treatment of bronchogenic cysts. Reference #1: Patel SR, Meeker DP, Biscotti CV, et al. Presentation and management of bronchogenic cysts in the adult. Chest 1994;106(1):79-85. Reference #2: Liu HS, Li SQ, Cao ZL, et al. Clinical features and treatment of bronchogenic cyst in adults. Chin Med Sci J 2009;24(1):60-3. Reference #3: Maturu VN, Dhooria S, Agarwal R. Efficacy and Safety of transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol 2015;22(3):195-203 DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Please note: $5001 - $20000 Added 03/17/2019 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Adrian Mayo, source=Web Response No relevant relationships by Scott Oh, source=Web Response