THE EXPANDING ROLE OF EBUS: USE OF ENDOBRONCHIAL ULTRASOUND FOR MANAGEMENT OF A LARGE THORACIC CYST

Abstract

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: The role of endobronchial ultrasound in the diagnosis and staging of malignancy, infections, and other inflammatory conditions causing enlarged lymph nodes has been well established. However, there have been only a number of case reports suggesting a role for EBUS in the diagnosis and management of mediastinal and thoracic cysts as well. We present a case of a large right apical, fluid filled cyst which was successfully drained with EBUS guidance. CASE PRESENTATION: A 73 y/o female with PMH of polycystic kidney disease and multiple brain aneurysms s/p clipping presented with chest pain and dyspnea. She was referred to the ED by her PCP after a failed trial of azithromycin. CXR revealed a large, right upper lobe mass which was further evaluated with a CT chest showing a 7.1 x 10 cm fluid filled lesion in the right apex with compression of the mediastinum. She was evaluated by both CT surgery and Interventional Pulmonology with the recommendation to attempt bronchoscopic biopsy and drainage. Using EBUS guidance, the Olympus 22g ViziShot needle was advanced into the cyst at the right paratracheal location with successful drainage of 100 cc of clear, yellow fluid. Bacterial, fungal, and AFB cultures were negative. Pathology review showed significant lymphocytes and epithelial cells. The decrease in size of the lesion was visible with EBUS, but also confirmed with post procedure CXR. The patient tolerated the procedure well with resolution of symptoms and no recurrence on imaging at 4 months. DISCUSSION: Despite the significant size of the initial lesion, bronchoscopic drainage of the thoracic cyst using EBUS guidance was both safe and effective. While a clear diagnosis was not obtained to establish the cause of the lesion, the patient had immediate improvement in symptoms with the decrease in size of the lesion and no recurrence to date. EBUS proved to be a useful tool as direct visualization of the lesion during drainage of the cyst allowed for adjustment of needle positioning as the underlying lung re-expanded. The patient was spared the side effects and potential complications that could be associated with a blind biopsy or a surgical intervention. CONCLUSIONS: EBUS appears to be a safe and effective means of drainage of even large thoracic or mediastinal cysts and should be considered prior to more invasive alternatives. Additional studies would be required before routine use of EBUS for this indication can be recommended. Reference #1: Takeda, S et al. "Clinical Spectrum of Mediastinal Cysts." CHEST Journal. Vol 124, Issue 1, pp 125-132. Juy 2003. DISCLOSURES: no disclosure on file for Neeraj Desai; No relevant relationships by Jessica Johnson, source=Web Response