SESSION TYPE: Bronchology Global Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a relatively less invasive and effective diagnosis method. Here we reported a polyp formation following fine needle punctures. It is a rare complication of EBUS-TBNA, which has no previous report.
CASE PRESENTATION: A 72-year-old woman was examined for one year’s intermittent fever and productive cough. Physical examination, blood test and spirometry were within normal range. Chest CT showed mild mediastinal adenopathy. Bronchoscopy was performed and no airway lesions were found. EBUS showed a mild enlargement of lower paratracheal (4R) lymphnote with clear edge and scattered high resonance spots. EBUS-TBNA samples were obtained using Olympus NA-201SX-4022 needle. Cytological examination demonstrated benign inflammatory pattern. After antibiotic therapy her symptoms relieved. Five months later she developed progressive exertional dyspnea with productive cough. The sputum was difficult to expectorate. CT scan showed a mass in the trachea. A polyp was found in the lower trachea under bronchoscopy, and sub-totally obstructed the airway. The mass was round with smooth surface and Φ 1cm. After snare cautery excision, the polyp basement was found locating in the right front of the trachea, just above the branch of the right main bronchus, which was the TBNA puncture site for 4R lymphnote. Repeated EBUS showed the 4R lymphnote had similar size and resonance distribution as before. Pathological examination of the removed neoplasm revealed granulation tissue; no malignant cell or epithelioid cell granuloma was found. The patient symptom relieved completely and no related symptoms after one year follow up.
DISCUSSION: EBUS-TBNA is widely used in diagnosing clinical conditions presented by lymphatic adenopathies and proved to be extremely useful. It is a safe procedure. Reported complications include agitation, cough and presence of blood at the puncture site[1,2]. No serious complications were found. There is no record of tumor seeding or inflammatory polypus formation. Our patient has no clue to malignant disorders. The pathological examination of 4R lymphnote and tracheal mass did not exhibit any signs of malignancy. Besides, the 4R lymphadenopathy remains stable after 5 months. We also care about the infectious disease, especially tuberculosis but got no support. In this patient the polyp has close relation to the operation of TBNA. Pathological inspect revealed granulation tissue without any evidence of implantation of malignant cell or contamination of infectious microorganism. In addition, the patient original symptom disappeared except for trachea obstruction. We come to the conclusion that the mass is a reactive proliferation after TBNA, but not the progression of her primary disease. We use 22-gauge needle for aspiration. It is thin and yield less sizable stromal fragments, therefore healing process should be quick and don’t induce inflammatory response. There is no granulation on the site of puncture was reported even in trans-thoracic needle aspiration. It might because a granulation formation on the skin has no clinical significance, or the difference of healing process between skin and mucosa.
CONCLUSIONS: Here we report a rear complication of TBNA which have not reported before to our knowledge. The proliferated granulation tissue grew quickly in our patient and sub-totally obstructed the trachea in only 5 months. Therefore this complication can be life threatening if not treated promptly.
1) Bauwens O, Dusart M, Pierard P, et al. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung cancer 2008;61:356-361.
2) Yasufuku K, Chiyo M, Sekine Y, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymphnodes. Chest 2004;126:122-128.
3) Varela-Lema L, Ferna'ndez-Villar A, Ruano-Ravina A. Effectiveness and safety of endobronchial ultrasound-transbronchial needle aspiration: a systematic review. Eur Respir J 2009;33:1156-1164.
DISCLOSURE: The following authors have nothing to disclose: Hong Zhang, Guangfa Wang, Chengli Que, Wei Zhang, Nan Li
No Product/Research Disclosure InformationDepartment of Respiratory Medicine, Peking University First Hospital, Beijing, China