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Pulmonary Procedures |

Endobronchial Ultrasound (EBUS) - Guided Bronchoscopy Is Useful in Diagnosing Pulmonary Coccidioidomycosis

Harsh Shah, MD; Ara Chrissian, MD
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Loma Linda University Medical Center, Loma Linda, CA


Chest. 2013;144(4_MeetingAbstracts):820A. doi:10.1378/chest.1701155
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Abstract

SESSION TITLE: EBUS: New Approaches

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 29, 2013 at 04:30 PM - 05:30 PM

PURPOSE: Pulmonary coccidioidomycosis can have non-specific manifestations. To avoid inappropriate therapy, prompt and accurate diagnosis is crucial. Typical evaluation includes a combination of serologic studies and respiratory fluid culture, but sensitivities for these methods are not clearly established, and the results can be delayed. Histologic exam for organisms provides the most definitive diagnosis, but is not routinely pursued. EBUS bronchoscopy efficiently evaluates malignant pulmonary nodules and thoracic adenopathy. However, there is a paucity of literature about its performance in diagnosing pulmonary coccidioidomycosis. We report our experience with EBUS-bronchoscopy in this setting.

METHODS: We retrospectively reviewed patient diagnoses obtained using curvilinear and/or radial EBUS-guided bronchoscopic sampling in 140 consecutive patients referred for evaluation of various chest lesions. Among the patients with benign disease, we noted cases of pulmonary coccidiodomycosis and the testing methods used to achieve the diagnosis.

RESULTS: Of the 119 patients in whom a definitive final diagnosis was available, 39 (33%) had benign disease. Among these, 13 (33%) had infection attributed to a specific organism. Five of these patients, representing 13% of benign diagnoses and 4% of all EBUS cases, were diagnosed with Coccidioides infection. All five (100%) had characteristic spherules identified among granuloma on histologic exam. Three of these patients (60%) had positive serum antibodies, three (60%) had positive respiratory fluid cultures, and none (0%) had positive staining of respiratory fluid. The mean time from EBUS bronchoscopy to histologic diagnosis was 1.5 days; for serum antibodies to be reported, 6 days; and for bronchoscopic respiratory cultures to turn positive, 28 days. Of the remaining 26 patients with benign tissue histology, none had positive Coccidioides antibodies and/or respiratory cultures.

CONCLUSIONS: Patients with pulmonary coccidiodomycosis may present with findings mimicking malignancy. EBUS-guided bronchoscopic tissue sampling provides a more rapid and sensitive diagnosis of pulmonary Coccidioides infection compared to routine methods.

CLINICAL IMPLICATIONS: For patients with thoracic lesions from a region in which Coccidioides is endemic, EBUS bronchoscopy should be considered the preferred diagnostic tool.

DISCLOSURE: The following authors have nothing to disclose: Harsh Shah, Ara Chrissian

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