SESSION TITLE: Bronchoscopy and Interventional Procedures Posters II
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: The endobronchial ultrasound (EBUS) scope has become a vital tool for mediastinal staging of lung cancer, but its full potential has yet to be realized. If used in the esophagus, the EBUS scope gives access to areas of mediastinum which were previously inaccessible to a bronchoscope. We present a case in which chronic chest pain was treated by access to and drainage of a mediastinal pseudocyst using an EBUS scope.
METHODS: Review of chart and radiologic data.
RESULTS: A 49-year-old male with history of alcoholism, chronic pancreatitis and a 120 pack-year smoking history presented with dull achy chest pain radiating to the back. A CT scan demonstrated enlarged cystic areas in the middle mediastinum read by radiology as adenopathy. Pulmonary was asked to evaluate the mediastinal nodes, with infection and malignancy leading the differential diagnosis. Whereas the majority of the lesion was not accessible from the airways, the EBUS scope was passed into the esophagus. EUS demonstrated the lesions to be lacunar dilations of a fluid-filled tubular structure which was drained with a 21-gauge needle such that there was complete ultrasonographic resolution of the abnormality. The fluid contained pancreatic amylase consistent with pancreatic fluid, and subsequent radiologic analysis was consistent with a pseudocyst that had ruptured into the mediastinum. The patient's pain resolved, and subsequent follow-up did not demonstrate recurrence of pain or of the pseudocyst.
CONCLUSIONS: There are plenty of reports of endoscopic drainage of pseudocyts by gastroenterologists, with gastric and duodenal approaches the common approaches. This is the only reported case of an EBUS scope used via the esophagus to drain a mediastinal pancreatic pseudocyst, leading to both diagnostic and therapeutic success.
CLINICAL IMPLICATIONS: The utility of the EBUS scope extends beyond the diagnosis and staging of cancer, and access to the mediastinium with the EBUS scope should not be limited to the bronchial tree; pulmonologists adept at using an EBUS scope in the bronchial tree should not hesitate from entering the esophagus.
DISCLOSURE: The following authors have nothing to disclose: Nikhil Meena, Thaddeus Bartter
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