SESSION TITLE: Bronchology Case Report Posters II
SESSION TYPE: Affiliate Case Report Poster
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: The increase of intracranial pressure (ICP) secondary to fluctuation of intrathoracic tension can be significant during bronchoscopy, Previous studies concluded that flexible bronchoscopy (FB) carries a low risk in patients with elevated ICP. Endobronchial Ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) of lymph nodes requires a longer procedural duration. There is currently no guideline report on the safety of EBUS in patients with intracranial mass (ICM). We present two cases where EBUS-TBNA was performed without complications.
CASE PRESENTATION: Case 1: 58 year old male presented with right sided weakness. Computed Tomogram (CT) head showed hemorrhagic lesions with mass effect and midline shift and a CT chest showed parenchymal masses with lymphadenopathy. Decadron was initiated for 2 days. The EBUS-TBNA and transbronchial biopsy (TBB) confirmed a diagnosis of Adenocarcinoma of the lung. There was no change in his respiratory or neurological status during or after the procedure. Case 2: 71 year old male presented with vomiting and headaches. CT head showed multiple large low-density abnormalities with mass effect and a CT chest showed nodules with lymphadenopathy. He was on Decadron for 5 days. The EBUS-TBNA and TBB, confirmed a diagnosis of Adenocarcinoma of the lung. He received Propofol and Rocurorium. Post procedure he remained stable with no neurological symptoms
DISCUSSION: EBUS-TBNA is an essential diagnostic tool in thoracic malignancies. Patients may often present with neurological symptoms as a result of metastatic brain masses and mediastinal lymphadenoapthy. During FB, the ICP rapidly increased in 81% cases and the mean highest ICP was 38.0mm Hg. Localized cerebral ischemia and herniation may be precipitated. We performed EBUS-TBNA under general anesthesia and paralytics. Both patients received pre-procedural steroid for at least 48 hours. The possible rise in arterial pressure probably maintained the perfusion even though the ICP might have increased. The use of paralytics during EBUS may have prevented sudden rise in pressure to avoid herniation
CONCLUSIONS: EBUS-TBNA can be performed safely without any neurological or respiratory sequelae in patients with metastatic ICM and neurological manifestations under general anesthesia with paralysis
Reference #1: Lee T. Fiberoptic bronchoscopy and intracranial pressure. Chest. 1994;105:1909.
Reference #2: Bajwa MK. Fiberopticbronchoscopy in the presence of space-occupying Lesions.. intracranial lesions. Chest1993;104:101
Reference #3: Kerwin AJ. Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury:a prospective clinical study.l .J Trauma. 2000;48
DISCLOSURE: The following authors have nothing to disclose: Mohamed Ali, Shaheen Islam, Abdulgadir Adam
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