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Pulmonary Procedures |

Role of EBUS-TBNA in the Management of Bronchogenic Cysts

Wissam Jaber; Danai Khemasuwan, MBA; Jinesh Patel; Abdul Hamid Alraiyes; Joseph Cicenia; Thomas Gildea, MS; Abha Goyal; Micheal Machuzak; Atul Mehta; Sonali Sethi; Francisco Almeida, MS
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Univeristy of Alabama at Birmingham, Birmingham, AL


Chest. 2014;146(4_MeetingAbstracts):741A. doi:10.1378/chest.1992899
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Abstract

SESSION TITLE: EBUS and Advanced Bronchoscopy Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: We present a case series of adult patients with bronchogenic cysts diagnosed and managed with endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA).

METHODS: Bronchoscopic records of patients with bronchogenic cysts who were diagnosed and managed with EBUS-TBNA were reviewed for clinical presentation, radiological and pathological findings, management and overall outcome. Study period spanned between August 2008 and December 2013.

RESULTS: Over the 5 year period, 14 patients, median age 54.5 years were diagnosed with bronchogenic cysts and managed with EBUS-TBNA. Eleven patients had one or more symptoms. Three cases were diagnosed incidentally. CT findings in 9 showed right paratracheal cyst; subcarinal location being second most common. Average cyst size was 46 mm (17-100). Average amount of fluid aspirated was 54 ml (0-270). Pathology was consistent with bronchogenic cyst content in all cases. The most common findings on cytology were mesothelial cells, cyst content and benign epithelial cells. Inflammatory pericaditis was a complication in one patient. Patients were followed up for an average of 8.5 months (1-19). Five patients on follow up were symptom free and did not require surgery. At least one patient had near resolution of the cyst at 9 months. Four patients underwent surgical resection due to persistent symptoms. Five patients were lost to follow up.

CONCLUSIONS: EBUS-TBNA is a safe, minimally invasive, outpatient procedure. The pathologic diagnosis of bronchogenic cyst was achieved in all cases. Drainage of the cyst successfully achieved symptom control or resolution in one third of the patients thus delaying or avoiding surgical excision. Bronchoscopic drainage was an ultimate management for at least one fourth of the cases.

CLINICAL IMPLICATIONS: The management of bronchogenic cysts remains controversial. In our case series, EBUS-TBNA was diagnostic in all cases. Sonographic images also highlighted loculations, septations and effective drainage. Bronchoscopic drainage achieved symptom control in most and was exclusively therapeutic in 30% of cases. Larger studies with long-term follow up are desirable to establish the role of EBUS-TBNA among patients with mediastinal cysts.

DISCLOSURE: Micheal Machuzak: Other: Olympus of America consultant The following authors have nothing to disclose: Wissam Jaber, Danai Khemasuwan, Jinesh Patel, Abdul Hamid Alraiyes, Joseph Cicenia, Thomas Gildea, Abha Goyal, Atul Mehta, Sonali Sethi, Francisco Almeida

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