Procedures: Procedures: Bronchology |

Transarterial EBUS-TBNA in the Diagnosis of Hilar Lesions FREE TO VIEW

Noelia Cubero, MD; Matt Salamonsen, MD; Rosa Lopez Lisbona, MD; Jordi Dorca, MD; Antoni Rosell, MD
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Hospital Universitari Bellvitge, Barcelona, Spain

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A427. doi:10.1016/j.chest.2016.02.445
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SESSION TITLE: Procedures: Bronchology

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Obtaining tissue diagnosis from a lung tumor or a mediastinal lymph node located adjacent to the aorta or pulmonary artery has been conventionally regarded as a diagnostic challenge.

CASE PRESENTATION: We present the case of a 51 year old man, with a history of metastatic rectal adenocarcinoma, (cT2N3M1 with liver metastasis). A PET-TC showed a PET positive left hilar lesion. Evaluation by a multidisciplinary tumor board, decided that the lesion was suspicious of malignancy and warranted further investigation to differentiate metastasis versus primary lung cancer. An EBUS procedure was performed and an anechoic structure was seen between the left main bronchial wall and the target node. This was the only window to visualize the lesion. Doppler examination confirmed flow within the hypoechoic structure, which along with the location allowed it to be positively identified as the pulmonary artery. TBNA of the node was performed with a 22 G needle. Final cytological examination of the sample showed metastatic rectal adenocarcinoma.

DISCUSSION: Wallace et al published the first case report of one trans-aortic fine needle aspiration (FNA). Recently there was a study of 14 patients who underwent EUS guided trans-aortic FNA for the diagnosis and staging of lung cancer. The first report of EBUS-TBNA through a major vascular structure was in 2006 by Vincent et al, who intentionally punctured a left hilar mass through the Pulmonary artery without any complications. More recently, Boujaude et al presented two cases of right hilar masses that were successfully diagnosed with EBUS-TBNA performed by traversing the Pulmonary artery, also without any complications. Our results support that transpulmonary artery EBUS-TBNA seems a feasible method that can provide a minimally-invasive positive diagnosis.

CONCLUSIONS: In our experience EBUS-TBNA through the pulmonary artery can achieve a diagnosis without major bleeding complications. This technique should be performed with major caution and only by experienced bronchoscopists in highly selected cases.

Reference #1: Wallace MB, Woodward T, Raimondo M, et al: Transaortic Fine-Needle Aspiration of Centrally Located Lung Cancer under Endoscopic Ultrasound Guidance: The Final Frontier. Ann Thorac Surg 2007;84:1019-21.

Reference #2: Vincent B, Huggins JT, Doelken P, Silvestri G: Successful real-time endobronchial ultrasoundguided transbronchial needle aspiration of hilar lung mass obtained by traversing the pulmonary

Reference #3: Boujaoude Z, Pratter M, Abouzgheib W: Transpulmonary artery needle aspiration of hilar masses with endobronchial ultrasound: a necessary evil. J Bronchology Interv Pulmonol

DISCLOSURE: The following authors have nothing to disclose: Noelia Cubero, Matt Salamonsen, Rosa Lopez Lisbona, Jordi Dorca, Antoni Rosell

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