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EBUS-TBNA of Pulmonary Artery Clot

Mahajan, Amit K. MD; Ibrahim, Omar MD; Shostak, Eugene MD; VanderLaan, Paul A. MD, PhD; Majid, Adnan MD; Folch, Erik MD, MSc

Journal of Bronchology & Interventional Pulmonology: October 2014 - Volume 21 - Issue 4 - p 371–373
doi: 10.1097/LBR.0000000000000109
Letters to the Editor
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Division of Thoracic Surgery and Interventional Pulmonology Harvard Medical School Beth Israel Deaconess Medical Center Boston, MA

Disclosure: There is no conflict of interest or other disclosures.

To the Editor:

A 70-year-old male with a history of squamous cell lung cancer status post right middle and lower lobe resection was found to have a new 1.3 cm right upper lobe nodule, ipsilateral hilar lymphadenopathy, and a right pulmonary artery lesion on CT scan of the chest. (Fig. 1). The right pulmonary artery lesion was concerning for tumor invasion. The patient underwent convex probe endobronchial ultrasound (CP-EBUS) bronchoscopy with transbronchial needle aspiration (TBNA) of the hilar lymph nodes and pulmonary artery lesion. The lung nodule was sampled using conventional 19 G TBNA needle and brush. Cytology of the right upper lobe nodule revealed atypical cells, whereas the ipsilateral lymph node was negative for malignancy. The pulmonary artery lesion was also visualized (Fig. 2) and underwent CP-EBUS TBNA using a 21 G needle (Fig. 3). The cytologic smear and associated cell block specimen showed no evidence of malignancy, only fragments of bland, unorganized thrombus (Figs. 4A, B).

FIGURE 1

FIGURE 1

FIGURE 2

FIGURE 2

FIGURE 3

FIGURE 3

FIGURE 4

FIGURE 4

As CP-EBUS continues to be widely implemented in clinical practice, alternative avenues for its use are being further explored. In addition to diagnosing and staging lung cancer, CP-EBUS has been reported in sampling and diagnosing pulmonary artery sarcomas and acute pulmonary emboli.1–3 This case highlights the ability to safely biopsy pulmonary artery lesions using CP-EBUS–guided TBNA. In the setting of biopsy-proven negative lymph nodes and the absence of tumor invasion into the right pulmonary artery, rather than being classified as stage 4 disease our patient’s malignancy was staged as 1a. On the basis of his localized staging, he was treated with radiofrequency ablation rather than chemotherapy and radiation.

Amit K. Mahajan, MD

Omar Ibrahim, MD

Eugene Shostak, MD

Paul A. Vanderlan, MD, PhD

Adnan Majid, MD

Erk Folch, MD, MSc

Division of Thoracic Surgery and Interventional Pulmonology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA

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REFERENCES

1. Aumiller J, Herth FJ, Krasnik M, et al.. Endobronchial ultrasound for detecting central pulmonary emboli: a pilot study. Respiration. 2009;77:298–302.
2. Montani D, Jais X, Sitbon O, et al.. EBUS-TBNA in the differential diagnosis of pulmonary artery sarcoma and thromboembolism. Eur Respir J. 2011;39:1549–1550.
3. Park JS, Chung JH, Jheon S, et al.. EBUS-TBNA in the differential diagnosis of pulmonary artery sarcoma and thromboembolism. Eur Respir J. 2011;38:1480–1482.
© 2014 by Lippincott Williams & Wilkins.