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Research Letter

Barrier enclosure device to sample difficult to access lesions by endobronchial ultrasound during the pandemic

Rao, Harshith; Chhabria, Bharath A; Dhooria, Sahajal; Muthu, Valliappan; Agarwal, Ritesh; Sehgal, Inderpaul Singh

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doi: 10.4103/lungindia.lungindia_737_21


We have previously described a barrier enclosure device use to limit aerosol dispersion during high aerosol-generating procedures such as flexible bronchoscopy and endotracheal intubation to protect health-care workers.[12] While using the barrier enclosure device, one may occasionally encounter difficulty in sampling lesions located either distally or in the upper lobes posterior segment. Furthermore, there is a restriction of hand movements due to the enclosure device.[34] Herein, we describe an instance where we encountered difficulty in accessing a lesion located posterior to the trachea.

A 62-year-old lady presented with cough and fever for 2 months. She was diagnosed with renal cell carcinoma (RCC) 2 years back and was treated with nephrectomy followed by chemotherapy. On evaluation, the computed tomography of the thorax revealed a heterogenous retro tracheal mass [Figure 1, panel A]. We considered recurrence of RCC versus other causes (tuberculosis, lung carcinoma) and performed endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). Such posteriorly located lesions can be accessed with EBUS by changing the position of the bronchoscopist to the side of patient and directing the EBUS scope to face posteriorly. However, the barrier enclosure device precluded the access at this location. We performed the EBUS TBNA using the side oblong ports in the barrier enclosure device. The patient was initially intubated with the EBUS scope using the main port at the head end of the patient. Subsequently, the operator stood to the right side of the patient. The EBUS scope was manipulated and directed posteriorly using the oblong aperture on the right side of the barrier device to localize the lesion. Once the lesion was located with EBUS, the needle was inserted into the lesion with the operator remaining in the same position. We completed the procedure without any complications. Our experience suggests that barrier enclosure devices (with suitable modifications) can be used to perform EBUS at difficult target locations without compromising on the safety of health-care workers during the pandemic.

Figure 1:
Panel A represents the mediastinal window of computed tomography thorax demonstrating a heterogenous mass (arrow) located in the posterior aspect of trachea. Panel B demonstrates the operator using one of the side ports to maneuver the endobronchial ultrasound scope for puncturing the lesion

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


1. Sehgal IS, Dhooria S, Prasad KT, Muthu V, Aggarwal AN, Agarwal R Barrier enclosure device during patient preparation for flexible bronchoscopy Lung India 2020 37 463 4
2. Sehgal IS, Yaddanapudi LN, Dhooria S, Prasad KT, Puri GD, Muthu V, et al. Barrier protection during airway intubation Indian J Crit Care Med 2020 24 485 6
3. Sehgal IS, Dhooria S, Prasad KT, Muthu V, Aggarwal AN, Agarwal R Experience with barrier enclosure device during flexible bronchoscopy J Bronchology Interv Pulmonol 2021 28 e26 8
4. Sehgal IS, Dhooria S, Prasad KT, Muthu V, Aggarwal AN, Agarwal R Barrier enclosure device:One size does not fit all Lung India 2021 38 S128 9
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