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EBUS-TBNA ofPulmonary Artery Clot Amit MahajanOmar M. IbrahimEugene Shostak2014 год

EBUS-TBNA of Pulmonary Artery Clot
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Аннотация: 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: Axial view of chest CT displaying right pulmonary artery mass. The red circle highlights the pulmonary artery mass.FIGURE 2: Right pulmonary artery mass visualized using linear EBUS bronchoscopy.FIGURE 3: Right pulmonary artery mass undergoing TBNA under ultrasound guidance.FIGURE 4: Pulmonary artery thrombus sampled by EBUS. Fragments of bland, unorganized thrombus were identified on the cytologic air-dried direct smear (A, Wright-Geimsa stain; original magnification, ×200) and the subsequently prepared cell block (B, hematoxylin and eosin stain; original magnification, ×100).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
Год издания: 2014
Авторы: Amit Mahajan, Omar M. Ibrahim, Eugene Shostak, Paul A. VanderLaan, Adnan Majid, Erik Folch
Издательство: Lippincott Williams & Wilkins
Источник: Journal of Bronchology & Interventional Pulmonology
Ключевые слова: Venous Thromboembolism Diagnosis and Management, Cardiac tumors and thrombi, Atrial Fibrillation Management and Outcomes
Другие ссылки: Journal of Bronchology & Interventional Pulmonology (HTML)
journals.lww.com (HTML)
PubMed (HTML)