Right Hilar Mass Diagnosed by Endobronchial Ultrasound Guided Transvascular Needle Aspiration

Abstract

The Endo Bronchial Ultrasound–guided Transbronchial Needle Aspiration (EBUSTBNA) for diagnosis and staging of benign and malignant thoracic diseases is the standard of care nowadays. The complications associated with it are rare and minor. We report one case of a 47-year-old male, was evaluated by his primary care physician for complaints of cough, chest pain on right side and episodic dyspnea of one month duration. He was a non smoker and chef by occupation. He denied any history of fever, chills, sputum production, wheezing, or haemoptysis. Chest radiograph showed right lower zone mass. Computed tomography (CT) of the chest revealed well defined a 3×4 centimeter tumorous lesion arising from the right middle lobe bronchus. Fiberoptic bronchoscopy was normal. Endobronchial Ultrasound (EBUS) revealed 2.3×3.3 cm hypoechoic lesion at station 12R lying adjacent to a branch of right inferior pulmonary artery. We examined the pulmonary artery segment using color flow Doppler enhancement. It showed no blood flow over the mass. We next deployed the biopsy needle to its full length into the mass, traversing the near and far walls of the pulmonary artery branch in the process. Rapid on site evaluation by a cytopathologist revealed diagnosis of spindle cell neoplasm. In present case, we did EBUSTBNA of a right hilar mass traversing the pulmonary artery. There was no vascular injury in the current procedure and with the small diameter needle and real-time guidance such procedures can be performed safely.

Keywords

• carcinoid
• complications
• transpulmonary artery
• transvascular puncture