Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

New-Onset Malignant Pleural Effusion after Abscess Formation of a Subcarinal Lymph Node Associated with Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

  • Jang, Sun Mi (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Min Ji (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Cho, Jeong Su (Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine) ;
  • Lee, Geewon (Department of Radiology, Pusan National University School of Medicine) ;
  • Kim, Ahrong (Department of Pathology, Pusan National University School of Medicine) ;
  • Kim, Jeong Mi (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Chul Hong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Jong Man (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Song, Byeong Gu (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Eom, Jung Seop (Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2014.06.02
  • Accepted : 2014.07.14
  • Published : 2014.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.

Keywords

References

  1. Gomez M, Silvestri GA. Endobronchial ultrasound for the diagnosis and staging of lung cancer. Proc Am Thorac Soc 2009; 6:180-6. https://doi.org/10.1513/pats.200808-081LC
  2. Evison M, Crosbie PA, Martin J, Bishop P, Doran H, Joseph L, et al. EBUS-TBNA in elderly patients with lung cancer: safety and performance outcomes. J Thorac Oncol 2014;9:370-6. https://doi.org/10.1097/JTO.0000000000000085
  3. Kokkonouzis I, Strimpakos AS, Lampaditis I, Tsimpoukis S, Syrigos KN. The role of endobronchial ultrasound in lung cancer diagnosis and staging: a comprehensive review. Clin Lung Cancer 2012;13:408-15. https://doi.org/10.1016/j.cllc.2012.05.001
  4. Asano F, Aoe M, Ohsaki Y, Okada Y, Sasada S, Sato S, et al. Complications associated with endobronchial ultrasoundguided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013;14:50. https://doi.org/10.1186/1465-9921-14-50
  5. Detterbeck FC, Lewis SZ, Diekemper R, Addrizzo-Harris D, Alberts WM. Executive Summary: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143(5 Suppl):7S-37S. https://doi.org/10.1378/chest.12-2377
  6. Lee JW, Kim WJ, Park CW, Kang HW, Ban HJ, Oh IJ, et al. Endotracheal tuberculous granuloma formation following endobronchial ultrasound transbronchial needle aspiration. Intern Med 2013;52:1207-10. https://doi.org/10.2169/internalmedicine.52.9360
  7. Kinsey CM, Arenberg DA. Endobronchial ultrasound-guided transbronchial needle aspiration for non-small cell lung cancer staging. Am J Respir Crit Care Med 2014;189:640-9. https://doi.org/10.1164/rccm.201311-2007CI
  8. Mohammed KA, Nasreen N, Hardwick J, Logie CS, Patterson CE, Antony VB. Bacterial induction of pleural mesothelial monolayer barrier dysfunction. Am J Physiol Lung Cell Mol Physiol 2001;281:L119-25. https://doi.org/10.1152/ajplung.2001.281.1.L119
  9. Mohammed KA, Nasreen N, Hardwick J, Van Horn RD, Sanders KL, Antony VB. Mycobacteria induces pleural mesothelial permeability by down-regulating beta-catenin expression. Lung 2003;181:57-66. https://doi.org/10.1007/s00408-003-1006-1
  10. Kang HJ, Hwangbo B. Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration. Tuberc Respir Dis 2013;75:135-9. https://doi.org/10.4046/trd.2013.75.4.135
  11. Polkowski M, Larghi A, Weynand B, Boustiere C, Giovannini M, Pujol B, et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy 2012;44:190-206. https://doi.org/10.1055/s-0031-1291543

Cited by

  1. Surgical treatment for mediastinal abscess induced by endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review vol.15, pp.None, 2014, https://doi.org/10.1186/s12957-017-1206-4