Mediastinal Infection After Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: An Uncommon Complication.

Abstract

E ndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a modern bronchoscopic technique used in evaluating mediastinal adenopathy, masses, and pulmonary nodules, as well as lung cancer staging. It has the advantage of higher diagnostic yield than traditional TBNA, while being less invasive than mediastinoscopy or open biopsy.1 However, EBUSTBNA is associated with potential complications, including hemorrhage, pneumothorax, airway compromise, and anesthesia-related complications.1 The frequency of these complications, particularly mediastinal infection, is likely comparable to those occurring from conventional TBNA,2,3 which has existed for decades before the addition of EBUS. However, definitive data regarding this are lacking. Several types of infections can complicate EBUS-TBNA. These include mediastinitis, pericarditis, lymphadenitis, and empyema.1 Although these types of infections have been described, data are largely limited to case reports. As such, the incidence of such infections is difficult to estimate. Furthermore, these infections are often complicated, and little is known regarding their management or outcomes. We analyzed our institution’s cohort of patients who have undergone EBUS-TBNA. The aims of this study were to determine the incidence of subsequent mediastinal infection and describe their microbiology, treatment approach, and outcomes.