A rare complication of an endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB)

M. Oudah*^a (Dr), K. Diab^a (Dr)

^a George Washington University Hospital, Washington, D.C, UNITED STATES

* m_oudah22@hotmail.com

Endobronchial ultrasound-guided intranodal forceps biopsy (EBUS-IFB) is a novel technique used simultaneously after a transbronchial needle aspiration (TBNA). The TBNA needle creates a puncture path for the forceps to enter the lymph node for biopsy. The sample collected can provide an improved histological assessment to help diagnosed mediastinal lymphoma and sarcoidosis. We present the first case of a 22-gauge Vizishot^TM needle breaking off during sheath dilation for path formation. A 51-year-old man, never-smoker, with generalized weakness and a 30-pound unintentional weight loss presented with hypercalcemia at 13.4 mg/dL. A positron emission tomography (PET) scan confirmed extensive mediastinal and hilar adenopathy with increased uptake up to 7.9 max SUV. Due to suspicion of sarcoidosis or malignancy, he underwent EBUS with TBNA and IFB. TBNA was performed in stations 7 and 11L. Station 11L had the largest diameter and therefore was chosen for IFB. IFB puncture track was initially created using a 22-gauge Vizishot^TM needle. However, the needle tip was fractured in the lymph node during the fifth dilation pass and not visualized on the bronchial wall. The fractured needle underwent unsuccessful retrieval attempts using 2 mm forceps through the dilated tract. A new path was created with another 22-gauge Vizishot^TM needle sheet, and the 2 mm forceps advanced smoothly with a successful needle grip and removal. EBUS inspection showed complete removal of the needle. There were no post-procedure complications. Biopsy results showed non-necrotizing granulomas and were negative for infection or malignancy. He was diagnosed with pulmonary sarcoidosis. Most EBUS-IFB procedures were found successful using 19, 21, and 22-gauge needles with sheath dilation. Our case shows a potential complication of needle fracture related to sheath dilation. Further studies are needed to assess the efficacy and safety of various end-bronchial needles for IFB procedures.

Disclosure of funding source(s): none