Mediastinitis as Complication of EUS-B FNA

E. Tashi*^a (Mr), S. Golgota^a (Mr), D. Xhemalaj^a (Dr), P. Kapisyzi^a (Prof), S. Bala^a (Prof)

^a University Hospital Shefqet Ndroqi, Tirana, ALBANIA

* eritjantashi@gmail.com

Background

The combination of EBUS-TBNA and EUS-B FNA are used in diagnosis of mediastinalpathologies.EBUS-TBNA is a safe procedure with an overall complication rate less than 2%.Mediastinal cystic lesions account for 12% to 18% of primary mediastinal tumors, with bronchial cysts being the most common (40%)[1].The accuracy of CT in the diagnosis of mediastinal cysts was reported to be only 53.8%,[2]

Case report.

A 60 year old patient was hospitalised do to finding of a posterior mediastinal chest mass.The patient history is cough for many months. After taking several courses of medications no improvement was noted and was referred for further diagnosis. Laboratory findings and flexible bronchoscopy were in normal range. Flexible bronchoscopy was normal. In chest CT a 4 cm round mass in contact with oesophagus and pericardium was noted. No calcification or destruction were noted. Histologic diagnosis was requested. EUS - B FNA was conducted with 3 passages. Patient was discharged the following day After 48 hour patient developed fever and chest pain. Intravenous tazobactam and vancomicine was began.A Chest CT was conducted.There was annular enhancement of contrast ( capsule) and increased in size of the mass. After 4 days clinical status deteriorated with fever, chest pain, difficulty in breathing and dyspnea. Patient was referred for thoracotomy and a 11 cm encapsulated mass was removed. Culture resulted positive for streptococcus and pseudomonas.Cytology of the mass showed matured lymphocytes and no malignant cells

Conclusion.

Due to the rare nature of mediastinal cysts, there is still little evidence to guide management, and clinical recommendations are mostly derived from case reports.[3] For symptomatic mediastinal cysts, it is agreed that surgical removal of the cyst is a more reasonable option, while the choice of treatment for asymptomatic patients still remains controversial

Disclosure of funding source(s): none