A Life-Threatening Infection after Endobronchial Ultrasound Transbronchial Lung Biopsy with Guide Sheath: A Case Report.
bronchoscopy
complication
extracorporeal membrane oxygenation
respiratory infection
ultrasonography
Journal
Medicina (Kaunas, Lithuania)
ISSN: 1648-9144
Titre abrégé: Medicina (Kaunas)
Pays: Switzerland
ID NLM: 9425208
Informations de publication
Date de publication:
14 Sep 2022
14 Sep 2022
Historique:
received:
13
07
2022
revised:
28
08
2022
accepted:
12
09
2022
entrez:
23
9
2022
pubmed:
24
9
2022
medline:
28
9
2022
Statut:
epublish
Résumé
Endobronchial ultrasound transbronchial lung biopsy with guide sheath (EBUS-GS-TBLB) has been regarded as a reasonable diagnostic method with an acceptable diagnostic yield. In addition, EBUS-GS-TBLB is considered safer and less invasive compared to percutaneous needle biopsy and thoracoscopic surgery. However, we encountered a case of life-threatening procedure-related fatal infection, which was successfully managed. A 61-year-old man with a 30 pack-year smoking history was referred to our clinic with a necrotic lung mass in the right middle lobe on a chest computed tomography scan. EBUS-GS-TBLB was performed for a pathological diagnosis without immediate complications. Eight days after the procedure, the patient visited the hospital with sudden hemoptysis and severe dyspnea with fever. A chest computed tomography revealed a ruptured lung abscess and pneumonia, developed after EBUS-GS-TBLB. Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation were initiated to manage refractory hypoxia. While maintaining ECMO, video-assisted thoracoscopic surgery was performed at the patient's bedside in the intensive care unit. After surgery, the patient's vital signs gradually improved, and a chest computed tomography revealed a reduction in the extent of the lung abscess. Although EBUS-GS-TBLB is minimally invasive and relatively safe when used for the diagnosis of peripheral lung lesions, pulmonary physicians should be aware of this rare but critical complication. We suggest that the careful prescription of prophylactic antibiotics before EBUS-GS-TBLB would be wise if the mass featured a necrotic, cavitary, or cystic lesion.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Endobronchial ultrasound transbronchial lung biopsy with guide sheath (EBUS-GS-TBLB) has been regarded as a reasonable diagnostic method with an acceptable diagnostic yield. In addition, EBUS-GS-TBLB is considered safer and less invasive compared to percutaneous needle biopsy and thoracoscopic surgery. However, we encountered a case of life-threatening procedure-related fatal infection, which was successfully managed.
CASE PRESENTATION
METHODS
A 61-year-old man with a 30 pack-year smoking history was referred to our clinic with a necrotic lung mass in the right middle lobe on a chest computed tomography scan. EBUS-GS-TBLB was performed for a pathological diagnosis without immediate complications. Eight days after the procedure, the patient visited the hospital with sudden hemoptysis and severe dyspnea with fever. A chest computed tomography revealed a ruptured lung abscess and pneumonia, developed after EBUS-GS-TBLB. Extracorporeal membrane oxygenation (ECMO) and mechanical ventilation were initiated to manage refractory hypoxia. While maintaining ECMO, video-assisted thoracoscopic surgery was performed at the patient's bedside in the intensive care unit. After surgery, the patient's vital signs gradually improved, and a chest computed tomography revealed a reduction in the extent of the lung abscess.
RESULTS
RESULTS
Although EBUS-GS-TBLB is minimally invasive and relatively safe when used for the diagnosis of peripheral lung lesions, pulmonary physicians should be aware of this rare but critical complication.
CONCLUSIONS
CONCLUSIONS
We suggest that the careful prescription of prophylactic antibiotics before EBUS-GS-TBLB would be wise if the mass featured a necrotic, cavitary, or cystic lesion.
Identifiants
pubmed: 36143952
pii: medicina58091275
doi: 10.3390/medicina58091275
pmc: PMC9504971
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Pusan National University Hospital
ID : none
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Thorax. 2013 Aug;68 Suppl 1:i1-i44
pubmed: 23860341
Eur Respir J. 2011 Apr;37(4):902-10
pubmed: 20693253
Chest. 2012 Aug;142(2):385-393
pubmed: 21980059
Chest. 2004 Sep;126(3):959-65
pubmed: 15364779
Respiration. 2015;90(2):129-35
pubmed: 26112297
Chest. 2020 Aug;158(2):797-807
pubmed: 32145245
N Engl J Med. 2011 Aug 4;365(5):395-409
pubmed: 21714641
J Infect Chemother. 2021 Feb;27(2):237-242
pubmed: 33060045