Two Cases of Lung Cancer Complicated by Mediastinitis After Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Abstract

Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to be a useful and safe diagnostic method. However, there are reports of mediastinitis induced by EBUS-TBNA, and more information is thus needed to prevent this complication. We herein report two cases of mediastinitis following EBUS-TBNA and discuss the infectious complications of EBUS-TBNA in the context of the relevant literature. Case 1. EBUS-TBNA was performed to treat new mediastinal adenopathy (#7 lymph node) due to a relapse after surgery for lung cancer. The patient developed a fever seven days after the procedure and was diagnosed with mediastinitis. Treatment with antibiotics was successful. Case 2. EBUS-TBNA was performed to treat mediastinal adenopathy (#4R/#7 lymph nodes). Five days after the procedure, the patient developed a fever, and a diagnosis of mediastinitis was made. Although antibiotics were administered, the patient developed pericarditis and cardiac tamponade requiring urgent debridement and drainage with video-assisted thoracic surgery. In both cases, the specimens exhibited severe necrosis. Conclusions. Necrosis appears to be a risk factor for mediastinitis after EBUS-TBNA.