Abstract
Background. Endobronchial ultrasonography guided transbronchial needle aspiration (EBUS-TBNA), which is a type of real time needle biopsy performed in the diagnosis of mediastinal lymphadenopathy, is considered to cause few complications and be highly useful in the nodal staging of lung cancer. However, recently, the usefulness of EBUS-TBNA for peripheral lesions in the lung fields has been reported, and transbronchial and transtracheal approaches have been attempted. Here, we report a case of metastatic lung tumor adjacent to subsegmental bronchus which were not identified by endoscopy, approached by using EBUS-TBNA. Case. A 60-year-old woman was referred to our department for a thorough examination of abnormal shadows in the chest radiograph. Computed tomography showed nodules adjacent to lower B4b in S4 of the right lung, and bronchoscopy was performed for diagnosis. While no lesions were observed on endoscopy, hypoechoic lesions in lower B4b were detected by radial EBUS. By blindly wedging the Convex EBUS probe into the bronchus with reference to the fluoroscopic images obtained from previous radial EBUS, lesions were successfully visualized. We diagnosed lung metastasis of rectal cancer based on a biopsy with EBUS-TBNA at the same site. Conclusion. EBUS-TBNA is a useful tool to diagnose even for pulmonary lesions adjacent to the subsegmental bronchus by this method.
