UNASSIGNED:基于非小细胞肺癌(NSCLC)患者术前纵隔分期的算法,在计算机断层扫描(CT)扩大或正电子发射断层扫描(PET)阳性纵隔淋巴结的情况下,需要支气管内超声引导的经支气管针吸活检(EBUS-TBNA)。它既是一种安全的微创手术,并发症发生率低于1.5%,又是一种具有高灵敏度定义纵隔淋巴结疾病的有效工具。然而,感染性并发症,如纵隔炎或脓包。
未经证实:一名54岁的女性因疑似右上叶NSCLC而入院接受进一步调查。进行EBUS-TBNA以接受纵隔淋巴结的诊断和样本。EBUS-TBNA两周后,患者出现心源性/感染性休克症状:低血压,心动过速,胸痛和发烧。EBUS-TBNA可及时诊断合并感染性纵隔炎和广泛的脓包。除了全身性抗生素,双侧胸腔镜介入治疗终于取得突破。患者可以在紧急重新入院后大约三周出院。最终被诊断为NSCLC(IIIA期鳞状细胞癌),患者在诱导化疗后接受了明确的序贯放化疗.12个月的随访证实病情稳定。
UNASSIGNED:可以预期的是,随着EBUS-TBNA作为纵隔分期工具的应用越来越多,严重感染相关并发症的数量将相应增加。EBUS-TBNA后抗生素预防的有效性尚未得到证实,因此不包括在任何指南中。我们的案例给人留下了印象EBUS-TBNA后延迟感染并发症的严重程度,并概述了前期手术是广泛清除所有传染性脓肿/脓胸部位的主要目标。随着越来越多地使用EBUS-TBNA作为纵隔分期工具,临床医生应该意识到这种罕见但高度严重的介入围手术期并发症,以便密切监测濒危患者.
UNASSIGNED: Based on the algorithm on preoperative mediastinal staging in patients with non-small cell lung cancer (NSCLC), endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is indicated in case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes. It represents both a safe minimal invasive procedure with complication rates of less than 1.5% and a valid tool with a high sensitivity defining mediastinal nodal disease. However, infectious complications like mediastinitis or
pyopericardium are most feared.
UNASSIGNED: A 54-year-old woman was admitted to our hospital for further investigation of a suspected NSCLC of the right upper lobe. EBUS-TBNA was performed to receive both diagnosis and samples of the mediastinal lymph nodes. Two weeks after EBUS-TBNA, the patient presented with symptoms of cardiogenic/septic shock: hypotension, tachycardia, chest pain and fever. Prompt diagnosis of concomitant infectious mediastinitis and extensive
pyopericardium in consequence of EBUS-TBNA was obvious. Besides systemic antibiotics, bilateral thoracoscopic interventions finally made the breakthrough. The patient could be discharged roughly three weeks after emergent re-admittance. As being finally diagnosed with NSCLC (stage IIIA squamous cell carcinoma), the patient underwent-subsequent to induction chemotherapy-a definitive sequential chemoradiotherapy. Twelve-month follow-up confirmed stable disease.
UNASSIGNED: It is to be expected that with increasing application of EBUS-TBNA as mediastinal staging tool, the number of serious infection-related complications will rise accordingly. The efficacy of antibiotic prophylaxis after EBUS-TBNA has not yet been proved and is therefore not included in any guideline. Our case gives an impression on the severity of delayed infectious complications after EBUS-TBNA and outlines up-front surgery as primary objective to broadly debride all contagious abscess-/empyema sites. With increased use of EBUS-TBNA as mediastinal staging tool, clinicians should be aware of this rare but highly critical peri-interventional complication in order to closely monitor endangered patients.