Endobronchial ultrasound-guided transbronchial needle aspiration in patients with superior vena cava obstruction.

Lung cancer is commonly encountered by community and hospital services and patients may present with early signs of superior vena cava obstruction (SVCO). SVCO requires prompt but minimally invasive investigation to avoid bleeding and for prompt treatment. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) provides respiratory physicians with a less invasive technique to sample mediastinal lymph nodes at bronchoscopy, avoiding the need for general anesthesia and mediastinoscopy, and allowing real-time imaging and sampling of the nodes. It is therefore safer than conventional bronchoscopic techniques of sampling the nodes (transbronchial needle aspiration), reducing the risk of bleeding. If neck ultrasound biopsy is unhelpful in SVCO, then EBUS-TBNA should be considered as the best initial option, reserving mediastinoscopy for a last resort. A clinical case is described here to demonstrate the use of EBUS-TBNA in SVCO. EBUS-TBNA is a safe and effective mediastinal sampling tool in patients with SVCO and should be considered before mediastinoscopy or conventional TBNA in this setting. This study adds shoes there should be more emphasis on the use of EBUS-TBNA in the diagnosis of mediastinal disorders in settings where higher bleeding is anticipated, including SVCO.