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[一名76岁患者在进行超声内镜引导下经支气管冷冻活检(EBUS-TBCB)怀疑淋巴瘤后出现复杂的纵隔血肿]

[Complicated hematomediastinum in a 76-year-old patient after performing an endosonographically guided transbronchial cryobiopsy (EBUS-TBCB) with suspected lymphoma].

作者信息

Schwick Björn, Kintsler Svetlana, Lindemann-Docter Katharina, Jonigk Danny, Sodi Luna José Miguel, Krüger Ingo

机构信息

Klinik für Pneumologie, Luisenhospital Aachen, Aachen, Deutschland.

Institut für Pathologie, Universitätsklinikum Aachen, Aachen, Deutschland.

出版信息

Pneumologie. 2023 Mar;77(3):162-167. doi: 10.1055/a-2002-4972. Epub 2023 Feb 2.

Abstract

We present the case of a patient with severe complications from mediastinal bleeding after endosonographically guided transbronchial cryobiopsy (EBUS-TBKB) with suspected advanced lymphoma. The EBUS-TBKB is a new effective examination method in interventional pneumology for the diagnosis of diseases with mediastinal lymph node enlargement and intrathoracic tumors, with which large tissue cylinders in the mediastinum can be obtained. Due to the high diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the clarification of lymphadenopathy, the examination should not be carried out as a routine application. Indications for a primary EBUS-TBKB arise when there is a suspicion of intrathoracic malignant lymphomas or other rare tumors in which extensive unfragmented tissue material is required for diagnosis. A rare complication that has not yet been described in the literature is a hematomediastinum, so that a careful risk assessment of possible bleeding complications should be carried out before intervention and the more invasive mediastinoscopy can be a safer examination method.

摘要

我们报告了一例疑似晚期淋巴瘤患者在超声内镜引导下经支气管冷冻活检(EBUS-TBKB)后出现纵隔出血严重并发症的病例。EBUS-TBKB是介入肺病学中一种用于诊断纵隔淋巴结肿大和胸内肿瘤疾病的新型有效检查方法,通过该方法可获取纵隔内的大组织圆柱。由于支气管内超声引导下经支气管针吸活检(EBUS-TBNA)对明确淋巴结病具有较高的诊断价值,该检查不应作为常规应用。当怀疑有胸内恶性淋巴瘤或其他罕见肿瘤,且诊断需要大量完整的组织材料时,才是原发性EBUS-TBKB的适应证。文献中尚未描述的一种罕见并发症是纵隔血肿,因此在干预前应仔细评估可能的出血并发症风险,而侵入性更强的纵隔镜检查可能是一种更安全的检查方法。

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