Ultrasound guided fine needle aspiration of a lung mass via a transesophageal approach using endobronchial ultrasound bronchoscope

Diagnostic accuracy, safety and minimal invasiveness are well established advantages of the endobronchial ultrasound (EBUS) technique when used for lung cancer staging. Combining it with transesophageal ultrasound can offer complete mediastinal staging, extending the reach of this technique to lymph node stations that are inaccessible even by mediastinoscopy. Traditionally this has been achieved by arranging a bronchoscopist and gastroenterologist to perform the procedure on two separate occasions using two separate expensive systems. Performing the procedure with a single physician (pulmonologist) using a single scope offers logistical advantages. For this reason, the practice of fine needle aspiration (FNA) via both the transbronchial and transesophageal approach by a pulmonologist using the single EBUS scope has emerged and is likely to grow and become widely accepted in future. The present case reports illustrate the additional applicability of allowing direct puncture of a lung mass using transesophageal FNA done by a pulmonologist using a single EBUS scope as a part of the combined approach.