Open AccessRespiratory failure with hilar mass: Role of endobronchial ultrasound-guided transbronchial needle aspiration in the medical intensive care unit
Author(s) -
Astha Chichra,
Kimmoi Wong Lama,
Seth Koenig
Publication year - 2015
Publication title -
lung india
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 25
eISSN - 0974-598X
pISSN - 0970-2113
DOI - 10.4103/0970-2113.152647
Subject(s) - medicine , respiratory failure , etiology , intensive care unit , radiology , intubation , endobronchial ultrasound , bronchoscopy , surgery , intensive care medicine
We report the case of a 58-year-old man on chronic steroid therapy, who developed a rapidly progressive right upper lobe infiltrate/mass that extended into the right hilum. Respiratory failure necessitated endotracheal intubation. Broad spectrum antibiotics were initiated without clinical improvement and because of his immunosuppressive therapy opportunistic pathogens were considered. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed in the Medical Intensive Care Unit (MICU) with rapid onsite evaluation. Specimens obtained from the right hilar mass revealed organisms suspicious for cryptococcal infection, subsequently confirmed via a culture. No complications occurred during the EBUS procedure despite the patient requiring vasopressor support and 100% inspired oxygen. Little data exists regarding the use of EBUS in patients admitted to the MICU with respiratory failure of unknown etiology and mediastinal/hilar lymphadenopathy. This case illustrates the potential safe use of EBUS-TBNA in patients presenting with respiratory failure, with a mediastinal or hilar mass and suspected infectious etiology.