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Severe Infectious Complications after Endoscopic Ultrasound-Guided Fine Needle Aspiration of Suspected Mediastinal

Piero V Valli1, Christoph Gubler1, Peter Bauerfeind1

  • 1Division of Gastroenterology and Hepatology, University Hospital Zürich, Zurich, Switzerland.

Inflammatory Intestinal Diseases
|June 21, 2018
PubMed
Abstract

Insights

Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) for mediastinal duplication cysts carries a high risk of severe infection, leading to mediastinitis. Restrictive use of FNA is advised due to these infectious complications.

Area of Science:

  • Gastroenterology
  • Thoracic Surgery
  • Diagnostic Cytopathology

Background:

  • The diagnostic utility of cyst cytology for mediastinal duplication cysts is debated.
  • Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) has been considered safe for duplication cysts, with limited reports of infection.

Purpose of the Study:

  • To evaluate the safety and efficacy of EUS-guided FNA in diagnosing suspected mediastinal duplication cysts.
  • To assess the incidence of infectious complications following FNA of mediastinal lesions.

Main Methods:

  • A case series of 5 patients undergoing EUS for suspected mediastinal duplication cysts over 15 years.
  • EUS-guided FNA was performed on 4 patients with atypical EUS features to rule out malignancy.

Main Results:

  • In 3 of 4 patients, FNA confirmed duplication cysts; the fourth was a sarcoma.
  • All 4 patients who underwent FNA developed severe, infection-induced mediastinitis requiring surgical debridement.
  • Broad-spectrum antibiotics did not prevent these post-FNA infections.

Conclusions:

  • EUS-guided FNA for mediastinal masses should be used restrictively due to a high rate of infectious complications.
  • In ambiguous cases, FNA may be necessary to exclude mediastinal malignancy, despite potential adverse events.
Keywords:
Case seriesCyst infectionDuplication cystEndoscopic ultrasound-guided fine needle aspirationEsophagusSubmucosal mass

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