Airway stenosis complicated by endobronchial ultrasound-guided tissue acquisition: A case report

Endobronchial ultrasound (EBUS)-guided tissue acquisition (TA) performed by transbronchial needle aspiration (TBNA) is the main diagnostic procedure in mediastinal and hilar lymph node (LN) biopsy. EBUS-guided intranodal forceps biopsy (EBUS-IFB) and EBUS-guided cryobiopsy can achieve higher diagnostic yield of lymphomas, uncommon tumors, and benign diseases. However, these techniques require the creation of a tract to insert biopsy devices, which may result in critical complications. Here, we report a rare case of airway stenosis (AS) that occurred after EBUS-TA for mediastinal LN biopsy. An 80-year-old man had multiple pulmonary nodules and an enlarged mediastinal LN. EBUS-TBNA and EBUS-IFB were performed for histological diagnosis. Cutaneous adnexal carcinoma (CAC) was diagnosed. The patient underwent chemotherapy. Four months later, he was hospitalized for AS due to a tracheal tumor with dyspnea. Chest computed tomography and bronchoscopy revealed that the tracheal tumor was caused by invasion from the biopsied LN into the tracheal lumen by tract seeding (TS) caused by EBUS-TA. Cryotherapy was performed. The tracheal tumor was pathologically consistent with CAC and is currently under control with radiotherapy. TS-associated EBUS-TA is rare but may increase in frequency with aggressive tissue sampling techniques. Bronchoscopists should perform EBUS-TA with awareness of the potentially serious complications.