An unusual, life-threatening complication of EBUS-TBNA: Pneumoperitoneum

Abstract

Endobronchial ultrasound-guided with transbronchial needle aspiration (EBUS-TBNA) is a safe procedure. We present an unusual life-threatening complication after EBUS-TBNA in a 43-year-old female. She underwent EBUS-TBNA for enlarged lymph nodes evaluation. After EBUS-TBNA, a progressively worsening abdominal distension was observed. In computed tomography, subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitoneum were detected. This complication was successfully treated with chest tube insertion and bedside abdominal decompression. Even though EBUS-TBNA is considered to bear a low risk, the possibility of complication occurrence must be taken into account and clinicians must be more cautious about pulmonary barotrauma, especially when EBUS-TBNA is performed.

Keywords: EBUS-TBNA; pneumomediastinum; pneumoperitoneum; pneumothorax; pulmonary barotrauma.

Figure 1

Chest-computed tomography on admission showing enlarged lymph nodes

Figure 2

Chest and abdominal-computed tomography (CT) after EBUS-TBNA. (a) Coronal view of CT showing subcutaneous emphysema (red arrow), pneumothorax (purple arrow), pneumomediastinum (orange arrow) and pneumoperitoneum (blue arrows), (b) Sagittal view of CT showing pneumoperitoneum (blue arrow), (c) Axial view of chest CT showing pneumothorax (purple arrows), pneumomediastinum (orange arrow), (d) Axial view of abdomen CT showing pneumoperitoneum (blue arrow)

Figure 3

Chest-computed tomography (CT) and abdominal CT with oral contrast solution after insertion of the chest tube and bedside abdominal decompression. (a) Coronal view of CT, (b) Sagittal view of CT showing pneumoperitoneum (blue arrow), (c) Axial view of CT showing nasogastric tube (orange arrow) and chest tube (purple arrow), (d) Axial view of abdomen CT with oral contrast solution (red arrow) demonstrated no leakages neither perforation