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Case Reports
. 2025 Jan 8;25(1):10.
doi: 10.1186/s12890-024-03470-3.

Iatrogenic intramural esophageal hematoma during EUS-B-FNA procedure

João Oliveira Rodrigues  1 , Paulo Matos  2 , Luís Vaz Rodrigues  2   3 , Michele de Santis  2 , Lourdes Barradas  2
Affiliations
Case Reports

Iatrogenic intramural esophageal hematoma during EUS-B-FNA procedure

João Oliveira Rodrigues et al. BMC Pulm Med. .

Abstract

Background: Esophageal ultrasound with bronchoscope fine needle aspiration (EUS-B-FNA) is a valuable tool for the diagnosis and staging of lung cancer, complementing endobronchial lung ultrasound (EBUS). While generally considered safe, there is a notable lack of comprehensive knowledge within the interventional pulmonology community regarding potential complications.

Case presentation: We present a case involving a 66-year-old male with squamous cell lung carcinoma undergoing mediastinal staging. A systematic mediastinal assessment through EBUS confirmed the presence of enlarged lymph nodes at 4 L with limited access to puncture. Complementary EUS-B widened the visualization and access to station 4 L and after excluding nearby vessels, a single puncture was performed. Unexpectedly, an iatrogenic esophageal hematoma was promptly noted at the puncture site. The procedure was immediately interrupted, and subsequent workup confirmed the hematoma without active bleeding. Conservative management, including upper endoscopy and clip sealing, resulted in the patient's asymptomatic recovery.

Conclusion: This case underscores the importance of recognizing and managing complications associated with EUS-B-FNA, emphasizing the need for heightened awareness and education in the interventional pulmonology community. Despite being infrequently discussed in medical literature, EUS-B-FNA can give rise to both immediate and delayed complications, warranting increased vigilance during its practice.

Keywords: EBUS; EUS-B; Esophageal hematoma; Lung cancer.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Written informed consent was obtained from the patient. Ethics approval is not applicable to case reports. Consent for publication: A written and verbal informed consent was obtained from the patient for publication of this case report and accompanying images. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
(a) - Identification of station 4 L through EUS-B. (b) - Identification of esophageal hematoma after puncture of 4 L by EUS-B-FNA
Fig. 2
Fig. 2
(a) - Baseline CT scan where esophageal lumen is evident. (b) – CT angiography which confirms esophageal wall thickening and luminal collapse after EUS-B-FNA relating to the presence of a hematoma
See this image and copyright information in PMC

References

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