A Complication of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA): Pneumomediastinum

Abstract

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic tool with low complication rates. Pneumomediastinum is a rare complication. Here, we report a 67-year-old woman who underwent EBUS-TBNA for investigation of suspected lung cancer. During EBUS-TBNA, the posterior tracheal wall collapsed suddenly, and the patient reported neck swelling, voice changes, and pain on swallowing. Examination revealed subcutaneous emphysema and imaging showed extensive pneumomediastinum. The patient was managed conservatively. A subsequent EBUS revealed granulomas, and the final diagnosis was tuberculosis. Although EBUS-TBNA is generally safe, rare complications like pneumomediastinum can occur. Symptoms such as neck swelling, and chest pain should prompt further evaluation. Chest X-rays may miss the diagnosis in up to 30% of cases, making CT imaging the investigation of choice. Conservative management is appropriate in haemodynamically stable patients. This case describes the identification and management of EBUS-induced mediastinum in a haemodynamically stable patient. We recommend suspecting pneumomediastinum in cases where the posterior tracheal wall collapses suddenly during EBUS-TBNA.