Ultrasound-guided transbronchial needle aspiration using the bronchoscope with a dedicated curvilinear probe has emerged as a primary tool for the investigation of mediastinal pathology. Recently, the utility of this scope has been expanded to include access via the esophagus. In this case series, we describe a role for esophageal ultrasound using the endobronchial ultrasound bronchoscope in the diagnostic evaluation of critically ill/intubated patients with mediastinal disease. Esophageal access with the ultrasound bronchoscope allows the pulmonologist to diagnose mediastinal disease in the intubated patient with minimal risk.
KrasnikMVilmannPLarsenSSJacobsenGK. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax. 2003;58(12):1083–1086.
2.
WallaceMBRavenelJBlockMI. Endoscopic ultrasound in lung cancer patients with a normal mediastinum on computed tomography. Ann Thorac Surg. 2004;77(5):1763–1768.
3.
YasufukuKChiyoMSekineY. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126(1):122–128.
4.
HerthFJLunnWEberhardtRBeckerHDErnstA. Transbronchial versus transesophageal ultrasound-guided aspiration of enlarged mediastinal lymph nodes. Am J Respir Crit Care Med. 2005;171(10):1164–1167.
5.
VilmannPKrasnikMLarsenSSJacobsenGKClementsenP. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy. 2005;37(9):833–839.
6.
YasufukuKNakajimaTChiyoMSekineYShibuyaKFujisawaT. Endobronchial ultrasonography: current status and future directions. J Thorac Oncol. 2007;2(10):970–979.
AbouzgheibWNahraRHomsiSBartterT.Safety and feasibility of identifying and sampling of mediastinal structures through the esophagus using EBUS [abstract]. Chest. 2009;136(suppl):110S–b.
9.
HerthFJKrasnikMKahnNEberhardtRErnstA. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest. 2010;138(4):790–794.
10.
HwangboBLeeGKLeeHS. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest. 2010;138(4):795–802.
11.
BartterTPratterMR. Bronchoscopy and lung biopsy in the critically ill. In: JEParillo, ed. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. Philadelphia, PA: Mosby Elsevier; 2008:205–217.
12.
AlbertiniREHarrellJH 2ndKuriharaNMoserKM. Arterial hypoxemia induced by fiberoptic bronchoscopy. JAMA. 1974;230(12):1666–1667.
13.
LindholmCEOllmanBSnyderJMillenEGrenvikA.Flexible fiberoptic bronchoscopy in critical care medicine. Diagnosis, therapy and complications. Crit Care Med. 1974;2(5):250–261.
14.
MatsushimaYJonesRLKingEGMoysaGAltonJD. Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy. Chest. 1984;86(2):184–188.
15.
LindholmCEOllmanBSnyderJVMillenEGGrenvikA. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest. 1978;74(4):362–368.
16.
KennedyMPJimenezCABruzziJF. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of lymphoma. Thorax. 2008;63(4):360–365.
17.
TremblayAStatherDRMaceachernPKhalilMFieldSK. A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest. 2009;136(2):340–346.
18.
SwisherSGMaishMErasmusJJ. Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg. 2004;78(4):1152–1160.
19.
WildiSMJudsonMAFraigM. Is endosonography guided fine needle aspiration (EUS-FNA) for sarcoidosis as good as we think?Thorax. 2004;59(9):794–799.
20.
CaddyGConronMWrightGDesmondPHartDChenRY. The accuracy of EUS-FNA in assessing mediastinal lymphadenopathy and staging patients with NSCLC. Eur Respir J. 2005;25(3):410–415.
21.
Fritscher-RavensASriramPVPothmanWP. Bedside endosonography and endosonography-guided fine-needle aspiration in critically ill patients: a way out of the deadlock?Endoscopy. 2000;32(5):425–427.
22.
AbouzgheibWShweihatYBartterT. Oesophageal applications of the convex curvilinear ultrasound bronchoscope; an illustrative case series. Respirology. 2011;16(6):965–968.
23.
LeviMSchultzM. Coagulopathy and platelet disorders in critically ill patients. Minerva Anestesiol. 2010;76(10):851–859.
24.
LarsenSSVilmannPKrasnikM. Endoscopic ultrasound guided biopsy versus mediastinoscopy for analysis of paratracheal and subcarinal lymph nodes in lung cancer staging. Lung Cancer. 2005;48(1):85–92.
25.
YasufukuKPierreADarlingG. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142(6):1393–1400.
26.
MicamesCGMcCroryDCPaveyDAJowellPSGressFG. Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis. Chest. 2007;131(2):539–548.
27.
VilmannPLarsenSS. Endoscopic ultrasound-guided biopsy in the chest: little to lose, much to gain. Eur Respir J. 2005;25(3):400–401.
