Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with a three-way stopcock for mediastinal cysts through negative pressure drainage: a case report.

内容摘要

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can extract cystic fluid for diagnosis, but evidence is mainly limited to case reports with infection risk. Against this background, we will report the clinical case that explores the improvement strategy of EBUS-TBNA combined with a three-way stopcock device to reduce infection rates and review the relevant literature, using the search term '(((endobronchial ultrasound-guided transbronchial needle aspiration) OR (EBUS-TBNA)) AND ((cysts) OR (mediastinal cysts) OR (bronchogenic cysts)))' from PubMed. A 66-year-old female patient presented with exertional dyspnea, and computed tomography (CT) showed a 59 mm × 53 mm cystic lesion in the right upper posterior mediastinum, which was treated by EBUS-TBNA (utilizing a 22-gauge needle and a three-way stopcock), successfully aspirating 170 mL of clear yellow fluid. Postoperative tracheal compression was relieved with immediate symptomatic relief. No recurrence or complications were observed during the 3-month postoperative follow-up. Additionally, a total of 22 papers were included. Among 20 case reports (49 cases), 17 improved, 16 required surgery, and 7 had postoperative infections. While EBUS-TBNA serves as a valuable diagnostic and therapeutic tool for cystic lesions, postoperative infection remains a significant concern, particularly during necrotic cavity puncture. EBUS-TBNA combined with negative pressure drainage of the three-way stopcock optimizes the workflow to prevent spillage and may potentially mitigate infection risks by maintaining a closed system. While long-term outcomes require further observation, this technique may represent a feasible adjunct to EBUS-TBNA in selected patients with mediastinal cystic lesions.