Cystic lesions of the thorax: role of endobronchial ultrasound-guided transbronchial needle aspiration.

Traditional management of cystic lesions involving the mediastinum or lung parenchyma consists of surgical resection. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been reported to successfully treat bronchogenic cysts. We present 2 cases in which EBUS-TBNA was performed to aid in making the diagnosis. Endobronchial ultrasound imaging and TBNA were successful in both cases. The mediastinal cyst was therapeutically managed with complete aspiration in one case, whereas in the other an intraparenchymal cyst was found to be multiloculated and could only be partially aspirated and required surgical excision. EBUS-guided real-time aspiration of intrathoracic cysts can be both diagnostic and therapeutic in simple mediastinal bronchogenic cysts that can be fully aspirated. However, surgical resection may be required for multiloculated intraparenchymal cysts that cannot be aspirated completely. EBUS guidance helps to identify multiloculation and completeness of the aspiration.