BACKGROUND AND STUDY AIMS: The role of cyst cytology to diagnose mediastinal duplication cysts remains controversial. Since endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of duplication cysts has been considered as safe so far, there are only a few case reports of infections following FNA. CASE SUMMARY: We report a case series of all patients at our institution undergoing EUS evaluation for suspected mediastinal duplication cysts (n = 5) in the last 15 years. The mediastinal lesion in 4 patients did not feature typical EUS features for duplication cysts, wherefore we did perform EUS-guided FNA in order to rule out malignancy. In 3 out of 4 patients, a duplication cyst was confirmed. The fourth lesion turned out to be a sarcoma. All 4 patients developed severe FNA-induced cyst infection causing mediastinitis and the need for surgical debridement. Despite an immediate review of the FNA by the on-site cytopathologist with establishing the diagnosis of a duplication cyst, peri-interventional broad-spectrum antibiotics could not prevent severe infections of the lesions. CONCLUSIONS: Given the potentially high rate of infectious complications, we advocate a very restrictive indication for diagnostic FNA in mediastinal masses. Yet, in unclear cases, FNA might be indispensable despite the potential adverse events in order to rule out hypoechogenic, mediastinal malignancy.
BACKGROUND AND STUDY AIMS: The role of cyst cytology to diagnose mediastinal duplication cysts remains controversial. Since endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of duplication cysts has been considered as safe so far, there are only a few case reports of infections following FNA. CASE SUMMARY: We report a case series of all patients at our institution undergoing EUS evaluation for suspected mediastinal duplication cysts (n = 5) in the last 15 years. The mediastinal lesion in 4 patients did not feature typical EUS features for duplication cysts, wherefore we did perform EUS-guided FNA in order to rule out malignancy. In 3 out of 4 patients, a duplication cyst was confirmed. The fourth lesion turned out to be a sarcoma. All 4 patients developed severe FNA-induced cyst infection causing mediastinitis and the need for surgical debridement. Despite an immediate review of the FNA by the on-site cytopathologist with establishing the diagnosis of a duplication cyst, peri-interventional broad-spectrum antibiotics could not prevent severe infections of the lesions. CONCLUSIONS: Given the potentially high rate of infectious complications, we advocate a very restrictive indication for diagnostic FNA in mediastinal masses. Yet, in unclear cases, FNA might be indispensable despite the potential adverse events in order to rule out hypoechogenic, mediastinal malignancy.
Entities:
Keywords:
Case series; Cyst infection; Duplication cyst; Endoscopic ultrasound-guided fine needle aspiration; Esophagus; Submucosal mass
Authors: Dayna S Early; Ruben D Acosta; Vinay Chandrasekhara; Krishnavel V Chathadi; G Anton Decker; John A Evans; Robert D Fanelli; Deborah A Fisher; Lisa Fonkalsrud; Joo Ha Hwang; Terry L Jue; Mouen A Khashab; Jenifer R Lightdale; V Raman Muthusamy; Shabana F Pasha; John R Saltzman; Ravi N Sharaf; Amandep K Shergill; Brooks D Cash Journal: Gastrointest Endosc Date: 2013-06 Impact factor: 9.427
Authors: R St-Georges; J Deslauriers; A Duranceau; R Vaillancourt; C Deschamps; G Beauchamp; A Pagé; J Brisson Journal: Ann Thorac Surg Date: 1991-07 Impact factor: 4.330
Authors: Stephan M Wildi; Rana S Hoda; William Fickling; Nathan Schmulewitz; Shyam Varadarajulu; Stacey S Roberts; Brenda Ferguson; Brenda J Hoffman; Robert H Hawes; Michael B Wallace Journal: Gastrointest Endosc Date: 2003-09 Impact factor: 9.427