Diagnosis of pulmonary thromboembolism with endobronchial ultrasound

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities

Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.

Pulmonary Embolism Diagnosed During Endobronchial Ultrasound in a Patient With Major Trauma

Pulmonary embolism (PE) is a serious condition that often poses a diagnostic challenge. We report a case of a 57-year-old man with tobacco dependence who presented with multiple trauma, with chest imaging findings concerning for malignancy. While performing bronchoscopy with endobronchial ultrasound (EBUS), an echogenic material was incidentally found in the left pulmonary artery. Computed tomography pulmonary angiography (CTPA) was immediately obtained and confirmed the diagnosis of PE. This case illustrates the utility of routine pulmonary artery examination during EBUS procedures in patients at risk of PE and the importance of prompt management including confirmation with CTPA.

Role of Convex Probe Endobronchial Ultrasound in the Diagnosis and Treatment of Nonmalignant Diseases

Here we present a comprehensive review of the literature concerning the utility of convex probe endobronchial ultrasound (CP-EBUS) in the diagnosis and treatment of nonmalignant conditions and discuss the associated complications. CP-EBUS has been conventionally used for the staging of lung cancer and sampling of mediastinal and hilar nodes. However, its application is not limited to malignant conditions, and it is gaining acceptance as a diagnostic modality of choice for nonmalignant conditions such as tuberculosis, sarcoidosis, pulmonary embolism, thyroid lesions, and cysts. Moreover, its therapeutic value allows for extended applications such as mediastinal and thyroid cyst drainage, fiducial marker placement for radiation therapy, and transbronchial needle injection. The noninvasiveness, low complication rate, high diagnostic yield, and satisfactory sensitivity and specificity values are the main attributes that lend credence to the use of CP-EBUS as a standalone primary diagnostic and therapeutic tool in pulmonary medicine in the foreseeable future.

Four cases of pulmonary thromboembolism diagnosed by endobronchial ultrasound

Endobronchial ultrasound (EBUS) is a technique for the detection of mediastinal abnormalities. A total of 548 EBUS procedures were performed for various indications, and in four cases (0.7%), filling defects in central pulmonary arteries were demonstrated fortuitously during the procedure. Subsequently, all patients underwent contrast-enhanced CT of the thorax to confirm the diagnosis of pulmonary thromboembolism (PTE). In three of the four cases, there was a concomitant lung cancer. PTE can be incidentally detected during EBUS; therefore, pulmonary arteries should be examined carefully during EBUS in all patients, particularly in patients with suspected or proven malignancy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:441-444, 2017.

Diagnosis of pulmonary embolism by endobronchial ultrasound

This is a case report of a young 20-year-old male who was referred for an endobronchial ultrasound (EBUS) procedure to investigate a fever and a left hilar lymph node and patchy pleural-based opacities seen on CT of the chest. During the EBUS procedure besides the left hilar node, a large thrombus was noticed in the main pulmonary artery and another one in the right pulmonary artery. EBUS proved invaluable in making a diagnosis in an unsuspected case of pulmonary embolism.

Endobronchial ultrasound: beyond nodes and masses

Pulmonary embolism (PE) is a life‐threatening condition with varied presentation and, therefore, poses clinical challenge for early diagnosis and proper management without which it carries high mortality. Previous studies on the role of endobronchial ultrasound (EBUS) in diagnosis of PE were carried out after PE was already diagnosed by computed tomography pulmonary angiography. We report a case of massive PE with shock, promptly diagnosed with bed side EBUS – Doppler study, as patient's clinical condition did not allow conventionally proposed diagnostic algorithm.

Endobronchial ultrasound-guided transbronchial needle aspiration of pulmonary artery tumors: A systematic review (with video)

Convex probe endobronchial ultrasound (CP-EBUS) was originally introduced as a diagnostic and staging tool for lung cancer and subsequently utilized for diagnosis of other malignant and benign mediastinal diseases such as melanoma, lymphoma, and sarcoidosis. More recently, CP-EBUS has been successfully used for the visualization and diagnosis of pulmonary emboli and other vascular lesions including primary and metastatic pulmonary artery (PA) tumors. In this review, we will underline the role of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnosis of pulmonary arterial tumors such as sarcomas and tumor emboli. We will concisely discuss the clinical applications of EBUS-TBNA and the types of pulmonary arterial tumors and their different diagnostic modalities. We searched the Cochrane Library and PubMed from 2004 to 2014 to provide the most comprehensive review. Only 10 cases of EBUS-TBNA for intravascular lesions were identified in the literature. Although many cases of EBUS and EUS-guided transvascular tumor biopsies were described in the literature, there were no reported cases of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for intravascular tumor biopsies. Except for one paper, all cases were published as case reports.

Role of Transthoracic Lung Ultrasonography in the Diagnosis of Pulmonary Embolism: A Systematic Review and Meta-Analysis

Background

Pulmonary embolism (PE) is a potentially life-threatening condition. Although computed tomography pulmonary angiography (CTPA) is the reference standard for diagnosis, its early diagnosis remains a challenge, and the concerns about the radiation exposures further limit the general use of CTPA. The primary aim of this meta-analysis was to evaluate the overall diagnostic accuracy of transthoracic lung ultrasound (TLS) in the diagnosis of PE.

Methods

PubMed, Web of science, OvidSP, ProQuest, EBSCO, Cochrane Library and Clinicaltrial.gov were searched systematically. The quality of included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and hierarchical summary receiver operating characteristic (HSROC) curves were used to examine the TS performance. The Bayes analysis was used to calculate the post-test probability of PE. Publication bias was assessed with Deeks funnel plot.

Results

The results indicated that the sensitivity, specificity, PLR and NLR were 0.85 (95% confidence interval (CI), 0.78 to 0.90), and 0.83 (95% CI, 0.73 to 0.90). And the DOR and HSROC were 28.82 (95% CI, 17.60 to 47.21), 0.91(95% CI, 0.88, 0.93).

Conclusions

The present meta-analysis suggested that transthoracic lung ultrasonography is helpful in diagnosing pulmonary embolism. Although the application of transthoracic lung ultrasound may change some patients’ diagnostic processes, it is inappropriate to generally use transthoracic ultrasonography in diagnosing pulmonary embolism currently.

[Incidental bronchoscopic findings]

Inflexible and flexible bronchoscopy represents a standard diagnostic procedure in pneumology. Besides lung carcinomas, which is the most frequent indication for diagnostic bronchoscopy, a plethora of clinical symptoms such as chronic persistent cough, hoarseness, unexplained dyspnea, hemoptysis, and suspicious findings on auscultation require further endoscopic evaluation. Moreover, bronchoscopy plays a central role in the diagnostic work-up of interstitial lung diseases and persistent lung infiltrates, in particular those of infectious origin (e.g., fungal, viral, tuberculous, and Pneumocystis jiroveci infections). In addition, diagnostic bronchoscopy has more recently been complemented by endobronchial ultrasound (EBUS). EBUS is predominantly employed for the accurate diagnosis and mediastinal staging of lung carcinomas, and the assessment of lympadenopathy-associated diseases such as sarcoidosis.Since endoscopic evaluation is typically preceded by computed tomography (CT) of the chest, genuine incidental findings occur relatively seldom and usually account for pathological findings that have been missed on conventional imaging approaches. For instance, characteristic incidental findings include benign and malignant tumors in the area of the endoscopic access and central airways, anatomical variations and (vascular) malformations, tracheal and bronchial airway alterations, and aspirated objects. This review focuses on bronchoscopic findings that have either been completely missed by conventional imaging or differently interpreted due to its radiologic morphology.

Diagnostic imaging of pulmonary embolism using endobronchial ultrasound

Endobronchial ultrasound (EBUS) is a new technique that can be used for the diagnostic imaging of central pulmonary thromboembolism (PE). In eight cases at our clinic, EBUS was used because of mediastinal lymphadenopathies or paramediastinal nodular lesions and at the same time images were obtained of a PE by means of EBUS. The PE was diagnosed before the EBUS with computed tomography (CT) of the lungs in all cases (5 women and 3 men). The repletion defects of all the cases compatible with a PE were clarified with CT-angiography. EBUS may be an alternative method for the diagnosis of PE, as it can indicate the presence of a thrombus in the central pulmonary arteries in hemodynamically-stable cases.