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ABSTRACT
Year : 2017  |  Volume : 6  |  Issue : 8  |  Page : 51

Endoscopic ultrasound-guided fine needle aspiration of pleural deposits


Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.218423

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The most efficient and cost-effective approach to undiagnosed exudative pleural effusion remains uncertain. Both closed pleural biopsy and thoracoscopy may be utilized for the acquisition of pleural tissue. The cumulative yield of image-assisted (either ultrasound or computed tomography [CT]) repeat thoracocentesis and pleural biopsy has been reported to approach that of thoracoscopy. Thoracoscopy, either medical (pleuroscopy) or surgical (video-assisted thoracoscopic surgery [VATS]), remains gold standard in undiagnosed pleural effusion with or without pleural thickening/nodularity or mass. However, thoracoscopy has its own limitations and contraindications. Image-guided pleural biopsy by endoscopic ultrasound (EUS) has never been explored in the past. We describe case series of EUS-guided FNA of pleural deposits in four patients. Case 1: A 50-year-old man, chronic smoker, presented with cough and weight loss. A CT scan of chest revealed a 5 cm × 4 cm size lesion near the apex of lung with pleural effusion. Family was unwilling for thoracoscopy. Linear EUS was performed from esophagus. EUS revealed a well-defined hypoechoic mass above the aorta between esophagus and chest wall. Fine needle aspiration FNAC showed non-small cell lung cancer. Case 2: A 58-year-old man, a smoker for 34 years, was evaluated for breathlessness and chest pain. CT scan revealed a pleural effusion and a nodule on the mediastinal aspect of pleura. He was unfit for bronchoscopy/thoracoscopy. EUS revealed 1.7 cm × 1 cm hypoechoic deposit on mediastinal pleura with pleural effusion. FNAC was diagnostic of nonsmall cell lung cancer. Case 3: A 65-year-old man, a smoker for 40 years, presented with breathlessness. A CT chest showed a mass above right lobe of liver and right-sided pleural effusion. He had low baseline oxygen saturation and could not be stabilized even after supportive therapy. An EUS-guided examination was done without sedation. Hypoechoic deposit was seen extending from diaphragmatic aspect to mediastinal aspect of pleura. FNAC was diagnostic of nonsmall cell lung cancer. Case 4: A 60-year-old morbidly obese (weight 124 kg) female presented with recurrent undiagnosed exudative pleural effusion. CT scan showed a mass close to right bronchus with massive right side pleural effusion. She was unfit for bronchoscopy or thoracoscopy. An EUS examination was done without any sedation. EUS revealed 5 cm × 6 cm hypoechoic mass (deposit) on mediastinal pleura with pleural effusion. FNAC showed multiple caseating granulomas suggestive of tuberculosis.


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