Original Article

Major Complications Associated with Conventional Transbronchial Needle Aspiration

Authors: Muhammad K. Zaman, MD, Rabin Shrestha, MD

Abstract

Objectives: Transbronchial needle aspiration (TBNA) is a widely used sampling technique for diagnosis and staging of lesions centered around bronchoscopically accessible airways. We report our single-institution experience of complications associated with conventional TBNA (C-TBNA) performed in 606 consecutive cases.

Methods: Electronic medical records with bronchoscopy log data of C-TBNAs performed from January 2003 to December 2016 were assessed. All of the cases were included for a review of complications related to the performance of C-TBNA. C-TBNAs were performed in conjunction with other bronchoscopic sampling techniques such as brush, biopsy, and wash in most cases. Complications ascribed to C-TBNA only were included for this analysis and review.

Results: Infectious complications following the performance of TBNA are related to the inoculation of oropharyngeal bacteria from the airway lumen into the sterile mediastinal, pericardial, or pleural space.

Conclusions: Complications related to TBNA are underappreciated mainly because of the lack of reporting and awareness. These findings should lead to heightened awareness and precaution in all patients undergoing TBNA, and extra vigilance and monitoring during and after the procedure in those receiving anticoagulant and antiplatelet therapies.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Mehta AC, Wang KP. Teaching conventional transbronchial needle aspiration. A continuum. Ann Am Thorac Soc 2013;10:685-689.
 
2. Cağlayan B, Yilmaz A, Bilaceroğlu S, et al. Complications of convex-probe endobronchial ultrasound-guided transbronchial needle aspiration: a multi-center retrospective study. Respir Care 2016;61:243-248.
 
3. Yan JH, Pan L, Chen XL, et al. Endobronchial ultrasound versus conventional transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathy: a meta-analysis. Springerplus 2016;5:1716.
 
4. Asano F, Aoe M, Ohsaki Y, et al. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013;14:50.
 
5. Harrow EM, Oldenburg FA Jr, Lingenfelter MS, et al. Transbronchial needle aspiration in clinical practice. A five-year experience. Chest 1989;96:1268.
 
6. Sherling BE. Complication with a transbronchial histology needle. Chest 1990;98:783.
 
7. Witte MC, Opal SM, Gilbert JG, et al. Incidence of fever and bacteremia following transbronchial needle aspiration. Chest 1986;89:85-87.
 
8. Epstein SK, Winslow CJ, Brecher SM, et al. Polymicrobial bacterial pericarditis after transbronchial needle aspiration. Case report with an investigation on the risk of bacterial contamination during fiberoptic bronchoscopy. Am Rev Respir Dis 1992;146:523-525.
 
9. Wang KP, Britt EJ, Haponik EF, et al. Rigid transbronchial needle aspiration biopsy for histological specimens. Ann Otol Rhinol Laryngol 1985;94:382.
 
10. von Bartheld MB, van Breda A, Annema JT. Complication rate of endosonography (endobronchial and endoscopic ultrasound): a systematic review. Respiration 2014;87:343-351.
 
11. Miller DR, Mydin HH, Marshall AD, et al. Fatal haemorrhage following endobronchial ultrasound-transbronchial needle aspiration: an unfortunate first. QJM 2013;106:295-296.
 
12. Aguilar-Lopez CA, Weir I, Winter S. Fatal hemoptysis after endobronchial ultrasound guided mediastinal biopsies. Am J Respir Crit Care Med 2013;187:A5809.
 
13. Eapen GA, Shah AM, Lei X, et al. Complications, consequences, and practice patterns of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE registry. Chest 2013;143:1044-1053.
 
14. Kucera RF, Wolfe GK, Perry ME. Hemomediastinum after transbronchial needle aspiration. Chest 1986;90:466.
 
15. Lazzari Agli L, Trisolini R, Burzi M, et al. Mediastinal hematoma following transbronchial needle aspiration. Chest 2002;122:1106-1107.
 
16. Talebian M, Recanatini A, Zuccatosta L, et al. Hemomediastinum as a consequence of transbronchial needle aspiration. J Bronchology Interv Pulmonol 2004;11:178-181.
 
17. Botana-Rial M, Nunez-Delgado M, Pallarés-Sanmartin A, et al. Intramural hematoma of the pulmonary artery and hemopneumomediastinum after endobronchial ultrasound-guided transbronchial needle aspiration. Respiration 2012;83:353-356.
 
18. Franco J, Llopis E, Gala G. Hemothorax after endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol 2016;23:328-330.
 
19. Meena N, Abouzgheib W, Patolia S, et al. EBUS-TBNA and EUS-FNA: risk assessment for patients receiving clopidogrel. J Bronchology Interv Pulmonol 2016;23:303-307.
 
20. Ernst A, Eberhardt R, Wahidi M, et al. Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest 2006;129:734-737.
 
21. Watts WJ, Green RA. Bacteremia following transbronchial fine needle aspiration. Chest 1984;85:295.
 
22. Moffatt AF, Quraishi E, Zeitouni M, et al. Chylothorax complicating transbronchial needle aspiration: a case report. J Bronchology Interv Pulmonol 2007;14:127-128.
 
23. Haas AR. Infectious complications from full extension endobronchial ultrasound transbronchial needle aspiration. Eur Respir J 2009;33: 935-938.
 
24. Parker KL, Bizekis CS, Zervos MD. Severe mediastinal infection with abscess formation after endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Surg 2010;89:1271-1272.
 
25. Moffatt-Bruce SD, Ross P, Jr. Mediastinal abscess after endobronchial ultrasound with transbronchial needle aspiration: a case report. J Cardiothorac Surg 2010;5:33.
 
26. Kouskov OS, Almeida FA, Eapen GA, et al. Mediastinal infection after ultrasound-guided needle aspiration. J Bronchology Interv Pulmonol 2010;17:338-341.
 
27. Huang CT, Chen CY, Ho CC, et al. A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration. Eur J Cardiothorac Surg 2011;40:264-265.
 
28. Leong SC. Mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review. J Bronchology Interv Pulmonol 2013;20:338-341.
 
29. Gochi F, Chen F, Aoyama A, et al. Mediastinal infectious complication after endobronchial ultrasound-guided transbronchial needle aspiration. Interact Cardiovasc Thorac Surg 2013;17:751-752.
 
30. Lee HY, Kim J, Jo YS, et al. Bacterial pericarditis as a fatal complication after endobronchial ultrasound-guided transbronchial needle aspiration. Eur J Cardiothorac Surg 2015;48:630-632.
 
31. Voldby N, Folkersen BH, Rasmussen TR. Mediastinitis: a serious complication of endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol 2017;24:75-79.
 
32. Shweihat Y, Perry JD 3rd, Munn N. Severe pneumomediastinum complicating EBUS-TBNA. J Bronchology Interv Pulmonol 2015;22:e8-e9.
 
33. Ortiz R, Hayes M, Arias S, et al. Pneumomediastinum and pneumopericardium after endobronchial ultrasound-guided transbronchial needle aspiration. Ann Am Thorac Soc 2014;11:680-681.
 
34. Davis KL, Escobar SJ, Bradshaw DA. Pneumomediastinum complicating transbronchial needle aspiration. J Bronchology Interv Pulmonol 2009;16:193-195.
 
35. Gunasekaran K, Lone N, Edmonds P, et al. Contralateral pneumothorax: an unexpected complication of EBUS-TBNA. Chest 2016;150( 4 Suppl ):1033A.
 
36. Gnass M, Szlubowski A, Gil T, et al. Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes. Kardiochir Torakochirurgia Pol 2015;12:359-362.