Tracheomediastinal Fistulae: A Rare Complication of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration for Lung Cancer Diagnosis

Gregory Berra, Paola Marina Soccal and Jérôme Plojoux

Division of Pneumology, Geneva University Hospital, Switzerland

^*Correspondance to: Gregory Berra 

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Abstract:

Introduction: Tracheal or bronchial fistulae seem to be a very rare complication only reported in a few cases.Case Report: We report the case of a 68-year-old woman with poorly differentiated lung adenocarcinoma diagnosed by bronchoscopy with EBUS-TBNA of the 4R mediastinal station under local anesthesia. Because of a major mass effect on the superior cava vein by mediastinal adenopathies compression, the patient undergoes urgent decompressive radiotherapy (Total delivered dose = 45 Gy in 15 sessions). Adjuvant chemotherapy is planned. Before the initiation of chemotherapy, a few days after the end of radiotherapy, the patient presents with cough, purulent sputum and fever. A thoracic CT scan shows pulmonary infiltrates suggestive of acute community-acquired pneumonia. In addition, there is evidence of bronchomediastinal fistula in front of mediastinal 4R station and located at the site of TBNA but without any clinical or radiological element suggestive of acute mediastinitis. At this time a control bronchoscopy confirms the presence of BMF.Conclusion: BMF is a rare complication with few reported cases. Yet this complication could be underreported. Favoring risk factors of BMF are not well known. If an association with bevacizumab treatment and intratumoral injection of cisplatin has already been described, this is to our knowledge, the first published case of a BMF occurring after radiotherapy.

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Cite the Article:

Berra G, Soccal PM, Plojoux J. Tracheomediastinal Fistulae: A Rare Complication of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration for Lung Cancer Diagnosis. Ann Clin Case Rep. 2017; 2: 1419.