Tuberc Respir Dis.  2015 Oct;78(4):419-422. 10.4046/trd.2015.78.4.419.

The Natural Course of Endobronchial Inflammatory Polyps as a Complication after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

• Lee KM
• Jang SM
• Oh SY
• Kim DY
• Lee G
• Kim A
• Kim MJ
• Kim TH
• Park JW
• Lee K
• Kim KU
• Lee MK
• Eom JS

• KMID: 2320719
• DOI: http://doi.org/10.4046/trd.2015.78.4.419

Abstract

We presented a case of unusual endobronchial inflammatory polyps as a complication following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in a patient with tuberculous lymphadenitis. EBUS-TBNA of the right hilar lymph node was performed in a 29-year-old, previously healthy man. The patient was confirmed with tuberculous lymphadenitis and received antituberculosis medication over the course of 6 months. Chest computed tomography, after 6 months of antituberculosis therapy following the EBUS-TBNA showed nodular bronchial wall thickening of the right main bronchus. Histological and microbiological examinations revealed inflammatory polyps. After 7 months, the inflammatory polyps regressed almost completely without need for removal.

Keyword

Needles; Complications; Lymphadenitis; Polyps; Tuberculosis

MeSH Terms

Adult
Bronchi
Humans
Lymph Nodes
Lymphadenitis
Needles*
Polyps*
Thorax
Tuberculosis
Tuberculosis, Lymph Node

Figure

• 

  Figure 1 A 29-year-old male with tuberculous lymphadenitis of the right upper paratracheal, both lower paratracheal, subcarinal, and right hilar lymph nodes. (A) Initial chest computed tomography shows conglomerated, enlarged lymph nodes with central necrosis in the right hilar area. (B) No endobronchial lesion was found at the right main bronchus or secondary carina on initial flexible bronchosocpy. (C) An endobronchial ultrasound image of the right lower paratracheal and hilar lymph nodes showed a hypoechoic texture, and transbronchial needle aspiration was performed under real-time ultrasound guidance. (D) The histopathology showed chronic granulomatous inflammation with necrosis (H&E stain, ×400).

• 

  Figure 2 Computed tomography was performed to assess the treatment response after 6 months of antituberculosis treatment. (A) A newly developed endobronchial lesion was found on computed tomography (arrows). (B) Lobulating nodular lesions at the distal right main bronchus and right secondary carina were noted on flexible bronchoscopy. (C) Forceps biopsy of the newly developed endobronchial lesions revealed chronic granulomatous inflammation (H&E stain, ×400).

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  Figure 3 The natural course of the inflammatory polyps. (A) After 3 months, flexible bronchoscopy indicated a decreased size of the endobronchial inflammatory polyps . (B) A narrow-band imaging bronchoscopic scan taken after 3 months. (C) After 7 months, the endo bronchial inflammatory polyps had spontaneously regressed almost com pletely. (D) A narrow-band imaging bronchoscopic scan taken after 7 months.

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