Abstract Introduction Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard-of-care technique for evaluating mediastinal lesions. The EBUS bronchoscope can also be introduced through the oesophageal route to perform transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). This approach provides access to left para-oesophageal, subcarinal, and paraoesophageal nodes, as well as left adrenal gland (LAG). In suspected lung cancer, accurate staging is crucial since adrenal metastasis is common and maybe solitary. Here, we report a case of LAG sampling using the EUS-B-FNA approach. Case A 42-year-old iron factory worker and chronic smoker for 25 years presented with exertional breathlessness and a productive cough for two months, along with facial puffiness for six weeks associated with weight loss and poor appetite. Examination showed bilateral grade 3 clubbing. PET-CT revealed a heterogeneous right paratracheal mass and a left adrenal mass indenting the left kidney (Figure 1, Figure 2). An EUS-B-guided approach was planned for fine-needle aspiration of the LAG to allow simultaneous diagnosis and staging (Figure 3). The EBUS bronchoscope was passed through oesophagus and LAG was sampled via puncture of posterior stomach wall. The cytology was suggestive of small cell carcinoma. Discussion EUSB refers to oesophageal insertion of the EBUS bronchoscope to visualize and sample mediastinal and para-oesophageal structures. The transesophageal route offers direct access to the left adrenal gland, an important metastatic site in lung cancer. Differentiating adrenal metastasis from adenoma requires histological confirmation. Conventional EUS-FNA is the usual method for sampling; however, recent studies show EUS-B-FNA is similarly safe and effective. The procedure is performed under conscious sedation, inserting the EBUS bronchoscope through the mouth and oesophagus to visualize the liver and rotating left to identify the adrenal gland. Normally, adrenal appears as a seagull-shaped structure; loss of this appearance suggests metastasis. Though not yet incorporated into standard lung cancer staging guidelines, integrating it facilitates comprehensive staging and tissue sampling in a single setting. Figure 1A: PET-CT, B: CT scan of thorax showing heterogenous right paratracheal mass B AFigure 2A: PET-CT, B: CT scan of thorax showing left adrenal mass B AFigure 3- Transesophageal endoscopic ultrasound with bronchoscope This abstract is funded by: None
Halder et al. (Fri,) studied this question.