What question did this study set out to answer?

To present a novel case of urothelial carcinoma metastasizing to the pulmonary artery, diagnosed via EBUS-TBNA.

January 10, 2026BMJ Case Reports0 citationsOpen Access

Transvascular endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to confirm urothelial carcinoma metastasis to the pulmonary artery

KAK.J. AdmireSentara Norfolk General Hospital SGStephen GegickSentara Virginia Beach General Hospital

Key Result

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) successfully diagnosed urothelial carcinoma metastasis in the pulmonary artery, overcoming significant diagnostic challenge

Key Points

To present a novel case of urothelial carcinoma metastasizing to the pulmonary artery, diagnosed via EBUS-TBNA.
Described a case of urothelial carcinoma with pulmonary artery involvement.
Attempted endovascular and thoracoscopic sampling without success.
Utilized endobronchial ultrasound-guided transbronchial needle aspiration for diagnosis.
Successfully diagnosed pulmonary artery tumor using EBUS-TBNA after other methods failed.
Highlighted the challenges of identifying pulmonary artery tumors due to their similarity to emboli.
Documented the first case in English literature confirming urothelial carcinoma through EBUS-TBNA.

Structured PICO

Population

1 early-70s female with a history of T3aN0M0 bladder urothelial cell carcinoma (status postneoadjuvant chemotherapy and cystectomy >5 years prior) presenting with a soft tissue density in the left mediastinum abutting the proximal left pulmonary artery.

Intervention

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) using a 19-gauge needle.

Outcome

Successful diagnosis of metastatic urothelial carcinoma.

EBUS-TBNA is a feasible and safe minimally invasive technique for diagnosing central pulmonary artery tumor emboli when other methods fail.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Tumours within the pulmonary arteries provide a diagnostic challenge due to their similar appearance to pulmonary emboli. Often, the decision to sample is multidisciplinary and the best approach to take is often unknown. Here we describe a case of urothelial carcinoma which metastasised to the mediastinum with evidence of tumour burden within the pulmonary artery. Sampling of this by endovascular and thoracoscopic means was unsuccessful; however, we were able to provide a diagnosis using direct visualization with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). This report is the first of a central pulmonary artery tumour caused by urothelial carcinoma biopsied by EBUS-TBNA in the English literature. We describe the diagnostic challenges and steps in evaluating suspected tumour emboli with a focus on transbronchial needle aspiration.

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