Komplikatives Hämatomediastinum einer 76-jährigen Patientin nach Durchführung einer endosonografisch gesteuerten transbronchialen Kryobiopsie (EBUS-TBKB) bei Verdacht einer Lymphomerkrankung

Zusammenfassung

Wir präsentieren den Fall einer Patientin mit schwerem Verlauf einer komplikativen mediastinalen Blutung nach endosonografisch gesteuerter transbronchialer Kryobiopsie (EBUS-TBKB) bei Verdacht einer fortgeschrittenen Lymphomerkrankung. Die EBUS-TBKB ist eine noch nicht routinemäßig angewandte effektive Untersuchungsmethode in der interventionellen Pneumologie zur Diagnose von Erkrankungen mit mediastinalen Lymphknotenvergrößerungen und intrathorakalen Tumoren, mit der große Gewebezylinder im Mediastinum gewonnen werden können. Aufgrund der hohen diagnostischen Wertigkeit der endobronchialen ultraschallgesteuerten transbronchialen Nadelaspiration (EBUS-TBNA) zur Abklärung einer Lymphadenopathie sollte die Untersuchung nicht als Routineanwendung erfolgen. Indikationen für eine primäre EBUS-TBKB können sich bei Verdacht auf intrathorakale maligne Lymphome oder andere seltene Tumoren, bei denen umfangreiches unfragmentiertes Gewebematerial für die Diagnosefindung erforderlich ist, ergeben. Eine seltene und bisher nicht in der Literatur beschriebene Komplikation ist ein Hämatomediastinum, sodass vor Intervention eine sorgfältige Risikoabwägung von möglicherweise auftretenden Blutungskomplikationen erfolgen sollte und die invasivere Mediastinoskopie eine sicherere Untersuchungsmethode sein kann.

Abstract

We present the case of a patient with severe complications from mediastinal bleeding after endosonographically guided transbronchial cryobiopsy (EBUS-TBKB) with suspected advanced lymphoma. The EBUS-TBKB is a new effective examination method in interventional pneumology for the diagnosis of diseases with mediastinal lymph node enlargement and intrathoracic tumors, with which large tissue cylinders in the mediastinum can be obtained. Due to the high diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the clarification of lymphadenopathy, the examination should not be carried out as a routine application. Indications for a primary EBUS-TBKB arise when there is a suspicion of intrathoracic malignant lymphomas or other rare tumors in which extensive unfragmented tissue material is required for diagnosis. A rare complication that has not yet been described in the literature is a hematomediastinum, so that a careful risk assessment of possible bleeding complications should be carried out before intervention and the more invasive mediastinoscopy can be a safer examination method.

Schlüsselwörter

Hämatomediastinum - Mediastinale Lymphadenopathie - Kryobiopsie

Keywords

Hämatomediastinum - mediastinal lymphnode enlargement - cryobiopsie

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