Endosonography and endosonography-guided fine-needle aspiration (EUS-FNA) are now
established diagnostic techniques, which are performed electively in endoscopy suites.
We report here the bedside use of EUS-FNA in three critically ill patients in an intensive-care
unit, with a significant impact on the outcome. A mediastinal abscess after percutaneous
dilational tracheotomy was aspirated in one patient, leading to appropriate antibiotic
therapy and complete recovery. A paratracheal hematoma compressing the right main
bronchus was aspirated in a patient with polytrauma, relieving the pressure effects.
The third patient, who had end-stage dilated cardiomyopathy and was being evaluated
for cardiac transplantation, was found to have an apical lung lesion suspicious for
bronchogenic carcinoma. EUS was performed to exclude mediastinal metastasis and allow
simultaneous resection at the time of transplantation. Although a metastasis was excluded
by EUS-FNA, the patient died while awaiting surgery. We conclude that bedside EUS-FNA
is a feasible procedure, and in experienced hands it can offer an alternative in life-threatening
situations.
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M.D. A. Fritscher-Ravens
Dept. of Interdisciplinary Endoscopy University Hospital, Eppendorf
Martinistrasse 52
20246 Hamburg
Germany
Phone: +49-40-42803-4420
