Endobronchial Ultrasound: Beyond Tumors and Lymph Nodes

There is a filling defect in the pulmonary artery, which most likely represents a pulmonary embolism (PE).

Discussion

Linear EBUS examination of the pulmonary artery revealed a large echogenic lesion with flow around it on doppler consistent with pulmonary embolism. A lower extremity ultrasound revealed a deep vein thrombosis for which she was started on therapeutic anticoagulation. A CT angiogram was not performed as it would not have altered the management of the patient. A few days later, she was readmitted for a gastrointestinal hemorrhage. During that second hospitalization, the patient had CT scan of the chest that confirmed the diagnosis of bilateral pulmonary emboli (Figure 2).

Figure 2

Linear EBUS has been reported in the literature to detect incidental central pulmonary emboli [1-4] with an accuracy of more than 95% in patients undergoing the procedure for lung cancer staging [2]. CT angiography remains the preferred modality to diagnose PE [5]. However, for patients with renal failure, contrast allergy, or clinical instability precluding travel out of the ICU, linear EBUS may be considered to detect central PE. The routine use of EBUS to diagnose PE is not recommended but pulmonologists performing EBUS for other reasons should be aware of this possible finding.

References

1. Sachdeva A, Lee HJ, Malhotra R, Shepherd RW. Endobronchial ultrasound diagnosis of pulmonary embolism. J Bronchol Intervent Pulmonol 201;:20:33-34.
2. Aumiller J, Herth FJF, Krasnik M, et al. Endobronchial ultrasound for detecting central pulmonary emboli: a pilot study. Respiration. 2009;77:298–302
3. Segraves JM, Daniels CE. Pulmonary embolus diagnosed by endobronchial ultrasound. Respir Med Case Rep 2015;16:104.
4. Dhillon SS, Harris K. Endobronchial ultrasound for the detection of chronic pulmonary artery thrombus. Endoscopic Ultrasound. 2016;5(4):272-273.
5. Fedullo PF, Tapson VF: The evaluation of suspected pulmonary embolism. N Engl J Med 2007;349:1247–1256