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Mediastinitis after endobronchial ultrasound-guided transbronchial needle aspiration

Abstract : Inroduction. - Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure used for the diagnosis of mediastinal and hilar lymphadenopathy. Observation. - We describe a case of mediastinitis appearing 15 days after an EBUS-TBNA procedure in a 79 years old male patient. The mediastinitis was treated surgically by thoracotomy with a wide excision of infected tissue requiring transplantation of a serratus anterior muscle flap pedicled on a branch of the thoracodorsal artery. It was coupled with broad spectrum antibiotics. This medico-surgical management led to a favorable outcome. Microbiological analysis of the mediastinal collections revealed two pathogens: Streptococcus constellatus (a germ-present in the normal flora of the oral cavity) and Mycobacterium tuberculosis. A standard first line quadruple antituberculous drug regimen was subsequently given to the patient. Conclusion. - This episode of Streptococcus constellatus mediastinitis was a complication of the EBUS-TBNA procedure. The operating channel of the bronchoscope had probably been contaminated when aspirating the oral cavity secretions with subsequent needle contamination and a direct bacterial inoculation during the transbronchial mediastinal puncture. The severity of such a complication justifies a medical consultation in cases of fever or chest pain following an EBUS-TBNA procedure. (C) 2017 SPLF. Published by Elsevier Masson SAS. All rights reserved.
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Soumis le : lundi 28 février 2022 - 15:24:01
Dernière modification le : mardi 1 mars 2022 - 03:29:08

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Damien Basille, F. de Dominicis, E. Magois, Claire Andrejak, Pascal Berna, et al.. Mediastinitis after endobronchial ultrasound-guided transbronchial needle aspiration. Revue des maladies respiratoires, 2017, 34 (9), pp.1022-1025. ⟨10.1016/j.rmr.2017.01.007⟩. ⟨hal-03591336⟩

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