Archivos de Bronconeumología (English Edition) Archivos de Bronconeumología (English Edition)
Arch Bronconeumol 2017;53:207 - Vol. 53 Num.4 DOI: 10.1016/j.arbr.2017.02.006
Clinical Image
An Unexpected Guest in Ultrasound-Guided Bronchoscopy
Un invitado inesperado en la ecobroncoscopia
Paula Elisa Hernández Pérez, , Lorenzo Pérez Negrín, M. Purificación Ramírez Martín
Servicio de Neumología, Hospital Universitario de Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, Spain

A 55-year-old man, on the waiting list for annuloplasty for severe mitral stenosis, was investigated for suspicious mediastinal lymphadenopathies detected on chest computed tomography images. His medical records mentioned oral anticoagulation indicated by the cardiologist.

During an endobronchial ultrasound procedure, a round hyperechoic image was seen in the left atrial appendage, along with an enlarged atrial diameter (Fig. 1A and B). Atrial thrombus was suspected, so the cardiologist was contacted, who confirmed the diagnosis by transesophageal echocardiography. The procedure was suspended, and it was confirmed that the patient was not taking his prescribed anticoagulation, and treatment with low molecular weight heparin began.

Fig. 1.
(0.12MB).

(A and B) Round hyperechoic image in the left atrial appendage.

Linear endobronchial ultrasound can reveal structures adjacent to the tracheobronchial wall, including lymph nodes and tumor growth proximal to the central airway. The potential role of endobronchial ultrasound in the diagnosis of other entities has recently been pointed out.1 For it to be of benefit, knowledge is required, not only of the mediastinal lymphatic structures and their relationship with the bronchial tree, but also of the vascular structures, and their location and echographic characterization,2 so that incidental findings in these regions can be diagnosed.

References
1
P. Li,W. Zheng,L. Zhao
Convex probe endobronchial ultrasound: applications beyond conventional indications
2
M. Sharma,C.L. Arya,A. Somasundaram,S. Rameshbabu Ch
Techniques of linear endobronchial ultrasound imaging
J Bronchol Intervent Pulmonol, 17 (2010), pp. 177-187

Please cite this article as: Hernández Pérez PE, Pérez Negrín L, Ramírez Martín MP. Un invitado inesperado en la ecobroncoscopia. Arch Bronconeumol. 2017;53:207.

Copyright © 2016. SEPAR
Arch Bronconeumol 2017;53:207 - Vol. 53 Num.4 DOI: 10.1016/j.arbr.2017.02.006