A 57-year-old male, current smoker, with a history of right testicular neoplasia treated with orchiectomy in 1996 and subsequent resection of retroperitoneal, left supraclavicular, and pulmonary teratomas, was referred after incidental detection of a complex cystic lesion in the left lower lobe on chest CT. PET-CT revealed a 17mm lesion without increased glucose metabolism, with a bronchus sign and adjacent bronchiectasis. Bronchoscopy was performed through an orotracheal tube using thin and ultrathin bronchoscopes. r-EBUS identified a hypoechoic, heterogeneous image surrounding the ultrasound miniprobe. A 1.1mm cryoprobe was then introduced through the ultrathin bronchoscope and advanced to the target location. Real-time visualization of the distal end of the cryoprobe adjacent to the miniprobe appeared as a hyperechogenic beam (Fig. 1 and Video), confirming proper positioning. Biopsy specimens showed acute and chronic inflammation. We had previously demonstrated the feasibility of this precise technique in an unanimated model using a therapeutic bronchoscope (Video). A major limitation of r-EBUS has been the lack of real-time biopsy tools visualization [1,2]. Few reports have explored the use of r-EBUS to localize the biopsy tool [3–5]. We describe a novel ultrasound sign for the cryoprobe localization at the same site as the radial probe, which may provide valuable real-time guidance for accurate cryobiopsy of peripheral pulmonary lesions.
All the authors of the article have contributed substantially to the elaboration of the manuscript.
Artificial intelligence involvementThe authors declare that artificial intelligence tools were used solely to improve the clarity of the English language.
Funding on the researchThis project was awarded the second prize in the innovation program Healthcare Entrepreneur Exchange International Programme 2023 (HEEP), organized by Germans Trias i Pujol University Hospital (HUGTiP) and Leeds Teaching Hospitals NHS Trust (United Kingdom). The award includes funding from the Avança HUGTiP Grant.
Conflict of interestThe authors declare that they have no conflict of interest directly or indirectly related to the contents of this manuscript.
We would like to thank Alan Solís for his technical support to the project, as well as the HUGTiP Innovation team, led by Daniel Moreno Martínez (Head of Innovation at Germans Trias i Pujol University Hospital) and Josep Mª Torras (Innovation Project Manager, Germans Trias i Pujol Research Institute – IGTP).
