title: New-onset malignant pleural effusion after abscess formation of a subcarinal lymph node associated with endobronchial ultrasound-guided transbronchial needle aspiration.
abstract: We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Sun Mi
authors.initials: SM
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Cho
authors.affiliation: Department of Radiology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Geewon
authors.initials: G
authors.lastname: Lee
authors.affiliation: Department of Pathology, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Ahrong
authors.initials: A
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Jeong Mi
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Chul Hong
authors.initials: CH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Jong Man
authors.initials: JM
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Byeong Gu
authors.initials: BG
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Jung Seop
authors.initials: JS
authors.lastname: Eom
keywords: Endoscopic Ultrasound-Guided Fine Needle Aspiration; Lung Neoplasms; Pleural Effusion, Malignant