title: Respiratory failure with hilar mass: Role of endobronchial ultrasound-guided transbronchial needle aspiration in the medical intensive care unit.
abstract: We report the case of a 58-year-old man on chronic steroid therapy, who developed a rapidly progressive right upper lobe infiltrate/mass that extended into the right hilum. Respiratory failure necessitated endotracheal intubation. Broad spectrum antibiotics were initiated without clinical improvement and because of his immunosuppressive therapy opportunistic pathogens were considered. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed in the Medical Intensive Care Unit (MICU) with rapid onsite evaluation. Specimens obtained from the right hilar mass revealed organisms suspicious for cryptococcal infection, subsequently confirmed via a culture. No complications occurred during the EBUS procedure despite the patient requiring vasopressor support and 100% inspired oxygen. Little data exists regarding the use of EBUS in patients admitted to the MICU with respiratory failure of unknown etiology and mediastinal/hilar lymphadenopathy. This case illustrates the potential safe use of EBUS-TBNA in patients presenting with respiratory failure, with a mediastinal or hilar mass and suspected infectious etiology.
authors: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Hofstra North Shore - Long Island Jewish Health System, New York, United States.
authors: Astha
authors: A
authors: Chichra
authors: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Hofstra North Shore - Long Island Jewish Health System, New York, United States.
authors: Kimmoi Wong
authors: KW
authors: Lama
authors: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Hofstra North Shore - Long Island Jewish Health System, New York, United States.
authors: Seth J
authors: SJ
authors: Koenig
keywords: Cryptococcosis; endobronchial ultrasound; hilar mass; mediastinal lymphadenopathy; respiratory failure; trans bronchial needle aspiration