Endoscopic ultrasound (with an echobronchoscope)-guided fine-needle aspiration for diagnosis of a mediastinal lesion in a mechanically ventilated patient: A case report and systematic review of the literature.

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is routinely used for accessing mediastinal lymph nodes and masses. However, in patients with respiratory failure, who are being mechanically ventilated through an endotracheal tube, EBUS-TBNA may not be feasible due to several reasons. In such patients, the esophageal route offers a useful alternative for accessing mediastinal lesions. Herein, we describe a 50-year-old man with a mediastinal mass, who was being invasively ventilated for respiratory failure. Endoscopic ultrasound (with an echobronchoscope)-guided fine-needle aspiration was performed, which revealed a diagnosis of small cell carcinoma. Appropriate cancer chemotherapy resulted in successful liberation of the patient from mechanical ventilation. We have also performed a systematic review of literature for reports of endoscopic diagnostic procedures for mediastinal/hilar lesions in critically ill patients.