The Expanding Horizons of Endobronchial Ultrasound Diagnosis of a Tumor Embolism

A 51-year-old woman was given a diagnosis of primary retroperitoneal synovial sarcoma, which was surgically removed, and she was subsequently treated with chemotherapy and radiotherapy. Five years later, the patient was readmitted with a 1-month history of progressive dyspnea and was initially given a diagnosis of bilateral pulmonary embolism. Angiography performed some time later revealed progression of the previous filling defects and the appearance of two new nodular endovascular images. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed, and the cytologic analysis of the cell aspirate was compatible with endovascular metastatic sarcoma. In conclusion, EBUS-TBNA in the appropriate setting is an effective method for sampling endovascular lesions, adding pathologic information and allowing for early and accurate diagnosis. CHEST 2012; 142(5):1334-1336