Transesophageal Bronchoscopic Ultrasound-guided Fine-needle Aspiration (EUS-B-FNA) in a 3-Year-Old Child

Evaluation of mediastinal lymphadenopathy in children is challenging and surgical procedures (mediastinoscopy/thoracotomy) are usually performed wherever tissue sampling is required. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely utilized and minimally invasive modality for evaluation of mediastinum (lymphadenopathy, masses, and nodal staging in patients with lung cancer) in adults. Smaller size of pediatric trachea potentially limits the use of EBUS. The EBUS bronchoscope can also be introduced into the esophagus for mediastinal evaluation and sampling, a technique described as transesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA). We herein report the successful utilization of EUS-B-FNA to obtain diagnostic mediastinal lymph node sampling in a 3-year-old child. The procedure was accomplished under moderate conscious sedation without any procedural complications. EUS-B-FNA, by obviating entry of EBUS scope into small pediatric trachea and reduced anesthesia requirement can evolve into an extremely useful modality for evaluation of pediatric mediastinal lymphadenopathy.