Bronchial inflammatory granulation after endobronchial ultrasound-guided transbronchial needle aspiration and immunotherapy

Excerpt

A 41-year-old man with a newly detected lung tumour by CT underwent staging ¹⁸F-FDG PET/CT, which revealed intense uptake in the left upper pulmonary lesion (aarrowhead) and hypermetabolic mediastinal lymph nodes 4 L (alarge arrow) and 5 (asmall arrow). The pathology was adenocarcinoma following endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of lymph node 4 L, which prompted chemotherapy combined with pembrolizumab. However, during two cycles of therapy, the patient suffered a worsening cough. A repeat PET/CT scan was performed to evaluate therapeutic efficacy, which demonstrated a good response of the pulmonary lesion and lymph node 5. Conversely, lymph node 4 L showed an increase in size and ¹⁸F-FDG avidity (b–elarge arrows). Unexpectedly, a new small nodule was visualized in the tracheal wall around the puncture site (c–ecurly arrows). In addition, multiple sites of intramuscular ¹⁸F-FDG accumulation were observed, which were related to the worsening cough. The nodule was ablated with high-frequency electrocoagulation under bronchoscopic guidance (f, gcurly arrow), and pathology confirmed inflammatory granulation. Subsequently, the patient’s cough disappeared, and follow-up bronchoscopy showed good healing of the operative area (h). …