"Green Beret Opulence: Uncharted Territory" EUS Eclipsing EBUS Arbitrate in Lung Biopsy - A Fresh Outbreak

Introduction: Mediastinal and pulmonary lesions may be biopsied via endobronchial ultrasound (EBUS) or interventional radiology (IR). Transesophageal biopsy using endoscopic ultrasound (EUS) may be associated with fewer complications1,2. Biopsy via EUS has been rarely reported to aid in diagnosis of lung cancer3,4. Case Description/Methods: A 67 yo male presented for right lower lobe (RLL) lung mass, found by chest x-ray after suffering a fall. Percutaneous needle biopsy by IR revealed chronic inflammation without malignancy. PET scan was positive and the patient endorsed new onset fatigue, anorexia, and weight loss. Past history was remarkable for chronic anemia requiring epoetin, and negative GI evaluation, as well as 30 years of cigarette smoking. He was referred for EUS guided biopsy as EBUS was not possible due to distal location. The patient underwent the EUS procedure without endotracheal intubation in case of pneumothorax. Interventional linear echoendoscope was passed and 22G fine needle biopsy performed (Figure 1), with several core samples obtained of the lesion. The patient recovered from the procedure without complication. Histopathology showed squamous cell carcinoma. Discussion: Concerning lung lesions may be biopsied via EUS. Special consideration should be given to transesophageal accessibility, intervening vascular and airway structures, and minimal needle size for core biopsy. We report successful lung biopsy from the esophagus utilizing endoscopic ultrasound, without complication.Figure 1.: A: RLL lesion by EUS. B: Fine needle biopsy of lesion.