AN INTERESTING CASE OF PULMONARY EMBOLUS DETECTED IN ENDOSCOPIC BRONCHIAL ULTRASOUND

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Endobronchial Ultrasound is a technique that has become gold standard for diagnosing mediastinal masses, with implementation by 2015.[1] It allows excellent visualization of structures in and surrounding the central airways, providing significant additional information to diagnostic bronchoscopy.[3] EBUS can diagnose pulmonary embolism in, especially critical patients, as they are very unstable CT contrast help make decisions regarding embolectomy or medical management. [4] CASE PRESENTATION: A 64-year-old male past history peripheral arterial disease type 2 diabetes mellitus came acute limb ischemia. The patient current everyday smoker total smoking exposure 45 pack-years. His CT-angiogram showed multilevel ischemia bilateral superficial femoral popliteal arteries, after which, Invasive angiography was done, which revealed thrombus right artery. An attempt at thrombolysis unsuccessful. Subsequently, underwent below-knee amputation. Postoperatively, he developed hypoxemia (presumably 3 respiratory failure) admitted intensive care unit. Chest x-ray lymphadenopathy vascular congestion. review prior CECT chest lymphadenopathy.An endobronchial ultrasound-guided transbronchial needle aspirate performed sample lymph nodes; pathology NSCLC. Anatomic localization nodes done identifying blood vessels, incidentally filling defect left artery, better characterized doppler. He started on anticoagulation Low Molecular Weight Heparin. CTPA confirmed finding embolism. denied all further interventions. DISCUSSION: In 2009, Aumiller et al.[4] descriptive study 32 out 96% could detect CT-documented Pulmonary Embolism short procedure-time 3-5 mins negligible complications. Sentürk al. used 8/8 cases, documented scan.[4]Even though role diagnosis PE not yet established, it be utilized hemodynamically patients whom other techniques feasible.[5] CONCLUSIONS: Most cases embolism, being diagnosed EBUS, consistently show defects arteries. However, this patient's different indication, detected good correlation subsequent Angiographic findings.In retrospect, only findings EBUS. With time may tool Diagnose Embolism, critically ill patients. REFERENCE #1: 1. Channick CL, RN. Use ultrasound bedside patient. Chest. 2019;155(3):651-652. doi:10.1016/j.chest.2018.11.013 #2: 2. Mahajan AK, Ibrahim O, Shostak E, VanderLaan PA, Majid A, Folch E. EBUS-TBNA artery clot. J Bronchology Interv Pulmonol. 2014;21(4):371-373. doi:10.1097/LBR.0000000000000109 #3: 3. Llopis Pastor Franco Serrano J, Burés Sales thromboembolism ultrasound. Arch Bronconeumol. 2013;49(12):555-556. doi:10.1016/j.arbres.2013.04.011 DISCLOSURES: no disclosure file Ghassan Bachuwa; No relevant relationships Maryssa Gilbert, source=Web Response Harini Lakshman, Aashish Valvani, Vijay Sai Veerapaneni,