DIAGNOSING PULMONARY EMBOLISM ON ENDOBRONCHIAL ULTRASOUND

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Untreated acute pulmonary embolism (PE) is associated with mortality rate as high 30%, whereas the death of diagnosed and treated PE 8%. Hence, timely diagnosis important. CT angiogram arteries gold standard imaging. However, other modalities such ventilation perfusion scan deep vein thrombosis scans are used sometimes well depending upon patient presentation comorbidities. We hereby present a case incidental on Endobronchial Ultrasound (EBUS). CASE PRESENTATION: A 72-year-old male was admitted to medicine service for cholecystitis, previous history significant 100 pack years smoking, subcarinal mass from mycobacterium avium infection that appropriate therapy in past left upper lobe (LUL) lung stereotactic body radiation 2 ago. Hospital course complicated by hypoxic respiratory failure prompting chest showed an enlarged LUL mass, stable mediastinal lymphadenopathy new ovoid reverse halo consolidation at lateral right middle measuring 4.5*1.8cm. PET-CT done further evaluate condition which revealed hypermetabolic lymph nodes focal uptake distal esophagus. thus decided pursue EBUS guided biopsy. While taking sample station 4L, filling defect seen incidentally artery location (Image A). took samples 7, 11R immediately after procedure sent CTA confirmed large saddle involving B). Patient started anticoagulation. DISCUSSION: commonly staging cancer, obtaining node biopsy, sampling bronchial or peribranchial guide therapeutic procedures airway stenting. Major vascular structures can easily be hence, modality diagnose population patients renal failure, anaphylaxis contrast, inconclusive results, pregnant females, unstable ICU since bedside setting. CONCLUSIONS: expensive invasive compared available techniques diagnosing embolism. if subpopulation, it helpful decreasing early accurate similar aforementioned patient. REFERENCE #1: Abuserewa ST, Duff R. Incidental asymptomatic using endobronchial ultrasound (EBUS) during assessment. Cureus. 2021;13(2):e13404. #2: Segraves JM, Daniels CE. embolus ultrasound. Respir Med Rep. 2015;16:104-105. #3: Sachdeva A, Lee HJ, Malhotra R, Shepherd RW. J Bronchology Interv Pulmonol. 2013;20(1):33-34. DISCLOSURES: No relevant relationships Umama Adil, source=Web Response Himanshu Bhardwaj, FNU RABEL,