Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with a three-way stopcock for mediastinal cysts through negative pressure drainage: a case report
Case Report

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with a three-way stopcock for mediastinal cysts through negative pressure drainage: a case report

Xiaoting Cai, Chendi Fei, Shiman Pang, Chunli Tang, Shiyue Li

Department of Respiratory and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China

Contributions: (I) Conception and design: X Cai, C Tang; (II) Administrative support: C Tang, S Li; (III) Provision of study materials or patients: C Tang; (IV) Collection and assembly of data: X Cai, S Pang; (V) Data analysis and interpretation: X Cai, C Fei, S Pang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Chunli Tang, MSc. Department of Respiratory and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou 510120, China. Email: tcl8182@163.com.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can extract cystic fluid for diagnosis, but evidence is mainly limited to case reports with infection risk. Against this background, we will report the clinical case that explores the improvement strategy of EBUS-TBNA combined with a three-way stopcock device to reduce infection rates and review the relevant literature, using the search term ‘(((endobronchial ultrasound-guided transbronchial needle aspiration) OR (EBUS-TBNA)) AND ((cysts) OR (mediastinal cysts) OR (bronchogenic cysts)))’ from PubMed.

Case Description: A 66-year-old female patient presented with exertional dyspnea, and computed tomography (CT) showed a 59 mm × 53 mm cystic lesion in the right upper posterior mediastinum, which was treated by EBUS-TBNA (utilizing a 22-gauge needle and a three-way stopcock), successfully aspirating 170 mL of clear yellow fluid. Postoperative tracheal compression was relieved with immediate symptomatic relief. No recurrence or complications were observed during the 3-month postoperative follow-up. Additionally, a total of 22 papers were included. Among 20 case reports (49 cases), 17 improved, 16 required surgery, and 7 had postoperative infections.

Conclusions: While EBUS-TBNA serves as a valuable diagnostic and therapeutic tool for cystic lesions, postoperative infection remains a significant concern, particularly during necrotic cavity puncture. EBUS-TBNA combined with negative pressure drainage of the three-way stopcock optimizes the workflow to prevent spillage and may potentially mitigate infection risks by maintaining a closed system. While long-term outcomes require further observation, this technique may represent a feasible adjunct to EBUS-TBNA in selected patients with mediastinal cystic lesions.

Keywords: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA); three-way stopcock; mediastinal cysts; bronchogenic cysts; case report

Received: 29 October 2025; Accepted: 05 January 2026; Published online: 27 March 2026.

doi: 10.21037/acr-2025-306

Highlight box

Key findings

• Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with a three-way stopcock negative-pressure drainage was effective for mediastinal cysts. A PubMed literature review contextualizes its clinical application.

What is known and what is new?

• EBUS-TBNA can diagnose cystic lesions, but prior evidence is mostly case reports with high infection risk.

• This study introduces a novel three-way stopcock method and reports its practical use.

What is the implication, and what should change now?

• The case implies the device may optimize mediastinal cyst management (potentially reducing infections). Further systematic controlled studies are needed to confirm its advantages.

Introduction

Congenital mediastinal cysts account for 12–30% of mediastinal tumors, most commonly foregut-derived (bronchogenic, esophageal) (1). Often asymptomatic, cysts near major vessels may cause compressive symptoms. Imaging establishes diagnosis (1,2). Traditional treatments of mediastinal cysts involved thoracotomy or video-assisted thoracic surgery (VATS) (1). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), a minimally invasive operation with a high diagnostic rate, has become essential for evaluating mediastinal and hilar lymphadenopathy (3,4). In recent years, with the wide application of EBUS-TBNA, recent studies indicate EBUS-TBNA can be used to investigate the nature of the lesion in real-time through endobronchoscopic ultrasound, and at the same time, it can be used to extract cystic fluid through needle aspiration to provide a definitive diagnosis, which has gradually become an effective tool for the diagnosis and treatment of mediastinal cyst (5,6).

However, existing evidence regarding EBUS-TBNA for mediastinal cysts is largely limited to case reports, with procedure-related infections remaining a concern. Technical challenges during large-volume cyst aspiration, including repeated syringe exchanges and interruption of negative pressure, may increase procedural complexity.

The use of a three-way stopcock allows continuous aspiration within a closed system, potentially minimizing interruptions during drainage. While this approach does not alter the fundamental mechanism of infection related to transbronchial puncture, it may optimize procedural workflow and improve aspiration efficiency. Additionally, this technique is valuable for large cysts (>50 mL), where multiple syringe exchanges are necessary. For small cysts, this innovation is less relevant.

Here, we present a case of a mediastinal bronchogenic cyst treated with EBUS-TBNA combined with a three-way stopcock negative-pressure drainage system and review the relevant literature. We present this article in accordance with the CARE reporting checklist (available at https://acr.amegroups.com/article/view/10.21037/acr-2025-306/rc).

Case presentation

All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the ethics committee of The First Affiliated Hospital of Guangzhou Medical University (No. ES-2025-K090-02). Written informed consent was obtained from the patient for publication of this case report and accompany images. A copy of the written consent is available for review by the editorial office of this journal.

A 66-year-old female presented in May 2024 with a 3-month history of exertional dyspnea. A computed tomography (CT) scan of the chest revealed a 59 mm × 53 mm non-enhancing cystic lesion in the right upper posterior mediastinum, with a clear boundary, causing significant compression of adjacent lung tissues, esophagus, and trachea (panel A in Figure 1). She has a medical history of hypertension and cerebral infarction. Initial management included cefuroxime, methylprednisolone, and bronchodilator nebulization. Given the substantial size of the cyst and its proximity to the trachea, a bronchoscopy was performed on the following day to define the nature of the mediastinal cyst and place a tracheal stent for decompression if necessary. The lower trachea and the right main bronchus were obviously compressed under tracheoscopy, and the lumen was narrowed, twisted, and deformed (panel A in Figure 2). EBUS, performed using an Olympus EBUS scope (model BF-UC260F, Olympus Ltd., Tokyo, Japan) that was inserted orally and fitted with a 7.5 MHz convex probe, identified a homogeneous liquid hypoechoic area in the right upper mediastinum. Based on imaging and EBUS findings, the lesion demonstrated typical features of a bronchogenic cyst, including a well-defined thin wall, homogeneous hypoechoic fluid content, and absence of solid components. Other cystic mediastinal lesions, such as necrotic lymph nodes or cystic neoplasms, were considered less likely. Given the strong suspicion of a mediastinal cystic lesion, EBUS-TBNA was subsequently performed for diagnostic and therapeutic purposes. Under real-time ultrasound guidance, the 22-gauge needle (NA-201SX-4022, Olympus Ltd., Tokyo, Japan) was used to puncture the cystic cavity through the bronchoscopic biopsy channel of a convex ultrasound probe, and the end of the puncture needle was connected to a negative pressure syringe and a latching valve through a three-way stopcock (Figure 3). During aspiration, continuous negative pressure was maintained at all times during suction by switching the valve through the three-way stopcock. A total of 170 mL of yellowish-clear fluid was eventually aspirated. Post-procedure ultrasound confirmed reduced cyst volume, with immediate resolution of tracheal compression (panel B in Figure 2). The cystic fluid analysis [microbiology, cytology, and metagenomic next-generation sequencing (mNGS)] showed no abnormalities. After the operation, the patient reported immediate relief of dyspnea and shortness of breath. Follow-up chest CT performed 4 hours postoperatively revealed complete resolution of the mediastinal mass cyst (panel B in Figure 1). Following the procedure, the patient remained afebrile and reported no chest tightness, chest pain, or respiratory discomfort. Laboratory evaluation demonstrated a normal white blood cell count. No procedure-related complications, including pneumothorax, bleeding, or infection, were observed. During the 3-month follow-up period, the patient remained asymptomatic, with no recurrence of wheezing or dyspnea. Follow-up chest CT at 3 months demonstrated complete resolution of the right middle-upper mediastinal mass, with no significant reaccumulation of cystic fluid during short-term follow-up. The trachea and major bronchi remained patent without significant stenosis or dilation (panel C in Figure 1). The patient expressed satisfaction with the improvement in respiratory symptoms. Given the secretory nature of bronchogenic cyst epithelium, long-term imaging follow-up is required to assess the risk of recurrence.

Figure 1 Contrast-enhanced chest spiral CT. (A) Pre-treatment: cystic hypodense lesion in the right middle-upper posterior mediastinum with well-defined margins, measuring 59 mm × 53 mm, no enhancement was observed, marked compression of adjacent lung parenchyma, esophagus, and trachea, with the narrowest tracheal diameter measuring 21 mm × 3 mm; (B) 4 hours post-treatment: complete resolution of the right middle-upper mediastinal mass; (C) 3 months post-treatment: no recurrence of the right middle-upper mediastinal lesion. CT, computed tomography.
Figure 2 Pre- and post-puncture bronchoscopy images. (A) Pre-treatment: bronchoscopy revealed extrinsic compression stenosis of the trachea and right main bronchus; (B) post-treatment: follow-up bronchoscopy demonstrated marked improvement in tracheal compression with a patent lumen.
Figure 3 Operational procedure. The tip of the puncture needle was connected to a three-way stopcock device incorporating a negative pressure syringe and locking valve.

Literature review

A systematic search was conducted on PubMed using the query “(((endobronchial ultrasound-guided transbronchial needle aspiration) OR (EBUS-TBNA)) AND ((cysts) OR (mediastinal cysts) OR (bronchogenic cysts)))”, yielding 38 articles. After excluding non-English reports, studies involving mediastinal lymph nodes, non-EBUS-TBNA interventions, and reports without detailed case descriptions, 22 studies were included (1 retrospective study, 1 letter, and 20 case reports, encompassing 49 cases total) (Table 1). Among these, 17 cases showed symptomatic improvement without complications during 3-month to 1-year follow-up. Seven cases demonstrated positive cultures from aspirated fluid, identifying pathogens including Streptococcus, Corynebacterium, Actinomyces, alpha-hemolytic streptococci and so on. These were diagnosed as infected bronchogenic cysts, of which 3 cases stabilized after antibiotic therapy post-drainage and 4 cases required subsequent surgical resection. Follow-up assessments confirmed complete infection resolution and maintained clinical stability. Six cases experienced cyst recurrence. Sixteen cases ultimately required surgical resection due to infection, recurrence, or diagnostic confirmation (Table 2).

Table 1

Integration retrieved literature

Time (ref.) Literature type Sex Age (years) Symptoms CT scan EBUS-TBNA Diagnosis Complications Treatment and prognosis Follow-up
2023 (7) Case report Male 48 Chest pain, palpitations Right bronchus, 42 mm × 35 mm × 32 mm Yellow-brown mucus Bronchogenic cyst within the pericardium No Surgical resection Stable over 18 months of follow-up
2021 (8) Case report Male 28 Asymptomatic Right superior mediastinum, 71 mm × 81 mm 190 mL Serous fluid Lymphangioma Secondary pneumonia, mediastinitis, and cyst infection Antibiotic therapy, patient refuses surgery Stable over 6 months of follow-up
2020 (9) Case report Male 65 Fever, cough – Mucus Mediastinal cyst Mediastinitis, and cyst infection Antibiotic therapy, patient refuses surgery Stable
2020 (10) Retrospective study 12 males, 14 females Mean ± SD: 52±2.85 Dyspnea, cough, chest pain Most in the right paratracheal region, 42.0±4.1 mm – Bronchogenic cyst, pleuropericardial cyst, indeterminate nature 2 cases of recurrence, 1 infection, 1 cyst growth 5 surgical resections Follow-up 6 months: 5 recurrences, 1 enlargement, 7 lost
2020 (11) Case report Male 57 Chest pain, dyspnea Middle mediastinum, 73 mm × 70 mm × 60 mm 20 mL brownish purulent fluid Infected bronchogenic cyst (Actinomyces) No Antibiotic therapy and surgical resection Stable
2018 (6) Case report Male 33 Cough, dyspnea, fever Subcarinal, 86 mm × 24 mm 50 mL yellow mucus Infected bronchogenic cyst (Streptococcus, Corynebacterium) No Antibiotic therapy Stable over 32 months of follow-up
2018 (12) Case report Male 45 Dyspnea Subcarinal 50 mL pus Tuberculous lymphadenitis with bronchogenic cyst No Antituberculosis therapy and surgical resection Stable
2017 (13) Case report Male 67 Dyspnea Anterior superior mediastinum, 11.3 mm × 14 mm 1.5 mL turbid yellow viscous fluid Thyroid cyst No Cyst reduction Stable
2016 (14) Case report Female 61 Dyspnea Posterior mediastinum, 42 mm × 77 mm Proteinaceous material Bronchogenic cyst Postoperatively, recurrence Surgical resection Stable
2016 (15) Case report Female 33 Chest pain hemoptysis Subcarinal, 48 mm × 78 mm 10 mL yellow semisolid material Bronchogenic cyst Recurrence and infection Antibiotic therapy and surgical resection Stable
2015 (16) Case report Male 67 Chest pain dyspnea Right pulmonary artery 56 mL white turbid fluid Recurrent bronchogenic cyst No Cyst reduction Stable over 3 months of follow-up
2014 (17) Case report Female 56 Asymptomatic Anterior mediastinum, 26 mm × 16 mm White mucus Infected bronchogenic cyst (α-Streptococcus) Mediastinitis Antibiotic therapy and surgical resection Stable
2013 (18) Case report Female 54 Asymptomatic Posterior to the intermediate bronchus, 69 mm Serous fluid Bronchogenic cyst Secondary pneumonia Antibiotic therapy Stable over 4 months of follow-up
2013 (19) Case report Female 36 Chest pain palpitations Subcarinal, 52 mm × 42 mm White gelatinous material Bronchogenic cyst Secondary pneumonia, recurrence Antibiotic therapy and surgical resection Stable
2013 (20) Case report Female 64 Chest pain Left superior mediastinum, 30 mm × 40 mm 10 mL pale yellow turbid fluid Infected bronchogenic cyst (Prevotella and Klebsiella pneumoniae) No Surgical resection Stable
2013 (21) Case report Male 86 Dysphagia Left superior mediastinum, 42 mm × 57 mm 60 mL serous fluid Bronchogenic cyst No Cyst resolution Stable
2012 (22) Case report Female 56 Asymptomatic Anterior to T5, 19 mm Needle biopsy Thoracic duct cyst No Surgical resection Stable over 22 months of follow-up
2011 (23) Case report Female 37 Fever, chest pain, cough Right paratracheal, 40 mm × 56 mm 150 mL pale yellow fluid Bronchogenic cyst No Cyst reduction Stable over 16 months of follow-up
Female 54 Chest pain cough Septated cystic mass in the left lower lobe, 43 mm × 57 mm 27 mL of pale-yellow fluid aspirated from one locule and 33 mL from another Suspected bronchogenic cyst within lung parenchyma No Surgical resection Stable
2011 (24) Case report Male 54 Asymptomatic Right hilum 50 mL serous fluid Bronchogenic cyst No – Stable over 18 months of follow-up
Male 18 Asymptomatic Right hilum 10 mL pus Infected bronchogenic cyst (Haemophilus influenzae) No Antibiotic therapy and surgical resection Stable
2010 (25) Letter Female 56 Asymptomatic Posterior to the ascending aorta, 24 mm × 43 mm Yellow serous fluid Infected bronchogenic cyst (Streptococci viridans) No Antibiotic therapy Stable
2010 (26) Case report Male 38 Cough fever chest pain Right lower paratracheal, 45 mm 20 mL pus Infected bronchogenic cyst (β-hemolytic Streptococcus) No Antibiotic therapy Stable over 18 months of follow-up
2007 (27) Case report Male 78 Asymptomatic Superior mediastinum Serous fluid Bronchogenic cyst Recurrence EBUS-TBNA Stable over 12 months of follow-up

CT, computed tomography; EBUS-TBNA, endobronchial ultrasound-guided transbronchial needle aspiration; SD, standard deviation.

Table 2

Statistical table of case characteristics

Characteristics Results (total N=49)
Female 24 (49.00)
Patient age (years) 50.62±16.81
Symptoms
   Asymptomatic 7 (14.29)
   Cough 11 (22.45)
   Dyspnea 12 (24.48)
   Chest pain 14 (28.57)
   Dysphagia 1 (2.04)
   Fever 4 (8.16)
Largest dimension of the cyst (CT scan) (mm) 56.0 [42.5–73.0]
Aspirated fluid volume (mL) 30 [15–53]
Location
   Right paratracheal area 25 (51.02)
   Subcarinal 12 (24.48)
   Left paratracheal area 4 (8.16)
   Posterior paratracheal area 4 (8.16)
   Pretracheal area 1 (2.04)
Postoperative recurrence 6 (12.24)
Postoperative infection 7 (14.29)
Surgery required 16 (32.65)
Post-operative stability 17 (34.69)

Data are presented as n (%), mean ± SE, or median [P25, P75]. CT, computed tomography; SE, standard error.

Discussion

Clinical characteristics and therapeutic challenges of mediastinal cysts

Congenital mediastinal cysts account for 12–30% of all primary mediastinal tumors. Etiologically, they are classified into four categories: foregut-derived cysts (most common, including bronchogenic and esophageal cysts), mesothelial cysts (pericardial/pleural), thymic cysts, and rare anomalies (1). While most are asymptomatic and incidentally detected by physical examination, cysts located in deep regions adjacent to major vessels or vital organs may cause compressive symptoms (e.g., cough, dyspnea, chest tightness, pain, hoarseness). Severe complications such as infection may lead to life-threatening. Current diagnostic modalities primarily rely on imaging techniques, including chest X-ray and CT. Typical radiological features include well-circumscribed, non-calcified, round lesions with homogeneous water-attenuation density (1,2). Nevertheless, mediastinal cysts need to be differentiated from metastatic tumors like lymphomas, teratomas, hemangiomas, and lipomas. Surgical resection has traditionally served as the gold standard for both definitive diagnosis and curative treatment. Surgery (thoracotomy or VATS) is standard for bronchogenic cysts (2), but carries risks and may be unsuitable for critically ill patients (21). Recurrence after prior surgery may also preclude reoperation (16), indicating surgery is not always feasible.

The role of EBUS-TBNA in the diagnosis and treatment of mediastinal cysts

EBUS-TBNA plays an important role in evaluating hilar, mediastinal, and pulmonary lesions, serving as a cornerstone for lung cancer diagnosis and staging (3). With the further exploration and development of this technique, many scholars have found that patients with bronchogenic cysts who are unable to undergo surgery can be diagnosed and conservatively treated with EBUS-TBNA (6,16,23,27). Under real-time ultrasound guidance, EBUS-TBNA distinguishes cystic from solid lesions, evaluates cyst characteristics, and delineates spatial relationships with adjacent vasculature and tissues (5,27). Concurrently, needle aspiration enables fluid sampling for pathological analysis, achieving simultaneous diagnosis and therapy (5). Compared to traditional surgery, EBUS-TBNA offers minimally invasive, efficient, and safe advantages. Real-time ultrasound monitoring facilitates complete cyst aspiration, promoting cavity collapse and mucosal adhesion to reduce recurrence (27). However, Aravena et al. reported limited long-term efficacy in a retrospective study, with only 5.5% of patients achieving sustained remission, while others experienced recurrence or cyst enlargement necessitating surgery (10). Inadequate drainage has also been linked to cyst recurrence in prior studies (14,15,19). Notably, EBUS-TBNA carries infection-related risks (6,8,15,18). It was associated with lower efficiency in aspirating viscous fluid from infected cysts, with prolonged procedure time increasing the risk of iatrogenic infection (23). Contamination may occur during bronchoscope or needle passage through the oropharynx, introducing oral flora into the cyst. Incomplete aspiration or prolonged manipulation may also cause cyst fluid leakage into the mediastinum. Unlike vascularized tissues, mediastinal cysts lack bacterial clearance capacity, heightening susceptibility to secondary infection (8). Thus, EBUS-TBNA has inherent limitations in managing mediastinal cysts. Surgical resection remains the primary approach for symptomatic, surgically eligible patients (10). However, in selected clinical scenarios, particularly in patients at high surgical risk or those requiring urgent decompression to relieve airway or mediastinal compression, EBUS-TBNA may serve as a minimally invasive alternative or a bridging intervention prior to surgery (16).

Technical innovation of three-way stopcock negative-pressure drainage

To improve drainage efficiency while minimizing procedure-related risks, we innovatively employed a three-way stopcock negative-pressure drainage system. The three-way stopcock comprises three channels and a rotating plug valve, enabling controlled fluid diversion across distinct pathways (28). Its selective multi-channel design allows simultaneous infusion of multiple fluids via rotational adjustment, with established applications in emergency transfusions, anesthesia, chemotherapy administration, and critical care (29-32). Recent adaptations include pneumothorax drainage and central venous pressure monitoring (33,34). Notably, Kumar et al. designed a bronchoscopic oxygen delivery system using a three-way stopcock to concurrently manage suction and oxygen supply during bronchoscopic procedures, dynamically correcting hypoxia (35).

In this case, the three-way stopcock was integrated into the EBUS-TBNA workflow: post-puncture, the needle tract was connected to a pre-set negative-pressure syringe via the stopcock. Prior to syringe replacement, the valve at the stopcock’s distal end was closed to prevent air ingress, ensuring complete fluid evacuation. Due to the high pressure within the fluid-filled cyst cavity, as part of the fluid is aspirated, the internal pressure gradually decreases. When the syringe is replaced, the cyst cavity is exposed to the external environment, leading to pressure equilibrium and making it difficult to achieve complete aspiration in later stages. Our closed-loop system maintained continuous negative pressure by switching valve configurations, avoiding pressure imbalance in the cyst cavity caused by syringe replacement during conventional procedures, enabling rapid and complete fluid extraction without pressure fluctuations. Infection following EBUS-TBNA is primarily attributed to transbronchial inoculation of oropharyngeal microorganisms introduced during needle passage. The three-way stopcock-assisted closed-loop system does not sterilize the puncture tract and therefore cannot eliminate this fundamental mechanism of infection.

Nevertheless, by maintaining a closed system and continuous negative pressure during syringe replacement, this technical modification may reduce environmental exposure and procedural interruptions, thereby potentially lowering the risk of environmental contamination during large-volume cyst drainage.

Following complete drainage, collapse and apposition of the cyst walls may theoretically reduce the likelihood of early reaccumulation. In this case, approximately 170 mL of cystic fluid was successfully aspirated through a single puncture, and no recurrence or procedure-related complications were observed during the 3-month follow-up. Although Wei Liu aspirated 190 mL using a standard procedure, the patient subsequently developed infectious complications (8). This innovation provides a novel strategy for mediastinal cyst management. However, this report represents a single case, and the long-term efficacy and recurrence risk of this approach remain to be established. Future studies should focus on challenges such as managing viscous cystic fluid and preventing recurrence, ultimately supporting personalized and precise treatment strategies through technical innovation and evidence-based practice.

Conclusions

EBUS-TBNA combined with the three-way stopcock negative-pressure drainage method may be a feasible minimally invasive option for selected patients with mediastinal cysts who are poor surgical candidates or require rapid symptom relief. This technique appears to optimize procedural workflows during large-volume cyst aspiration. Further controlled studies are warranted to clarify its advantages and diagnostic value, potentially supporting broader clinical application.

Acknowledgments

The authors thank the respiratory interventional unit of The First Affiliated Hospital of Guangzhou Medical University for their help and collaboration.

Footnote

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at https://acr.amegroups.com/article/view/10.21037/acr-2025-306/rc

Peer Review File: Available at https://acr.amegroups.com/article/view/10.21037/acr-2025-306/prf

Funding: This work was supported by grants from the Major Project of Guangzhou National Laboratory (grant No. GZNL2023A03001), at The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China. This fund covered the costs associated with the approval of the submitted manuscript.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://acr.amegroups.com/article/view/10.21037/acr-2025-306/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the ethics committee of The First Affiliated Hospital of Guangzhou Medical University (No. ES-2025-K090-02). Written informed consent was obtained from the patient for publication of this case report and accompany images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Takeda S, Miyoshi S, Minami M, et al. Clinical spectrum of mediastinal cysts. Chest 2003;124:125-32. [Crossref] [PubMed]
  2. Patel SR, Meeker DP, Biscotti CV, et al. Presentation and management of bronchogenic cysts in the adult. Chest 1994;106:79-85. [Crossref] [PubMed]
  3. Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005;50:347-54. [Crossref] [PubMed]
  4. Kheir F, Itani A, Assasa O, et al. The utility of endobronchial ultrasound-transbronchial needle aspiration in lymphoma. Endosc Ultrasound 2016;5:43-8. [Crossref] [PubMed]
  5. Maturu VN, Dhooria S, Agarwal R. Efficacy and Safety of Transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol 2015;22:195-203. [Crossref] [PubMed]
  6. Bukamur HS, Alkhankan E, Mezughi HM, et al. The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults. Respir Med Case Rep 2018;24:46-9. [Crossref] [PubMed]
  7. Suzuki H, Ishida I, Kawatsu S, et al. Complete resection of an intrapericardial bronchogenic cyst with median sternotomy showing high CA19-9 level fluid sampling by EBUS-TBNA: a case report. Gen Thorac Cardiovasc Surg Cases 2023;2:5. [Crossref] [PubMed]
  8. Liu W, Wang Y, Zhang W, et al. Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration: A case report. Medicine (Baltimore) 2021;100:e25973. [Crossref] [PubMed]
  9. Hashimoto T, Ando M, Watanabe E, et al. Mediastinal cyst infection followed by bacteremia due to Streptococcus anginosus after endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Med 2020;15:95-7. [Crossref] [PubMed]
  10. Aravena C, Patel J, Goyal A, et al. Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis and Management of Mediastinal Cyst. J Bronchology Interv Pulmonol 2020;27:142-6. [Crossref] [PubMed]
  11. Lat T, Hayek SA, Sikka P, et al. Infected Bronchogenic Cyst With Left Atrial, Pulmonary Artery, and Esophageal Compression. Fed Pract 2020;37:190-3.
  12. Chhabria BA, Agarwal R, Garg M, et al. A rare cause of airway obstruction: Mediastinal cyst secondarily infected with Mycobacterium tuberculosis. Lung India 2018;35:421-4. [Crossref] [PubMed]
  13. Li P, Zheng W, Liu H, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for thyroid cyst therapy: A case report. Exp Ther Med 2017;13:1944-7. [Crossref] [PubMed]
  14. Rajmane R, Adams AM, Rajmane O, et al. Cyst Rupture After Endobronchial Ultrasound-guided Transbronchial Needle Aspiration. J Bronchology Interv Pulmonol 2016;23:e20-2. [Crossref] [PubMed]
  15. Mogal R, Banerjee N, Yung B, et al. A Young Woman With Severe Chest Pain After Undergoing Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for a Large Mediastinal Mass. J Bronchology Interv Pulmonol 2016;23:236-8. [Crossref] [PubMed]
  16. Alraiyes AH, Shaheen K, Reynolds J, et al. Recurrent Bronchogenic Cyst After Surgical Resection. Ochsner J 2015;15:176-9.
  17. Onuki T, Kuramochi M, Inagaki M. Mediastinitis of bronchogenic cyst caused by endobronchial ultrasound-guided transbronchial needle aspiration. Respirol Case Rep 2014;2:73-5. [Crossref] [PubMed]
  18. Hong G, Song J, Lee KJ, et al. Bronchogenic cyst rupture and pneumonia after endobronchial ultrasound-guided transbronchial needle aspiration: a case report. Tuberc Respir Dis (Seoul) 2013;74:177-80. [Crossref] [PubMed]
  19. Gamrekeli A, Kalweit G, Schäfer H, et al. Infection of a bronchogenic cyst after ultrasonography-guided fine needle aspiration. Ann Thorac Surg 2013;95:2154-5. [Crossref] [PubMed]
  20. Kuo CH, Chung FT, Kuo HP. Infected bronchogenic cyst diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. J Formos Med Assoc 2013;112:436-7. [Crossref] [PubMed]
  21. Aragaki-Nakahodo AA, Guitron-Roig J, Eschenbacher W, et al. Endobronchial ultrasound-guided needle aspiration of a bronchogenic cyst to liberate from mechanical ventilation: case report and literature review. J Bronchology Interv Pulmonol 2013;20:152-4. [Crossref] [PubMed]
  22. Wada H, Yoshida S, Ishikawa A, et al. Endobronchial ultrasonography in a patient with a mediastinal thoracic duct cyst. Ann Thorac Surg 2012;93:1722-5. [Crossref] [PubMed]
  23. Twehues A, Islam S. Cystic lesions of the thorax: role of endobronchial ultrasound-guided transbronchial needle aspiration. J Bronchology Interv Pulmonol 2011;18:265-8. [Crossref] [PubMed]
  24. Anantham D, Phua GC, Low SY, et al. Role of endobronchial ultrasound in the diagnosis of bronchogenic cysts. Diagn Ther Endosc 2011;2011:468237. [Crossref] [PubMed]
  25. Tian Q, Chen LA, Hu H. Infectious Risk Enhanced Because of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Bronchogenic Cysts. J Bronchology Interv Pulmonol 2010;17:283-4. [Crossref] [PubMed]
  26. Casal RF, Jimenez CA, Mehran RJ, et al. Infected mediastinal bronchogenic cyst successfully treated by endobronchial ultrasound-guided fine-needle aspiration. Ann Thorac Surg 2010;90:e52-3. [Crossref] [PubMed]
  27. Nakajima T, Yasufuku K, Shibuya K, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for the treatment of central airway stenosis caused by a mediastinal cyst. Eur J Cardiothorac Surg 2007;32:538-40. [Crossref] [PubMed]
  28. Rosenthal VD. Impact of needle-free connectors compared with 3-way stopcocks on catheter-related bloodstream infection rates: A meta-analysis. Am J Infect Control 2020;48:281-4. [Crossref] [PubMed]
  29. Yamaguchi K, Doi T, Muguruma T, et al. A simulation study of high-flow versus normal-flow three-way stopcock for rapid fluid administration in emergency situations: A randomised crossover design. Aust Crit Care 2022;35:66-71. [Crossref] [PubMed]
  30. Grossberg AJ, Fowl DA, Merritt BT, et al. Comparing the Push-Pull Technique to Pressure Bag for Administration of Blood Products: A Prospective Nonblinded Observation Simulation-based Study (CoPP toP Study). J Emerg Trauma Shock 2024;17:208-11. [Crossref] [PubMed]
  31. Masada T, Tanaka T, Nishiofuku H, et al. Use of a Glass Membrane Pumping Emulsification Device Improves Systemic and Tumor Pharmacokinetics in Rabbit VX2 Liver Tumor in Transarterial Chemoembolization. J Vasc Interv Radiol 2020;31:347-51. [Crossref] [PubMed]
  32. O'Connor S, Zhang YL, Christians U, et al. Remifentanil and propofol undergo separation and layering when mixed in the same syringe for total intravenous anesthesia. Paediatr Anaesth 2016;26:703-9. [Crossref] [PubMed]
  33. Yankelevitz DF, Davis SD, Henschke CI. Aspiration of a large pneumothorax resulting from transthoracic needle biopsy. Radiology 1996;200:695-7. [Crossref] [PubMed]
  34. Casey AL, Worthington T, Lambert PA, et al. A randomized, prospective clinical trial to assess the potential infection risk associated with the PosiFlow needleless connector. J Hosp Infect 2003;54:288-93. [Crossref] [PubMed]
  35. Kumar A, Kumar N, Sinha C. Oxygen through suction port: use of a three way stopcock during fiberoptic bronchoscopy. Anaesth Crit Care Pain Med 2019;38:83-4. [Crossref] [PubMed]
doi: 10.21037/acr-2025-306
Cite this article as: Cai X, Fei C, Pang S, Tang C, Li S. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined with a three-way stopcock for mediastinal cysts through negative pressure drainage: a case report. AME Case Rep 2026;10:101.

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