Supplementary Material for: A Case of Post-EBUS Polymicrobial Pericarditis and Mediastinitis in Metastatic Renal Cell Carcinoma

Introduction: Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a frequently used bronchoscopic method for sampling centrally located tumors and accessible mediastinal lymph nodes. It is widely employed for staging and obtaining tissue diagnosis in lung cancer, but it can also be used for other conditions with mediastinal lymph node metastases. Although the reported complication rate for EBUS-TBNA varies, it consistently remains low, including for severe infectious complications such as pericarditis and mediastinitis.
Case Presentation: We present a unique case of polymicrobial pyogenic pericarditis, mediastinitis, and death in a patient who underwent EBUS-TBNA for the evaluation of solitary mediastinal lymphadenopathy in the background of previously resected renal cell carcinoma. There were no complications during her procedure and her mediastinal lymph node biopsy confirmed metastatic renal cell carcinoma. However, 23 days after her procedure she presented to the emergency department with sepsis and cardiac tamponade. Pericardial fluid cultures and CT imaging confirmed polymicrobial pyogenic pericarditis and mediastinitis.
Conclusion: While complications from EBUS-TBNA are rare, clinicians need to be aware that pericarditis and mediastinitis are possible life-threatening complications in order to facilitate early recognition and interventions.

引言：支气管内超声引导经支气管针吸活检术（Endobronchial ultrasound transbronchial needle aspiration, EBUS-TBNA）是一种常用于采集中央型肿瘤及可及性纵隔淋巴结样本的支气管镜检查方法。其被广泛应用于肺癌的分期诊断与组织病理学取材，同时也可用于伴纵隔淋巴结转移的其他疾病的相关评估。尽管EBUS-TBNA的报道并发症发生率存在差异，但整体始终维持在较低水平，涵盖心包炎、纵隔炎等严重感染性并发症。
病例报告：我们报告一例特殊病例：患者既往曾接受肾细胞癌切除术，因孤立性纵隔淋巴结肿大接受EBUS-TBNA检查以明确评估，手术过程未出现并发症，纵隔淋巴结活检证实为转移性肾细胞癌。然而在术后23天，患者因脓毒症与心脏压塞前往急诊就诊，心包积液培养及CT影像学检查证实为多菌性化脓性心包炎与纵隔炎，最终患者死亡。
结论：尽管EBUS-TBNA的并发症较为罕见，但临床医师需警惕心包炎与纵隔炎作为可能危及生命的并发症，以便尽早识别并采取干预措施。