EBUS-Guided Mediastinal Cryobiopsy Diagnoses Sarcoidosis in a 29-Year-Old Womanration
Patient Profile
Age | 29 years |
Gender | Female |
Hospital | Medanta Hospital |
Background | Previously fit and well, no prior respiratory illness |
Presenting complaint | Shortness of breath and cough for three months |
Imaging finding | Enlarged mediastinal lymph nodes on CT scan of the chest |
Diagnosis | Sarcoidosis, confirmed on EBUS with mediastinal cryobiopsy |
Procedure | EBUS-guided mediastinal cryobiopsy |
Outcome | Marked clinical improvement with good response to steroid therapy |
The patient’s identity is withheld in line with confidentiality guidelines. All other details are recorded from the clinical record.
The Problem
The patient was a 29-year-old woman with no prior history of lung or systemic illness who developed shortness of breath and a persistent cough over three months. As the symptoms did not settle on their own, she underwent a CT scan of the chest, which showed enlarged lymph nodes in the mediastinum.
Enlarged mediastinal lymph nodes on a CT scan can point to several very different conditions, including sarcoidosis, tuberculosis, and lymphoma, each of which needs an entirely different line of treatment. A confirmed tissue diagnosis was therefore essential before any therapy could be planned.
The family travelled from West Bengal to Medanta Hospital to consult a pulmonologist in Noida, having heard of Dr. Manu Madan’s experience in diagnosing and managing exactly this kind of presentation.
CONSULTATION & TREATMENT PLAN
What Was Assessed
- Detailed history of the duration and pattern of breathlessness and cough, and screening for fever, night sweats, and weight loss.
- Review of the CT chest to map the size, number, and station of the enlarged mediastinal lymph nodes.
- Relevant blood investigations and screening to help narrow the differential diagnosis.
- Evaluation of the differential diagnosis: sarcoidosis, tuberculosis, and lymphoma.
- Assessment of fitness for a bronchoscopic procedure under sedation.
Why This Approach Was Chosen
Dr. Manu Madan recommended EBUS-guided sampling of the mediastinal lymph nodes, with cryobiopsy, as the first-line diagnostic step, rather than a surgical biopsy, for clear reasons:
- Minimally invasive: the enlarged nodes are reached through the airway using a bronchoscope fitted with an ultrasound probe, with no incision and no scar.
- Better tissue yield: a cryobiopsy retrieves a larger, better-preserved tissue core than a standard needle aspirate, which improves the chance of a confident histopathological diagnosis in a single sitting.
- Real-time accuracy: ultrasound guidance allows the target node to be visualised and sampled precisely.
- Safer profile: the procedure avoids general anaesthesia and the risks associated with surgical mediastinal biopsy, and is completed as a day-care procedure.
Procedure Details
The procedure followed the standard protocol for EBUS treatment in Noida, combining ultrasound-guided sampling with mediastinal cryobiopsy. The technique builds on the same airway access used in a conventional bronchoscopy, with the addition of an ultrasound probe and cryoprobe at the tip of the scope, performed under sedation with continuous monitoring.
Step by Step
- Pre-procedure assessment completed, fasting confirmed, and informed consent obtained.
- Sedation administered, with continuous monitoring of oxygen levels and vital signs.
- EBUS bronchoscope passed through the airway to visualise the enlarged mediastinal lymph nodes.
- Initial needle aspiration performed under real-time ultrasound guidance for on-site assessment.
- A cryoprobe passed through the working channel to obtain a larger core biopsy from the targeted lymph node station.
- Samples sent for histopathology and microbiological testing, including for tuberculosis.
- Patient monitored in recovery before discharge.
Procedure Facts
Procedure | EBUS-guided mediastinal cryobiopsy |
Target | Mediastinal lymph nodes |
Indication | Tissue diagnosis of mediastinal lymphadenopathy of unknown cause |
Anaesthesia | Sedation, as per institutional protocol |
Approach | Through the airway; no incision |
Intraoperative complications | None reported |
Hospital stay | Day-care procedure |
Post-Procedure Results
Histopathological examination of the cryobiopsy sample showed non-caseating granulomas, with negative stains and cultures for tuberculosis. Taken together with the clinical picture, this confirmed a diagnosis of sarcoidosis, avoiding the need for a surgical biopsy.
Once the diagnosis was confirmed, the patient was started on steroid therapy. On follow-up, she showed marked improvement in her breathlessness and cough, with a good response to treatment.
Outcomes at a Glance
Diagnostic yield | Definitive tissue diagnosis of sarcoidosis obtained via cryobiopsy. |
Surgery avoided | No open surgical biopsy, no general anaesthesia, no scar. |
Complications | None reported. |
Hospital stay | Day-care procedure. |
Treatment response | Started on steroids; good clinical response with symptomatic improvement. |
PATIENT FEEDBACK
Recorded during clinical follow-up:
“We travelled all the way from West Bengal after hearing Dr. Manu Madan‘s name. After being troubled so much, meeting him was a big relief.”
Post-Procedure Care and Recovery
Instructions Given to the Patient
- Avoid eating or drinking for two hours after the procedure until sedation and throat numbness wear off.
- Expect a mild sore throat or a small amount of blood-streaked sputum for a day; report anything more than this.
- Avoid driving or operating machinery on the day of the procedure.
- Attend the review appointment for biopsy results and take steroid therapy exactly as prescribed.
- Attend scheduled follow-up to monitor symptom control and response to treatment.
Recovery Timeline
| Day of procedure | Monitored recovery, then discharge home. Mild throat discomfort is common. |
| Day 1 to 2 | Return to normal activities. Any throat soreness settles. |
| Day 3 to 7 | Pathology results available. Diagnosis discussed and steroid therapy started. |
| Week 2 onwards | Noticeable improvement in breathlessness and cough on steroid therapy. |
| Month 3 | Follow-up review to assess sustained response to treatment. |
This case was managed by Dr. Manu Madan, Senior Consultant in Respiratory and Sleep Medicine at Medanta Hospital.
Frequently Asked Questions
What is EBUS-guided mediastinal cryobiopsy?
It is a minimally invasive bronchoscopic procedure in which an ultrasound-tipped bronchoscope locates enlarged lymph nodes in the mediastinum, and a cryoprobe is used to obtain a larger, well-preserved tissue sample for diagnosis, without any surgical incision.
Why was a cryobiopsy needed instead of a standard needle aspiration?
A cryobiopsy retrieves a larger tissue core than a fine-needle aspirate, which improves the chance of reaching a confident histopathological diagnosis, such as confirming non-caseating granulomas in sarcoidosis, in a single procedure.
Is EBUS with mediastinal cryobiopsy a major surgery?
No. It is performed through the airway under sedation, with no incision, and is typically completed as a day-care procedure with same-day or next-day discharge.
How was sarcoidosis confirmed in this case?
The cryobiopsy sample showed non-caseating granulomas on histopathology, and tests for tuberculosis were negative, which together with the clinical picture confirmed the diagnosis of sarcoidosis.
What was the treatment and outcome?
The patient was started on steroid therapy after diagnosis and showed a good clinical response, with marked improvement in her breathlessness and cough on follow-up.