The Essential cTBNA Bronchoscopist
The Essential Conventional TBNA Bronchoscopist© is the third of six volumes in The Essential Bronchoscopist™ Series. In addition to module-specific competency-oriented learning objectives and post-tests, it contains 30 multiple-choice question/answer sets pertaining to conventional transbronchial needle aspiration (cTBNA). Topics include mediastinal anatomy, proper equipment handling, patient preparation, procedural indications contraindications and complications, bronchoscopic techniques, nodal sampling strategies, lung cancer staging and classification, specimen collection, processing, and expected results for diagnosing malignant and benign mediastinal disorders.
The Essential Conventional TBNA Bronchoscopist© is the third of six volumes in The Essential Bronchoscopist™ Series. In addition to module-specific competency-oriented learning objectives and post-tests, it contains
30 multiple-choice question/answer sets pertaining to conventional transbronchial needle aspiration (cTBNA). Topics include mediastinal anatomy, proper equipment handling, patient preparation, procedural indications contraindications and complications, bronchoscopic techniques, nodal
sampling strategies, lung cancer staging and classification, specimen collection, processing, and expected results for diagnosing malignant and benign mediastinal disorders.
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Question I.16 While performing cTBNA from a subcarinal lymph node (level 7), you obtain a
bloody sample. This could be caused by which of the the following?
A. The left atrium has been pentrated.
B. The right pulmonary artery has been penetrated.
C. The inferior pulmonary vein has been penetrated.
D. A blood vessel within the lymph node itself has been penetrated.
E. All of the above.
Answer: E
Each of the anatomic structures listed: left atrium, right pulmonary artery and inferior
pulmonary vein could be inadevertently penetrated during cTBNA of a level 7 node. Keep in
mind that blood vessels inside a lymph node are not uncommon. The use of EBUS-TBNA alows
direct visualization of the node during needle insertion, as well as identification of blood vessels
as hypoechoic structures that are Doppler positive (see Image).
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