EUS-guided trans-aortic FNA

Nah Kyum Lee, MD, and Do Hyun Park, MD, PhD, from the Division of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, in Seoul, South Korea present this VideoGIE case “EUS-guided trans-aortic fine-needle aspiration for intra-abdominal plasmacytoma in a patient with multiple myeloma.”

Our video case describes EUS-guided trans-aortic fine-needle aspiration (FNA) for intra-abdominal plasmacytoma in a patient diagnosed with multiple myeloma. Multiple myeloma with intra-abdominal plasmacytoma is extremely rare, so a biopsy was performed to rule out other metastatic malignancies. The enlarged para-aortic lymph node is located inferior to the descending aorta, EUS-guided trans-aortic FNA was performed with a conventional 25-gauge EUS needle. No suction was applied during the procedure and in total two needle passes were performed. There was no adverse event during and after the procedure. The pathology revealed plasmacytoma. As a result, the patient underwent chemotherapy for multiple myeloma with intra-abdominal plasmacytoma.

Figure 1. A, EUS-guided trans-aortic FNA was performed with a conventional 25-gauge needle. B, An illustration of EUS-guided trans-aortic FNA.

EUS-guided FNA is used for the diagnosis and staging of gastrointestinal diseases and pulmonary disorders. Several reports demonstrated EUS-guided trans-aortic aspiration of para-aortic lymph nodes for the diagnosis of lung cancer. To the best of our knowledge, this is the first report of EUS-guided trans-aortic FNA for intra-abdominal lymphadenopathy.

EUS-guided FNA can be performed for the diagnosis of intra-abdominal lymphadenopathy, which is located adjacent to the aorta with conventional 25-gauge EUS needle, and it is technically feasible. Indications for EUS-guided FNA in retroperitoneal masses will be expanded in scope in the future.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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