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3. Repeat bronchoscopy with EBUS
She still needs a tissue diagnosis and repeat bronchoscopy with EBUS, needle biopsy of the lung lesion or VATS seems reasonable. A Chamberlain procedure is an anterior mediastinal lymph node exploration which allows access to station 5 and 6 lymph nodes via the left second intercostal space. It has largely been supplanted by bronchoscopy with EBUS. We chose to repeat the bronchoscopy with EBUS. It revealed a narrowed LUL bronchus (Figure 3).
Figure 3. Photograph of the left upper lobe bronchus showing narrowing and splaying of the carina.
Biopsies were taken with EBUS and transbronchial biopsies also performed. The EBUS revealed lymphocytes with a possible germinal center. No malignancy or granulomas were seen. The transbronchial biopsies showed a mixed inflammatory infiltrate with lymphocytes, plasma cells, histiocytes, eosinophils and small amount of necrotic debris. No malignancy was identified and smears and cultures were also negative.
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