. Step 22 of 41
Clinical Stem 3
A patient with right upper lobe adenocarcinoma progressing on biomarker-directed therapy

The Case Continues
The multidisciplinary team chose to proceed with bronchoscopy and EBUS-TBNA. White light bronchoscopy showed normal airways. EBUS exploration of the mediastinum showed lymph nodes at stations 4R and 11R superior. EBUS-TBNA from both nodes was attempted. The nodes were very difficult to penetrate. A different inter-cartilaginous space was chosen for puncturing the nodes by redirecting the needle; the 4R lymph node could not be penetrated. Two aspirates of the 11R superior lymph node were obtained. However, on rapid on-site evaluation (ROSE), only blood and a few scattered lymphocytes were visualized

Each fictitious clinical case scenario is based on a conglomerate of real patient data. Cases have been modified to avoid any possibility for patient identification and to help meet educational objectives. Any resemblance to real persons, living or deceased, is purely coincidental.

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