Endoscopic ultrasound-guided fine-needle aspiration of enlarged mediastinal lymph nodes in eosinophilic esophagitis

Abstract

A 29-year-old man presented with a 3-month history of dysphagia and chest pain. Esophagogastroduodenoscopy showed a narrowed mid-esophagus with smooth mucosa (Figure [1]). Endoscopic ultrasound (EUS) was performed, which showed loss of echo layers, esophageal wall thickening (Figure [2]), and enlarged mediastinal lymph nodes (Figure [3]). EUS-guided fine-needle aspiration (FNA) of these lymph nodes was not performed at this stage because the patient was agitated. Endoscopic biopsies from the mid-esophagus showed eosinophilic esophagitis with > 15 eosinophils per high-power field. He was treated with Advair (fluticasone/salmeterol) for 1 month by his physician and the dysphagia resolved.