Transpulmonary artery needle aspiration of hilar masses with endobronchial ultrasound a necessary evil

Summary: The safety with regard to bleeding complications of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of hilar and mediastinal lymphadenopathy has been well established. The real-time visualization of targeted and surrounding structures allows the operator to avoid puncturing even small vessels. However, on occasions, the only way to reach the target is by traversing vessels. We report 2 cases of right hilar masses that were successfully diagnosed with EBUS-TBNA performed by traversing the pulmonary artery without any complications. We suggest that transpulmonary artery needle aspiration can be safely conducted but should be performed only by experienced operators and should be reserved as a last resort for making a diagnosis.