Case 10-2012: a boy with epigastric pain and a mediastinal mass.

In the Case Record (March 29 issue) 1 about a 16-year-old boy with acute epigastric pain, Kelleher et al. focused on a mediastinal cystic mass seen on a computed tomographic scan. Since the mass was abutting the esophagus, endoscopic ultrasonography and fine-needle aspiration with a large-bore (19-gauge) needle were performed. Although endoscopic ultrasoundguided fine-needle aspiration of mediastinal solid lesions and lymph nodes is widely used and has a major effect on clinical outcome, 2 we believe that it is not advisable for mediastinal cystic lesions, since severe infection and mediastinitis can occur, even after prophylactic antibiotics are administered. 3,4 Recently, guidelines from the European Society of Gastrointestinal Endoscopy have discouraged the use of endoscopic ultrasound-guided fine-needle aspiration in mediastinal cysts (evidence level, 3; recommendation grade, D). 5 We do not think that endoscopic ultrasound-guided fine-needle aspiration was warranted in this 16-year-old boy, since the cytologic results were unlikely to affect the treatment, which was going to be, of necessity, surgical.