Case Report: Novel Insights Endobronchial Ultrasound-Guided Transbronchial Incision and Resection of Calcified Lymph Nodes - A Minimally Invasive Approach to Airway Stenosis

Introduction Although calcified mediastinal lymph nodes are often clinically silent, they can eventually compress vital structures, such as the trachea or bronchi, necessitating intervention. Traditional surgical resection can be risky for certain patients. We present a pioneering case in which endobronchial ultrasound (EBUS)-guided transbronchial resection effectively relieved bronchial obstruction caused by calcified lymph nodes. Case presentation A 59-year-old male with a history of treated tuberculosis presented with a 4-month history of persistent cough, sputum, and dyspnea. Imaging revealed calcified mediastinal lymph nodes compressing the right intermediate bronchus, with mucus plug formation and obstructive pneumonia. After attending a team consultation in which the risks were reviewed, the patient declined surgery. Hence, an EBUS-guided transbronchial resection was performed under general anesthesia. Two calcified lymph nodes were resected using a high-frequency needle knife and forceps under real-time ultrasound guidance. No perioperative complications occurred. The patient's respiratory symptoms resolved, and follow-up bronchoscopy at 4 months showed a fully healed airway without restenosis. Conclusion This case highlights the feasibility and safety of EBUS-guided transbronchial resection as a minimally invasive treatment for symptomatic mediastinal lymph node calcification. EBUS may potentially be a viable alternative for patients in whom thoracic surgery is contraindicated or declined.