A 54-year-old ex-smoker presented with an abnormal chest radiograph. He was asymptomatic had a normal physical examination, and the radiograph was taken as part of a license application. CT scan revealed a well-circumscribed lesion in the right lower paratracheal region abutting the azgos vein. EBUS-TBNA was performed using the 7.5 MHz convex probe bronchoscope (BF-UC260F; Olympus Ltd, Tokyo, Japan). The lesion was identified as a round, anechoic structure and distinguished from surrounding blood vessels using color Doppler (Figure 1). A dedicated 22-gauge needle (NA-202, Olympus Ltd, Tokyo, Japan) was used to puncture and aspirate the lesion under direct visual guidance. To ensure complete drainage of the lesion, the gradual shrinkage of the cyst was observed on ultrasound while 50 milliliters of serous fluid was aspirated (Figure 1). Cytological examination of the aspirate yielded metaplastic squamous cells with negative microbiological cultures. He has remained clinically and radiologically stable on followup for 18 months.