Missed distal tracheal foreign body in consecutive bronchoscopies in a 6-year-old boy

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Oghenevware Joel Eyekpegha

2017-01-01

Full Text Available It is unusual but not uncommon for foreign bodies to be missed at bronchoscopy. This case report highlights the importance of the clinical history in the diagnosis of aspirated foreign bodies and the usefulness of chest imaging modalities. A 6-year-old boy presented with recurrent breathlessness and cough of 2 months. He was said to have aspirated the base cap of a pen at about the time symptoms started. He had two sessions of rigid bronchoscopy and a session of flexible bronchoscopy at three different hospitals. He had an initial rigid bronchoscopy which failed to show the foreign body (FB. A chest computerized tomographic scan demonstrated the FB, which was retrieved at combined flexible/rigid bronchoscopy. Although rigid bronchoscopy is the gold standard for managing airway foreign bodies, there remains a false negative rate for this procedure and where necessary, appropriate imaging may compliment rigid bronchoscopy, especially where there is some confusion.

Management of antithrombotic agents in patients undergoing flexible bronchoscopy

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Sami Abuqayyas

2017-07-01

Full Text Available Bleeding is one of the most feared complications of flexible bronchoscopy. Although infrequent, it can be catastrophic and result in fatal outcomes. Compared to other endoscopic procedures, the risk of morbidity and mortality from the bleeding is increased, as even a small amount of blood can fill the tracheobronchial tree and lead to respiratory failure. Patients using antithrombotic agents (ATAs have higher bleeding risk. A thorough understanding of the different ATAs is critical to manage patients during the peri-procedural period. A decision to stop an ATA before bronchoscopy should take into account a variety of factors, including indication for its use and the type of procedure. This article serves as a detailed review on the different ATAs, their pharmacokinetics and the pre- and post-bronchoscopy management of patients receiving these medications.

Bronchial carcinoid tumor: helical CT and virtual bronchoscopy

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Diez, Eduardo; Carrascosa, Patricia; Capunay, Carlos; Spinozzi, German; Abramson, Horacio; Berna, Miguel

2001-01-01

The authors reported a case of a 61 years old man with recurrent neumonia of the inferior right lobe diagnosed by a chest radiography. A complementary helical CT showed an endobronquial mass on the right intermediate bronchus. Virtual bronchoscopy contributed to a better definition of this lesion, confirmed by a real bronchoscopy. The lesion was diagnosed as a carcinoid tumor by a bronchial biopsy. After surgery (sleeve resection of the tumor) the patient did not show any recurrence of his broncho-neumonic clinical features. (author)

Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions.

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Makris, D; Scherpereel, A; Leroy, S; Bouchindhomme, B; Faivre, J-B; Remy, J; Ramon, P; Marquette, C-H

2007-06-01

The present study prospectively evaluated the diagnostic yield and safety of electromagnetic navigation-guided bronchoscopy biopsy, for small peripheral lung lesions in patients where standard techniques were nondiagnostic. The study was conducted in a tertiary medical centre on 40 consecutive patients considered unsuitable for straightforward surgery or computed tomography (CT)-guided transthoracic needle aspiration biopsy, due to comorbidities. The lung lesion diameter was mean+/-sem 23.5+/-1.5 mm and the depth from the visceral-costal pleura was 14.9+/-2 mm. Navigation was facilitated by an electromagnetic tracking system which could detect a position sensor incorporated into a flexible catheter advanced through a bronchoscope. Information obtained during bronchoscopy was superimposed on previously acquired CT data. Divergence between CT data and data obtained during bronchoscopy was calculated by the system's software as a measure of navigational accuracy. All but one of the target lesions was reached and the overall diagnostic yield was 62.5% (25-40). Diagnostic yield was significantly affected by CT-to-body divergence; yield was 77.2% when estimated divergence was drainage was required in one case. Electromagnetic navigation-guided bronchoscopy has the potential to improve the diagnostic yield of transbronchial biopsies without additional fluoroscopic guidance, and may be useful in the early diagnosis of lung cancer, particularly in nonoperable patients.

High-Flow Nasal Interface Improves Oxygenation in Patients Undergoing Bronchoscopy

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Umberto Lucangelo

2012-01-01

Full Text Available During bronchoscopy hypoxemia is commonly found and oxygen supply can be delivered by interfaces fed with high gas flows. Recently, the high-flow nasal cannula (HFNC has been introduced for oxygen therapy in adults, but they have not been used so far during bronchoscopy in adults. Forty-five patients were randomly assigned to 3 groups receiving oxygen: 40 L/min through a Venturi mask (V40, N=15, nasal cannula (N40, N=15, and 60 L/min through a nasal cannula (N60, N=15 during bronchoscopy. Gas exchange and circulatory variables were sampled before (FiO2 = 0.21, at the end of bronchoscopy (FiO2 = 0.5, and thereafter (V40, FiO2 = 0.35. In 8 healthy volunteers oxygen was randomly delivered according to V40, N40, and N60 settings, and airway pressure was measured. At the end of bronchoscopy, N60 presented higher PaO2, PaO2/FiO2, and SpO2 than V40 and N40 that did not differ between them. In the volunteers (N60 median airway pressure amounted to 3.6 cmH2O. Under a flow rate of 40 L/min both the Venturi mask and HFNC behaved similarly, but nasal cannula associated with a 60 L/min flow produced the better results, thus indicating its use in mild respiratory dysfunctions.

Bronchoscopy Simulation: A Brief Review

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Davoudi, Mohsen; Colt, Henri G.

2009-01-01

More than 500,000 flexible bronchoscopies are performed annually by chest physicians in the United States (Ernst et al., Chest 123:1693-1717, 2003). Indications include diagnosis of lung cancer and airway tumors, benign strictures, pulmonary infections, and treatment of central airway obstruction, emphysema, and intraepithelial lesions such as…

Virtual reality bronchoscopy simulation: a revolution in procedural training.

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Colt, H G; Crawford, S W; Galbraith, O

2001-10-01

In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner. We prospectively studied five novice bronchoscopists entering a pulmonary and critical care medicine training program. They were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill center; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h of individual unsupervised practice. Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control groups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired two-sample t tests were used. Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performance equaled or surpassed that of the skilled physicians. Novices performed

Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules.

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Schwarz, Carsten; Schönfeld, Nicolas; Bittner, Roland C; Mairinger, Thomas; Rüssmann, Holger; Bauer, Torsten T; Kaiser, Dirk; Loddenkemper, Robert

2013-01-01

The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin. Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n=1, small cell lung cancer n=1, bacterial pneumonia n=2), and the surgical strategy had to be modified to bilobectomy in one patient. Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular pre-operative work-up of patients with SPN.

Interactive navigation and bronchial tube tracking in virtual bronchoscopy.

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Heng, P A; Fung, P F; Wong, T T; Siu, Y H; Sun, H

1999-01-01

An interactive virtual environment for simulation of bronchoscopy is developed. Medical doctor can safely plan their surgical bronchoscopy using the virtual environment without any invasive diagnosis which may risk the patient's health. The 3D pen input device of the system allows the doctor to navigate and visualize the bronchial tree of the patient naturally and interactively. To navigate the patient's bronchial tree, a vessel tracking process is required. While manual tracking is tedious and labor-intensive, fully automatic tracking may not be reliable. We propose a semi-automatic tracking technique called Intelligent Path Tracker which provides automation and enough user control during the vessel tracking. To support an interactive frame rate, we also introduce a new volume rendering acceleration technique, named as IsoRegion Leaping. The volume rendering is further accelerated by distributed rendering on a TCP/IP-based network of low-cost PCs. With these approaches, a 256 x 256 x 256 volume data of human lung, can be navigated and visualized at a frame rate of over 10 Hz in our virtual bronchoscopy system.

Risks and recommendations to perform flexible bronchoscopy in pregnant woman

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Majid, Adnan; Ernst, Armin; Begolli, Melissa; Canas, Alejandra

2008-01-01

If possible, it is advisable to postpone Flexible Bronchoscopy until after delivery, or at least until after the twenty eighth week of pregnancy. Bronchoscopy should be carried out by the most experienced pulmonologist and in a hospital facility where anesthesiology, obstetrics and neonatology departments are available. Consultation with these specialists is recommended. A pharmacologist should be consulted with regard to the teratogenic potential of the drugs that are to be used during bronchoscopy. The lowest possible doses of drugs should be used for sedation, and drugs of the D and X categories should not be used. During the procedure, it is advisable to carry out continual monitoring of cardiac rhythm and pulse oximetry, as well as intermittent measurements of arterial blood pressure. If possible, fetal monitoring should be carried out. The patient should be placed in the left lateral decubitus position. If this is not possible, the procedure should be carried out with the patient in the sitting position. The duration of the procedure should be minimized, and it should be terminated if the patient does not tolerate it well. The convenience of using fluoroscopy has to be considered separately in each case, taking into consideration its potential risks and benefits. Technological advances for the diagnosis and treatment of pulmonary and airway diseases, such as endobronchial ultrasound, CT scanning with fluoroscopy and bronchoscopy

Bronchoscopy findings in children with recurrent and chronic stridor.

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Najada, Abdelhamid S; Dahabreh, Muna M

2011-01-01

To describe the bronchoscopic findings and treatment decision of children with chronic or recurrent stridor referred to the pediatric respiratory clinic at Queen Rania Hospital for Children. All children who underwent flexible bronchoscopy at the pediatric bronchoscopy unit for chronic stridor from January 2009 to January 2010 were included. Stridor was divided into 3 groups: inspiratory, expiratory, or biphasic. All patients from 2 weeks of age till 14 years were included. Files of these patients were retrospectively reviewed. A specially formulated data sheet including clinical history and physical findings, type of stridor, bronchoscopic findings, and management decision was used. Radiologic investigation results were included when relevant. Flexible bronchoscopy was performed under sedation and topical anesthesia. A total of 64 children [35 (54.7%) male and 29 (45.3%) female] were included. Twenty-four patients had inspiratory stridor. There were 33 patients with biphasic stridor (subglottic stenosis in 9, paradoxical vocal cord movement in 6, vascular ring in 5, subglottic hemangioma in 3, vocal cord paralyses in 4, foreign body in 2, laryngeal web in 2, and absent vocal cord and tracheal bronchus in 1 each). Seven children had expiratory stridor. Of patients with laryngomalacia, 50% had associated tracheomalacia and 70% of those with laryngomalacia and all patients with tracheomalacia had associated gastroesophageal reflux. Two patients with paradoxical vocal cord movement were found to have Arnold-Chiari malformation. All patients with vascular rings underwent surgery. Flexible bronchoscopy should be performed in all patients with chronic or recurrent stridor to assess the airway and guide further investigations and management.

Diagnostic potential of virtual bronchoscopy: advantages in comparison with axial CT slices, MPR and mIP?

International Nuclear Information System (INIS)

Rapp-Bernhardt, U.; Doehring, W.; Bernhardt, T.M.; Welte, T.; Kropf, S.

2000-01-01

The aim of this study was to evaluate the diagnostic potential of virtual endoscopy (VE) and to compare it with axial CT slices, multiplanar reconstructions (MPR), minimal intensity projections (mIP), and bronchoscopy in patients diagnosed with bronchogenic carcinoma. Thirty patients underwent a spiral CT. Axial CT images were transferred to an Onyx workstation (Silicon Graphics, Sun Microsystems, Mountain View, Calif.) for performing virtual endoscopy. Accuracy for this procedure was tested by three radiologists on a monitor in comparison with axial CT slices, MPR, mIP, and bronchoscopy concerning the localization and degree of stenoses. Endoluminal tumors were identified by virtual bronchoscopy with no statistically significant difference of localization or grading of stenosis in comparison with bronchoscopy, axial CT slices, MPR and mIP. Axial CT slices, MPR, and mIP showed poorer results with over- or underestimation of stenoses compared with VE and bronchoscopy. Passing of stenoses was only possible with VE in 5 patients. Virtual endoscopy is a non-invasive method for identification of endoluminal tumors and is comparable to real bronchoscopy. (orig.)

Diagnostic potential of virtual bronchoscopy: advantages in comparison with axial CT slices, MPR and mIP?

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Rapp-Bernhardt, U.; Doehring, W.; Bernhardt, T.M. [Department of Diagnostic Radiology, Otto-von-Guericke University, Magdeburg (Germany); Welte, T. [Department of Cardiology, Angiology, and Pneumology, Otto-von-Guericke University, Magdeburg (Germany); Kropf, S. [Department of Biometrics and Medical Informatics, Otto-von-Guericke University, Magdeburg (Germany)

2000-06-01

The aim of this study was to evaluate the diagnostic potential of virtual endoscopy (VE) and to compare it with axial CT slices, multiplanar reconstructions (MPR), minimal intensity projections (mIP), and bronchoscopy in patients diagnosed with bronchogenic carcinoma. Thirty patients underwent a spiral CT. Axial CT images were transferred to an Onyx workstation (Silicon Graphics, Sun Microsystems, Mountain View, Calif.) for performing virtual endoscopy. Accuracy for this procedure was tested by three radiologists on a monitor in comparison with axial CT slices, MPR, mIP, and bronchoscopy concerning the localization and degree of stenoses. Endoluminal tumors were identified by virtual bronchoscopy with no statistically significant difference of localization or grading of stenosis in comparison with bronchoscopy, axial CT slices, MPR and mIP. Axial CT slices, MPR, and mIP showed poorer results with over- or underestimation of stenoses compared with VE and bronchoscopy. Passing of stenoses was only possible with VE in 5 patients. Virtual endoscopy is a non-invasive method for identification of endoluminal tumors and is comparable to real bronchoscopy. (orig.)

Distributed practice. The more the merrier? A randomised bronchoscopy simulation study.

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Bjerrum, Anne Sofie; Eika, Berit; Charles, Peder; Hilberg, Ole

2016-01-01

The distribution of practice affects the acquisition of skills. Distributed practice has shown to be more effective for skills acquisition than massed training. However, it remains unknown as to which is the most effective distributed practice schedule for learning bronchoscopy skills through simulation training. This study compares two distributed practice schedules: One-day distributed practice and weekly distributed practice. Twenty physicians in training were randomly assigned to one-day distributed or weekly distributed bronchoscopy simulation practice. Performance was assessed with a pre-test, a post-test after each practice session, and a 4-week retention test using previously validated simulator measures. Data were analysed with repeated measures ANOVA. No interaction was found between group and test (F(4,72) 0.16), except for the measure 'percent-segments-entered', and no main effect of group was found for any of the measures (F(1,72)0.36), which indicates that there was no difference between the learning curves of the one-day distributed practice schedule and the weekly distributed practice schedule. We found no difference in effectiveness of bronchoscopy skills acquisition between the one-day distributed practice and the weekly distributed practice. This finding suggests that the choice of bronchoscopy training practice may be guided by what best suits the clinical practice.

Multimodal system for the planning and guidance of bronchoscopy

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Higgins, William E.; Cheirsilp, Ronnarit; Zang, Xiaonan; Byrnes, Patrick

2015-03-01

Many technical innovations in multimodal radiologic imaging and bronchoscopy have emerged recently in the effort against lung cancer. Modern X-ray computed-tomography (CT) scanners provide three-dimensional (3D) high-resolution chest images, positron emission tomography (PET) scanners give complementary molecular imaging data, and new integrated PET/CT scanners combine the strengths of both modalities. State-of-the-art bronchoscopes permit minimally invasive tissue sampling, with vivid endobronchial video enabling navigation deep into the airway-tree periphery, while complementary endobronchial ultrasound (EBUS) reveals local views of anatomical structures outside the airways. In addition, image-guided intervention (IGI) systems have proven their utility for CT-based planning and guidance of bronchoscopy. Unfortunately, no IGI system exists that integrates all sources effectively through the complete lung-cancer staging work flow. This paper presents a prototype of a computer-based multimodal IGI system that strives to fill this need. The system combines a wide range of automatic and semi-automatic image-processing tools for multimodal data fusion and procedure planning. It also provides a flexible graphical user interface for follow-on guidance of bronchoscopy/EBUS. Human-study results demonstrate the system's potential.

[Virtual bronchoscopy in the child using multi-slice CT: initial clinical experiences].

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Kirchner, J; Laufer, U; Jendreck, M; Kickuth, R; Schilling, E M; Liermann, D

2000-01-01

Virtual bronchoscopy of the pediatric patient has been reported to be more difficult because of artifacts due to breathing or motion. We demonstrate the benefit of the accelerated examination based on multislice spiral CT (MSCT) in the pediatric patient which has not been reported so far. MSCT (tube voltage 120 kV, tube current 110 mA, 4 x 1 mm Slice thickness, 500 ms rotation time, Pitch 6) was performed on a CT scanner of the latest generation (Volume Zoom, Siemens Corp. Forchheim, Germany). In totally we examined 11 patients (median age 48 months, range 2-122 months) suspected of having tracheoesophageal fistula (n = 2), tracheobronchial narrowing (n = 8) due to intrinsic or extrinsic factors or injury of the bronchial system (n = 1). In all patients we obtained sufficient data for 3D reconstruction avoiding general anesthesia. 6/11 examinations were described to be without pathological finding. A definite diagnosis was obtained in 10 patients. Virtual bronchoscopy could avoid other invasive diagnostic examination in 8/11 patients (73%). Helical CT provides 3D-reconstruction and virtual bronchoscopy in the newborn as well as the infant. It avoids additional diagnostic bronchoscopy in a high percentage of all cases.

Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine

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Mefkur Bakan

2014-06-01

Full Text Available OBJECTIVE:Laryngoscopy and stimuli inside the trachea cause an intense sympatho-adrenal response. Remifentanil seems to be the optimal opioid for rigid bronchoscopy due to its potent and short-acting properties. The purpose of this study was to compare bolus propofol and ketamine as an adjuvant to remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy.MATERIALS AND METHODS:Forty children under 12 years of age who had been scheduled for a rigid bronchoscopy were included in this study. After midazolam premedication, a 1 µg/kg/min remifentanil infusion was started, and patients were randomly allocated to receive either propofol (Group P or ketamine (Group K as well as mivacurium for muscle relaxation. Anesthesia was maintained with a 1 µg/kg/min remifentanil infusion and bolus doses of propofol or ketamine. After the rigid bronchoscopy, 0.05 µg/kg/min of remifentanil was maintained until extubation. Hemodynamic parameters, emergence characteristics, and adverse events were evaluated.RESULTS:The demographic variables were comparable between the two groups. The decrease in mean arterial pressure from baseline values to the lowest values during rigid bronchoscopy was greater in Group P (p= 0.049, while the reduction in the other parameters and the incidence of adverse events were comparable between the two groups. The need for assisted or controlled mask ventilation after extubation was higher in Group K.CONCLUSION:Remifentanil-based total intravenous anesthesia with propofol or ketamine as an adjuvant drug along with controlled ventilation is a viable technique for pediatric rigid bronchoscopy. Ketamine does not provide a definite advantage over propofol with respect to hemodynamic stability during rigid bronchoscopy, while propofol seems more suitable during the recovery period.

Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

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Karan Madan

2014-01-01

Full Text Available Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65 min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

Post-bronchoscopy pneumonia in patients suffering from lung cancer: Development and validation of a risk prediction score.

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Takiguchi, Hiroto; Hayama, Naoki; Oguma, Tsuyoshi; Harada, Kazuki; Sato, Masako; Horio, Yukihiro; Tanaka, Jun; Tomomatsu, Hiromi; Tomomatsu, Katsuyoshi; Takihara, Takahisa; Niimi, Kyoko; Nakagawa, Tomoki; Masuda, Ryota; Aoki, Takuya; Urano, Tetsuya; Iwazaki, Masayuki; Asano, Koichiro

2017-05-01

The incidence, risk factors, and consequences of pneumonia after flexible bronchoscopy in patients with lung cancer have not been studied in detail. We retrospectively analyzed the data from 237 patients with lung cancer who underwent diagnostic bronchoscopy between April 2012 and July 2013 (derivation sample) and 241 patients diagnosed between August 2013 and July 2014 (validation sample) in a tertiary referral hospital in Japan. A score predictive of post-bronchoscopy pneumonia was developed in the derivation sample and tested in the validation sample. Pneumonia developed after bronchoscopy in 6.3% and 4.1% of patients in the derivation and validation samples, respectively. Patients who developed post-bronchoscopy pneumonia needed to change or cancel their planned cancer therapy more frequently than those without pneumonia (56% vs. 6%, ppneumonia, which we added to develop our predictive score. The incidence of pneumonia associated with scores=0, 1, and ≥2 was 0, 3.7, and 13.4% respectively in the derivation sample (p=0.003), and 0, 2.9, and 9.7% respectively in the validation sample (p=0.016). The incidence of post-bronchoscopy pneumonia in patients with lung cancer was not rare and associated with adverse effects on the clinical course. A simple 3-point predictive score identified patients with lung cancer at high risk of post-bronchoscopy pneumonia prior to the procedure. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Training on a new, portable, simple simulator transfers to performance of complex bronchoscopy procedures

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Loumann Krogh, Charlotte; Konge, Lars; Bjurström, Johanna Margareta

2013-01-01

Virtual-reality (VR) simulation provides a safe and effective learning environment prior to practicing on patients. However, existing bronchoscopy simulators are expensive and not easily portable.......Virtual-reality (VR) simulation provides a safe and effective learning environment prior to practicing on patients. However, existing bronchoscopy simulators are expensive and not easily portable....

Management of airway foreign body using flexible bronchoscopy: Experience with 80 cases during 2011–2013

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Safy Kaddah

2015-01-01

Conclusions: Flexible bronchoscopy is successful in retrieving airway foreign bodies (88.8%. With skilled personnel and perfect equipments, flexible bronchoscopy could be considered as the first choice for the removal of airway foreign body.

Bronchoscopy as a supplement to computed tomography in patients with haemoptysis may be unnecessary

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Nielsen, Klaus; Gottlieb, Magnus; Colella, Sara

2016-01-01

. RESULTS: A total of 326 patients were included in the study (mean age 60.5 [SD 15.3] years, 63.3% male). The most common aetiologies of haemoptysis were cryptogenic (52.5%), pneumonia (16.3%), emphysema (8.0%), bronchiectasis (5.8%) and lung cancer (4.0%). In patients diagnosed with lung cancer......BACKGROUND: Haemoptysis is a common symptom and can be an early sign of lung cancer. Careful investigation of patients with haemoptysis may lead to early diagnosis. The strategy for investigation of these patients, however, is still being debated. OBJECTIVES: We studied whether the combination......, bronchoscopy, CT and the combination of bronchoscopy and CT had a sensitivity of 0.61, 0.92 (pemphysema and bronchiectasis. Bronchoscopy did...

Electromagnetic navigation bronchoscopy: clinical utility in the diagnosis of lung cancer

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Seijo LM

2016-10-01

Full Text Available Luis M Seijo Pulmonary Department, Instituto de Investigación Sanitaria-Fundación Jimenez Díaz-Centro de Investigación Biomedica en Red Enfermedades Respiratorias, Madrid, Spain Abstract: Electromagnetic navigation bronchoscopy (ENB is one of several technological advances which have broadened the indications for bronchoscopy in the diagnostic workup of lung cancer. The technique facilitates bronchoscopic sampling of peripheral pulmonary nodules as well as mediastinal lymph nodes, although wide availability and expertise in endobronchial ultrasonography has limited its application in routine clinical practice to the former. ENB in this setting is quite versatile and may be considered an established alternative to more invasive techniques, especially in selected patients with underlying pulmonary disease or comorbidities at high risk for complications from computer topography-guided fine needle aspiration or surgical resection. Nodule sampling may be performed with a variety of instruments, including forceps, cytology brushes, and transbronchial needles. Although samples are generally small, they are often suitable for molecular analysis. Keywords: lung cancer, ENB, electromagnetic navigation, bronchoscopy, diagnosis, pulmonary nodule

Do technical parameters affect the diagnostic accuracy of virtual bronchoscopy in patients with suspected airways stenosis?

International Nuclear Information System (INIS)

Jones, Catherine M.; Athanasiou, Thanos; Nair, Sujit; Aziz, Omer; Purkayastha, Sanjay; Konstantinos, Vlachos; Paraskeva, Paraskevas; Casula, Roberto; Glenville, Brian; Darzi, Ara

2005-01-01

Purpose: Virtual bronchoscopy has gained popularity over the past decade as an alternative investigation to conventional bronchoscopy in the diagnosis, grading and monitoring of airway disease. The effect of technical parameters on diagnostic outcome from virtual bronchoscopy has not been determined. This meta-analysis aims to estimate accuracy of virtual compared to conventional bronchoscopy in patients with suspected airway stenosis, and evaluate the influence of technical parameters. Materials and methods: A MEDLINE search was used to identify relevant published studies. The primary endpoint was the 'correct diagnosis' of stenotic lesions on virtual compared to conventional bronchoscopy. Secondary endpoints included the effects of the technical parameters (pitch, collimation, reconstruction interval, rendering method, and scanner type), and date of publication on the diagnostic accuracy of virtual bronchoscopy. Results: Thirteen studies containing 454 patients were identified. Meta-analysis showed good overall diagnostic performance with 85% calculated pooled sensitivity (95% CI 77-91%), 87% specificity (95% CI 81-92%) and area under the curve (AUC) of 0.947. Subgroups included collimation of 3 mm or more (AUC 0.948), pitch of 1 (AUC 0.955), surface rendering technique (AUC 0.935), and reconstruction interval of more than 1.25 mm (AUC 0.914). There was no significant difference in accuracy accounting for publication date, scanner type or any of the above variables. Weighted regression analysis confirmed none of these variables could significantly account for study heterogeneity. Conclusion: Virtual bronchoscopy performs well in the investigation of patients with suspected airway stenosis. Overall sensitivity and specificity and diagnostic odds ratio for diagnosis of airway stenosis were high. The effects of pitch, collimation, reconstruction interval, rendering technique, scanner type, and publication date on diagnostic accuracy were not significant

Removal of metallic tracheobronchial stents in lung transplantation with flexible bronchoscopy

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Fruchter Oren

2010-09-01

Full Text Available Abstract Background Airway complications are among the most challenging problems after lung transplantation, and Self-Expandable Metallic Stents (SEMS are used to treat airway complications such as stenosis or malacia at the bronchial anastomosis sites. Several transplantation centers are reluctant to use SEMS since their removal is sometimes needed and usually requires the use of rigid bronchoscopy under general anesthesia. The objective of the current report is to describe our experience in SEMS retrieval by flexible bronchoscopy under conscious sedation. Methods A retrospective review was done of patients requiring tracheobronchial stent placement after lung transplantation in which the SEMS had to be removed. The retrieval procedure was done by flexible bronchoscopy on a day-care ambulatory basis. Results Between January 2004 and January 2010, out of 305 lung transplantation patients, 24 (7.8% underwent SEMS placement. Indications included bronchial stenosis in 20 and bronchomalacia in 4. In six patients (25% the SEMS had to be removed due to excessive granulation tissue formation and stent obstruction. The average time from SEMS placement to retrieval was 30 months (range 16-48 months. The stent was completely removed in five patients and partially removed in one patient; no major complications were encountered, and all patients were discharged within 3 hours of the procedure. In all procedures, new SEMS was successfully re-inserted thereafter. Conclusions The retrieval of SEMS in patients that underwent lung transplantation can be effectively and safely done under conscious sedation using flexible bronchoscopy on a day-care basis, this observation should encourage increasing usage of SEMS in highly selected patients.

Reliable and Valid Assessment of Clinical Bronchoscopy Performance

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Konge, Lars; Larsen, Klaus Richter; Clementsen, Paul

2012-01-01

: The interrater reliability was high, with Cronbach's a = 0.86. Assessment of 3 bronchoscopies by a single rater had a generalizability coefficient of 0.84. The correlation between experience and performance was good (Pearson correlation = 0.76). There were significant differences between the groups for all...

High-risk respiratory patients' experiences of bronchoscopy with conscious sedation and analgesia: A qualitative study.

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Saxon, Catherine; Fulbrook, Paul; Fong, Kwun M; Ski, Chantal F

2017-10-20

To understand the experiences of high-risk respiratory patients undergoing bronchoscopy with conscious sedation. Due to possible complications, high-risk respiratory patients are usually given smaller, cautious doses of sedation and analgesia for bronchoscopy. Described as "conscious sedation," this facilitates depression of the patient's consciousness without causing respiratory compromise. Previously, studies have investigated patient experience using quantitative methods. This is the first study that has explored the patient experience during bronchoscopy from a qualitative perspective. Qualitative, phenomenological approach as described by Van Manen. The setting was an endoscopy unit within an Australian tertiary hospital. Unstructured interviews were conducted with 13 patients with chronic obstructive pulmonary disease who underwent day-case bronchoscopy. All participants received conscious sedation. They were interviewed twice, within a week, postprocedure. Interviews were transcribed verbatim and analysed using Van Manen's interpretive approach. Participants had varying experiences. Five themes emerged from the analysis: Frustration and fear; Comfort and safety; Choking and coughing; Being aware; and Consequences. Whilst not all participants experienced procedural awareness or remembered it, for those who did it was a significant event. Overall, experiences were found to be negative; however, participants accepted and tolerated them, perceiving them as necessary to obtain a diagnostic result. The findings demonstrate that often patients are aware during the procedure and their experience may be uncomfortable and distressing. These findings have implications for patient preparation pre- and post-bronchoscopy in terms of what they might expect, and to discuss what has happened after the procedure. Some practices of the bronchoscopy team during the procedure may need modification. For example, in anticipation of the possibility that the patient may be aware

[Application of bispectral index monitoring in sedation and analgesia for flexible bronchoscopy].

Science.gov (United States)

Fang, S R; Liu, Y J; Su, N J; Shu, Y; Gu, W

2017-12-12

Objective: To investigate the feasibility of using bispectral index monitoring in sedation and analgesia for bronchoscopy. Methods: Totally 285 patients admitted to the Respiratory Medicine Department of Nanjing First Hospital for bronchoscopy between June 2016 and December 2016 were assigned, according to their own wishes, into a conscious sedation group (171 cases receiving local anesthesia and conscious sedation, 89 males, 82 females, mean age 59±10 years) and a control group (114 cases undergoing local anesthesia, 59 males, 55 females, average age 61±12 years). The 2 groups were compared in terms of operation time, blood pressure, heart rate and other indicators during bronchoscopy including incidence of adverse events, memory of the procedure, willingness to be re-examined, safety of sedation and analgesia for bronchoscopy under bispectral index monitoring, and patient satisfaction in the postoperative follow-up. Results: The conscious sedation group and the control group had no difference in age and sex ratio( P >0.05). Compared with the patients in the control group(operation time 16±5 min and systolic blood pressure 153±21 mmHg, 1 mmHg=0.133 kPa), those in the conscious sedation group had a shorter operation time(14±5 min) and a lower systolic blood pressure(144±22 mmHg), with statistically significant difference ( P sedation group and 92±12 mmHg and 87±14 times/min in the control group, P >0.05). Adverse events, overall intraoperative cough and bleeding were found to be significantly reduced in the conscious sedation group (27%, 4% and 13% and 60%, 13% and 35% in the control group, P sedation group, and 14% in the control group, P =0.72). Patient satisfaction and willingness to be re-examined were markedly higher in the conscious sedation group (97%) than in the controls (4%, P sedation and analgesia for bronchoscopy and has higher patient satisfaction, suggesting that it is a potential tool for use in clinical practice.

Therapeutic flexible bronchoscopy in child with cystic fibrosis

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Amina Selimović

2008-05-01

Full Text Available The report deals with the case of a 10-year-old girl with chronic cystic fibrosis. She has been repeatedly treated at the hospital. She has been hospitalized due to respiratory deterioration. Cystic fibrosis is a rare disease, inherited autosomaly recessively, but is very complex in terms of diagnostic and treatment (2. The diagnosis is confirmed based on a clinical picture of the child, measure of Chloride in the sweat, chest X-ray, CT thorax, laboratory findings--genetic confirmation CFTR ( cystic fibrosis transmembrane conductance regulator genes (3, which result in the production of hyper-viscous mucus and chloride malabsorption in the sweat glands ducts (5,6. Bronchial thickening and plugging and ring shadows suggesting bronchiectasis, segmental or lobar atelectasis are often. Computer tomography of the chest can be used to detect and localize thickening of bronchial airways walls, mucus plugging, hyperinflation and early bronchieactasiae. Pulmonary therapy: the object is to clear secretions from airways and to control infection (7. The diagnosis is originally set when she was 4 years old. She is now admitted due to a deterioration of the main disease. Day before admission in the hospital had a higher bodily temperature, cough and difficult breathing. She already treated conservatively (Ceftazidim, Ceftriakson, Kloksacillin Since the girl is a chronic patient with bronchiectasie chronic walls of bronchi changes full of the mucus, who is not responding to conservative treatment (antibiotics, therapeutic and diagnostic flexible bronchoscopy had to be performed, resulting in a gram-negative bacteria pseudomonas aeruginosa--a typical bacteria for chronically sick C. F.PATIENT:A pseudomonas therapy was prescribed according to the sensitive antibiogram, during which bronchoscopy was given locally on changes mucous pulmozyme and garamycin. Flexible bronchoscopy was performed as therapeutic. Local bronchoscopy

Diagnosis of Peripheral Lung Lesions via Conventional Flexible Bronchoscopy with Multiplanar CT Planning

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Marianne Anastasia De Roza

2016-01-01

Full Text Available Background. Conventional flexible bronchoscopy has limited sensitivity in the diagnosis of peripheral lung lesions and is dependent on lesion size. However, advancement of CT imaging offers multiplanar reconstruction facilitating enhanced preprocedure planning. This study aims to report efficacy and safety while considering the impact of patient selection and multiplanar CT planning. Method. Prospective case series of patients with peripheral lung lesions suspected of having lung cancer who underwent flexible bronchoscopy (forceps biopsy and lavage. Endobronchial lesions were excluded. Patients with negative results underwent CT-guided transthoracic needle aspiration, surgical biopsy, or clinical-radiological surveillance to establish the final diagnosis. Results. 226 patients were analysed. The diagnostic yield of bronchoscopy was 80.1% (181/226 with a sensitivity of 84.2% and specificity of 100%. In patients with a positive CT-Bronchus sign, the diagnostic yield was 82.4% compared to 72.8% with negative CT-Bronchus sign (p=0.116. Diagnostic yield was 84.9% in lesions > 20 mm and 63.0% in lesions ≤ 20 mm (p=0.001. Six (2.7% patients had transient hypoxia and 2 (0.9% had pneumothorax. There were no serious adverse events. Conclusion. Flexible bronchoscopy with appropriate patient selection and preprocedure planning is more efficacious in obtaining a diagnosis in peripheral lung lesions compared to historical data. This trial is registered with ClinicalTrials.gov Identifier: NCT01374542.

Fiberoptic bronchoscopy in the diagnosis and therapeutic decision for respiratory infections in hematological febrile neutropenic patients

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Luiza Bento

2014-06-01

Full Text Available Background: Febrile neutropenia is a common complication in patients undergoing chemotherapy or hematopoietic Stem Cell Transplantation (HSCT. Flexible fiberoptic bronchoscopy has been used to aid in the diagnosis of pulmonary diseases. However, there is no consensus regarding the benefit of the exam in establishing diagnosis and in changing the treatment of lung disease in this context. Previous retrospective studies, quite heterogeneous and with non-HIV immunocompromised patients, showed that the yield of fiberoptic bronchoscopy in establishing etiology ranges from 13% to 81%, and in changing therapy, from 5% to 51%. Aim: To evaluate the efficiency of Fiberoptic bronchoscopy and the procedure-related risk for neutropenic patients with hematologic malignancy. Methods: This retrospective cross-sectional study analyzed the medical records of patients with hematologic malignancy with febrile neutropenia who had undergone diagnostic fiberoptic bronchoscopy between January 2011 and December 2012 at the Hospital de Clínicas de Porto Alegre. Results: A total of 45 patients were included: 18 (36% tested positive for bronchoalveolar lavage, with change in therapeutic management occurring for 95% of them. The procedure-related risk was 2.2%, with one patient showing desaturation immediately after the procedure. Conclusion:  Despite the limited number of patients, our findings indicate that fiberoptic bronchoscopy in neutropenic patients is safe, and the results are similar to those previously reported.

Complete subglottic tracheal stenosis managed with rigid bronchoscopy and T-tube placement

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Kuruswamy Thurai Prasad

2016-01-01

Full Text Available Surgery is the preferred treatment modality for benign tracheal stenosis. Interventional bronchoscopy is used as a bridge to surgery or in instances when surgery is not feasible or has failed. Stenosis in the subglottic trachea is particularly a treatment challenge, in view of its proximity to the vocal cords. Herein, we describe a patient with complete tracheal stenosis in the subglottic region, which developed after prolonged intubation and mechanical ventilation. The patient developed recurrent stenosis despite multiple surgical and endoscopic procedures. We were able to manage the patient successfully with rigid bronchoscopy and Montgomery T-tube placement.

Using Performance in Multiple Simulated Scenarios to Assess Bronchoscopy Skills

DEFF Research Database (Denmark)

Konge, Lars; Arendrup, Henrik; Buchwald, Christian von

2011-01-01

using a standardized scoring form. Methods: The test was administered on a virtual reality bronchoscopy simulator to a total of 42 test subjects (14 senior consultants, 14 trainees and 14 medical students). The inter-rater reliability of the test procedure was explored according to examination of test......Background: International guidelines suggest that trainees should perform at least 100 flexible bronchoscopies in a supervised setting, but this number is not evidence based. An objective assessment method could provide educational feedback to trainees and help supervisors decide when basic...... competency is established. No former assessment instrument has been able to distinguish between trainees and experts. Objectives: The aim of this study was to explore the validity and reliability of a new assessment procedure relating to testing operators across multiple tasks with increasing difficulty...

Comparative study between computed tomography and bronchoscopy in the diagnosis of lung cancer

International Nuclear Information System (INIS)

Oliveira, Christopher; Saraiva, Antonio

2010-01-01

Objective: to analyze the role of computed tomography and bronchoscopy in the diagnosis of lung cancer, evaluating the effectiveness of these techniques in the presence of this disease. Parameters such as age, gender, smoking habits, histological types, staging and treatment were also analyzed. Materials and methods: the sample of the present study included 70 patients assisted at the Department of Pneumology of Hospital Distrital da Figueira da Foz, Coimbra, Portugal, who were submitted to both diagnostic methods, namely, computed tomography and bronchoscopy, to confirm the presence or the absence of lung cancer. Results: thirty-seven patients (23 men and 14 women) were diagnosed with lung cancer. Histologically 40.54% were adenocarcinoma, followed by squamous carcinoma (32.43% cases) and small-cell lung cancer (18.92%). Staging showed 6.70% stage IB disease, 23.30% stage IIIA and 36.70% stage IIIB, and 33.30% stage IV. Chemotherapy alone was the first treatment of choice for 75.7% of patients. Bronchoscopy sensitivity was 83.8%, specificity 81.8%, and accuracy 82.8%. Computed tomography sensitivity was 81.1%, specificity 63.6%, and accuracy 72.8%. Conclusion: bronchoscopy results corroborated the relevance of the method in the diagnosis of lung cancer, considering its dependence on the anatomopathological study of tissue or cells obtained through different biopsy techniques. Computed tomography presented good sensitivity (81.1%), however the specificity of only 63.6% is related to the rate of false-positive results (36.4%). (author)

Comparative study between computed tomography and bronchoscopy in the diagnosis of lung cancer

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Oliveira, Christopher; Saraiva, Antonio, E-mail: asaraiva@estescoimbra.p [Escola Superior de Tecnologia da Saude de Coimbra (ESTeSC), Coimbra (Portugal)

2010-07-15

Objective: to analyze the role of computed tomography and bronchoscopy in the diagnosis of lung cancer, evaluating the effectiveness of these techniques in the presence of this disease. Parameters such as age, gender, smoking habits, histological types, staging and treatment were also analyzed. Materials and methods: the sample of the present study included 70 patients assisted at the Department of Pneumology of Hospital Distrital da Figueira da Foz, Coimbra, Portugal, who were submitted to both diagnostic methods, namely, computed tomography and bronchoscopy, to confirm the presence or the absence of lung cancer. Results: thirty-seven patients (23 men and 14 women) were diagnosed with lung cancer. Histologically 40.54% were adenocarcinoma, followed by squamous carcinoma (32.43% cases) and small-cell lung cancer (18.92%). Staging showed 6.70% stage IB disease, 23.30% stage IIIA and 36.70% stage IIIB, and 33.30% stage IV. Chemotherapy alone was the first treatment of choice for 75.7% of patients. Bronchoscopy sensitivity was 83.8%, specificity 81.8%, and accuracy 82.8%. Computed tomography sensitivity was 81.1%, specificity 63.6%, and accuracy 72.8%. Conclusion: bronchoscopy results corroborated the relevance of the method in the diagnosis of lung cancer, considering its dependence on the anatomopathological study of tissue or cells obtained through different biopsy techniques. Computed tomography presented good sensitivity (81.1%), however the specificity of only 63.6% is related to the rate of false-positive results (36.4%). (author)

Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy

DEFF Research Database (Denmark)

Jeppesen, Elisabeth; Pedersen, Carsten M; Larsen, Klaus R

2016-01-01

BACKGROUND: The use of music to relieve anxiety has been examined in various studies, but the results are inconclusive. METHODS: From April to October 2015, 160 patients undergoing examination of pulmonary nodules were randomly assigned to MusiCure or no music. MusiCure was administered through e...... earplugs to ensure blinding of the staff and was played from admission to the operating theatre to the end of the bronchoscopy. Spielberger's State-Trait Anxiety Inventory (STAI) was administered on admission, immediately before bronchoscopy, and on discharge. Secondary outcomes were p...

Case report: Inhaled foreign body mismanaged as TB, finally removed using a rigid bronchoscopy after 6 years of impaction

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Justin Rubena Lumaya

2016-02-01

Full Text Available Foreign body aspiration is an important cause of mortality in children aged less than three years. Foreign body (FB inhalation can pose diagnostic and therapeutic challenges, especially in longstanding cases and complications such as recurrent pneumonia, lung collapse and lung abscess may develop. We report a case of an 11-year old boy with foreign body impacted in his bronchus for six years, which was mistakenly managed as pulmonary tuberculosis. Radiological evidence confirmed the diagnosis and a rigid bronchoscopy was used to remove the metallic foreign body. The standard of care for the management of a FB in a bronchus is a rigid bronchoscopy; however flexible bronchoscopy can be used, especially in adults. A thorough history with radiological evidence are essential and sometimes, followed by a diagnostic bronchoscopy.

Web-based versus traditional lecture: are they equally effective as a flexible bronchoscopy teaching method?

OpenAIRE

Sterse Mata, Caio Augusto [UNIFESP; Ota, Luiz Hirotoshi [UNIFESP; Suzuki, Iunis [UNIFESP; Telles, Adriana [UNIFESP; Miotto, Andre [UNIFESP; Leao, Luiz Eduardo Villaca [UNIFESP

2012-01-01

This study compares the traditional live lecture to a web-based approach in the teaching of bronchoscopy and evaluates the positive and negative aspects of both methods. We developed a web-based bronchoscopy curriculum, which integrates texts, images and animations. It was applied to first-year interns, who were later administered a multiple-choice test. Another group of eight first-year interns received the traditional teaching method and the same test. the two groups were compared using the...

Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results.

Science.gov (United States)

Jacomelli, Márcia; Silva, Priscila Regina Alves Araújo; Rodrigues, Ascedio Jose; Demarzo, Sergio Eduardo; Seicento, Márcia; Figueiredo, Viviane Rossi

2012-01-01

To evaluate the diagnostic accuracy of bronchoscopy in patients with clinical or radiological suspicion of tuberculosis who were unable to produce sputum or with negative sputum smear microscopy results. A prospective cross-sectional study involving 286 patients under clinical or radiological suspicion of having pulmonary tuberculosis and submitted to bronchoscopy-BAL and transbronchial biopsy (TBB). The BAL specimens were submitted to direct testing and culture for AFB and fungi, whereas the TBB specimens were submitted to histopathological examination. Of the 286 patients studied, 225 (79%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 127 (44%); nonspecific chronic inflammation, in 51 (18%); pneumocystis, fungal infections, or nocardiosis, in 20 (7%); bronchiolitis obliterans organizing pneumonia, alveolites, or pneumoconiosis, in 14 (5%); lung or metastatic neoplasms, in 7 (2%); and nontuberculous mycobacterium infections, in 6 (2%). For the diagnosis of tuberculosis, BAL showed a sensitivity and a specificity of 60% and 100%, respectively. Adding the TBB findings significantly increased this sensitivity (to 84%), as did adding the post-bronchoscopy sputum smear microscopy results (total sensitivity, 94%). Minor post-procedure complications occurred in 5.6% of the cases. Bronchoscopy is a reliable method for the diagnosis of pulmonary tuberculosis, with low complication rates. The combination of TBB and BAL increases the sensitivity of the method and facilitates the differential diagnosis with other diseases.

Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review

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Laurie Putz

2016-01-01

Full Text Available The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min−1; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures.

Application of the Virtual Bronchoscopy in Children with Suspected Aspiration of the Foreign Body - Case Report

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Kostic Gordana

2016-12-01

Full Text Available In diagnosing the aspiration of the foreign body (AFB in children most important are: medical history, clinical signs and positive radiography of the lungs. Common dilemmas in the diff erential diagnosis are life-threatening asthma attacks or difficult pneumonia. Conventional rigid bronchoscopy (RB is not recommended as a routine method. Virtual bronchoscopy (VB can be a diagnostic tool for solving dilemmas. Fiber-optic bronchoscopy (FOB has a therapeutic stake in severe cases. Herein, we describe a girl, at the age of 6, who was hospitalized due to rapid bronchoconstriction and based on the anamnesis, clinical symptoms and physical fi ndings the suspicion was that she aspirated the foreign body. Due to the poor general condition and possible sequel, the idea of RB was dropped out. Multidetector computed tomography of the chest and VB was performed and AFB was not found. Due to positive epidemiological situation, virus H1N1 was excluded. FOB established that the foreign body does not exist in the airways. During bronchoscopy numerous castings are aspirated from the peripheral airways which lead to faster final recovery. With additional procedures, the diagnosis of asthma was confirmed and for girl that was the first attack. Along with inhaled corticosteroids as prevention she feels well.

[The flexible fiberoptic bronchoscopy report: medico-legal issues].

Science.gov (United States)

Trosini-Désert, V; Morin, J-M; Fournier, C; Similowski, T; Vergnon, J-M

2010-09-01

The flexible bronchoscopy report is one of the tools permitting exchange of medical information in respiratory medicine and is an integral part of the medical record. Currently, there is no consensus on its content, and consequently, there are no recommendations. A survey was carried out involving experts from the Groupe d'Endoscopie de Langue Française (GELF--Endoscopy Research Group of the French Language Society of Pneumology) and a lawyer from the legal affairs and patient's rights department of the Paris public hospital system. Thirty-four questions distributed in eight chapters were asked in an eight-part questionnaire covering: 1) general administration, 2) environmental safety, 3) medical and anatomical description of the examination, 4) tolerance/complications of the examination, 5) conclusion, 6) image and video sequence capture, 7) administrative data for archiving, 8) disposable elements used during the examination. The results showed as many areas of convergence as they did divergence, between physicians, and between physicians and lawyer. Collective consideration is required to harmonize the writing of bronchoscopy reports, to provide a tool that is not only consensual and complete, but also valid and sound from the medicolegal viewpoint. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

[Application of electric coagulation treatment via bronchoscopy in the management of congenital vallecular cyst in children].

Science.gov (United States)

Liu, Xia; Ma, Jing; Zhao, Feng-mei; Zhang, Zhong-xiao; Niu, Tie-huan; Yan, Xiu-li; Wang, Chao; Meng, Chen

2013-11-01

To discuss the effect of electric coagulation through bronchoscopy in diagnosis and treatment of congenital vallecular cyst in children. Ten cases of congenital vallecular cyst in the study with age ranged from 21 days to 4 years and 10 months were treated with electric coagulation through bronchoscopy. The therapeutic effect was evaluated by endoscopic and clinical manifestation. And all the patients were followed-up for 6-12 months. All the patients obtained 3-5 times electric coagulation. After the operation, the cyst decreased in size, epiglottis softening was subsided, uplift uncompression, dyspnea and laryngeal stridor were improved obviously. After follow-up periods of 6-12 months, no capsule wall were left, and the activity of the epiglottis resumed.No severe complication was found in any patient. Electric coagulation through bronchoscopy is a simple, effective and safe method to treat congenital vallecular cyst in children.

Diagnostic bronchoscopy: state of the art

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V. Ninane

2010-09-01

Full Text Available Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.

Interventional bronchoscopy in malignant central airway obstruction by extra-pulmonary malignancy.

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Shin, Beomsu; Chang, Boksoon; Kim, Hojoong; Jeong, Byeong-Ho

2018-03-13

Interventional bronchoscopy is considered an effective treatment option for malignant central airway obstruction (MCAO). However, there are few reports of interventional bronchoscopy in patients with MCAOs due to extra-pulmonary malignancy. Therefore, the objective of this study was to investigate treatment outcomes and prognostic factors for bronchoscopic intervention in patients with MCAO due to extra-pulmonary malignancy. We retrospectively analyzed consecutive 98 patients with MCAO due to extra-pulmonary malignancy who underwent interventional bronchoscopy between 2004 and 2014 at Samsung Medical Center (Seoul, Korea). The most common primary site of malignancy was esophageal cancer (37.9%), followed by thyroid cancer (16.3%) and head & neck cancer (10.2%). Bronchoscopic interventions were usually performed using a combination of mechanical debulking (84.7%), stent insertion (70.4%), and laser cauterization (37.8%). Of 98 patients, 76 (77.6%) patients had MCAO due to progression of malignancy, and 42 (42.9%) patients had exhausted all other anti-cancer treatment at the time of bronchoscopic intervention. Technical success was achieved in 89.9% of patients, and acute complications and procedure-related deaths occurred in 20.4% and 3.1% of patients, respectively. Reduced survival was associated with MCAO due to cancer other than thyroid cancer or lymphoma, mixed lesions, and not receiving adjuvant treatment after bronchoscopic intervention. Bronchoscopic intervention could be a safe and effective procedure for MCAO due to end-stage extra-pulmonary malignancies. In addition, we identified possible prognostic factors for poor survival after intervention, which could guide clinicians select candidates that will benefit from bronchoscopic intervention.

Web-based versus traditional lecture: are they equally effective as a flexible bronchoscopy teaching method?

Science.gov (United States)

Mata, Caio Augusto Sterse; Ota, Luiz Hirotoshi; Suzuki, Iunis; Telles, Adriana; Miotto, Andre; Leão, Luiz Eduardo Vilaça

2012-01-01

This study compares the traditional live lecture to a web-based approach in the teaching of bronchoscopy and evaluates the positive and negative aspects of both methods. We developed a web-based bronchoscopy curriculum, which integrates texts, images and animations. It was applied to first-year interns, who were later administered a multiple-choice test. Another group of eight first-year interns received the traditional teaching method and the same test. The two groups were compared using the Student's t-test. The mean scores (± SD) of students who used the website were 14.63 ± 1.41 (range 13-17). The test scores of the other group had the same range, with a mean score of 14.75 ± 1. The Student's t-test showed no difference between the test results. The common positive point noted was the presence of multimedia content. The web group cited as positive the ability to review the pages, and the other one the role of the teacher. Web-based bronchoscopy education showed results similar to the traditional live lecture in effectiveness.

Pseudo-outbreak of pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy

DEFF Research Database (Denmark)

Kolmos, H J; Lerche, A; Kristoffersen, Kirsten Lydia

1994-01-01

Pseudomonas aeruginosa was isolated from bronchoalveolar lavage fluid from 8 consecutive patients undergoing bronchoscopy at an infectious diseases unit. None of the patients developed signs of respiratory tract infection that could be ascribed to the organism. The source of contamination...

The influence of airway supporting maneuvers on glottis view in pediatric fiberoptic bronchoscopy

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Tarik Umutoglu

2015-10-01

Full Text Available ABSTRACTINTRODUCTION:Flexible fiber optic bronchoscopy is a valuable intervention for evaluation and management of respiratory diseases in both infants, pediatric and adult patients. The aim of this study is to investigate the influence of the airway supporting maneuvers on glottis view during pediatric flexible fiberoptic bronchoscopy.MATERIALS AND METHODS:In this randomized, controlled, crossover study; patients aged between 0 and 15 years who underwent flexible fiberoptic bronchoscopy procedure having American Society of Anesthesiologists I---II risk score were included. Patients having risk of difficult intubation, intubated or patients with tracheostomy, and patients with reduced neck mobility or having cautions for neck mobility were excluded from this study. After obtaining best glottic view at the neutral position, patients were positioned jaw trust with open mouth, jaw trust with teeth prottution, head tilt chin lift and triple airway maneuvers and best glottis scores were recorded.RESULTS:Total of 121 pediatric patients, 57 girls and 64 boys, were included in this study. Both jaw trust with open mouth and jaw trust with teeth prottution maneuvers improved the glottis view compared with neutral position (p 0.05. Head tilt chin lift and triple airway maneuvers improved glottis view when compared with both jaw trust with open mouth and jaw trust with teeth prottution maneuvers and neutral position (p 0.05.

Maintaining Oxygenation Successfully with High Flow Nasal Cannula during Diagnostic Bronchoscopy on a Postoperative Lung Transplant Patient in the Intensive Care

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Sara Diab

2014-01-01

Full Text Available Bronchoscopy is an important diagnostic and therapeutic intervention for a variety of patients displaying pulmonary pathology. The heterogeneity of the patients undergoing bronchoscopy affords a challenge for providing minimal and safe respiratory support during anesthesia. Currently, options are intubation and general anesthesia versus frequently inadequate sedation or local anaesthesia with low flow oxygen through nasal prongs or mouthpiece. The advent of high flow nasal cannula allows the clinician to have a “middle man” that allows high flow oxygen delivery as well as a degree of respiratory support, which in some cases has been noted to be between 3 and 4 cm of continuous positive airway pressure-like effect. There are minimal data analyzing the use of high flow nasal cannula during anesthesia for bronchoscopy. We present a case report of orthotropic lung transplant recipient undergoing diagnostic bronchoscopy whilst being supported with high flow nasal oxygen in the intensive care unit.

Topical Nasal Anesthesia in Flexible Bronchoscopy--A Cross-Over Comparison between Two Devices.

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Thomas Fuehner

Full Text Available Topical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB. Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients.Using a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA. Those enrolled between 25-11-2014 and 30-01-2015, received a disposable intranasal mucosal atomization device (DIMAD. After each procedure, the treating physician, their assistant and the patient independently rated side-effects and satisfaction, basing their responses on visual analogue scales (VAS. At their next scheduled bronchoscopy during the study period, patients then received the alternative atomizer. Written consent was obtained prior to the first bronchoscopy, and the study approved by the institutional ethics committee.Of the 252 patients enrolled between 01-10-2014 and 30-01-2015, 80 (32% received both atomizers. Physicians reported better efficacy (p = 0.001 and fewer side effects (p< = 0.001 for DIMAD in patients exposed to both procedures. Among patients with one visit, physicians and their assistants reported improved efficacy (p = 0.018, p = 0.002 and fewer side effects (p< = 0.001, p = 0.029 for the disposable atomizer, whereas patients reported no difference in efficacy or side effects (p = 0.72 and p = 0.20. No severe adverse events were noted. The cost of the reusable device was 4.08€ per procedure, compared to 3.70€ for the disposable device.Topical nasal anesthesia via a disposable intranasal mucosal atomization device (DIMAD offers comparable safety and patient comfort, compared to conventional reusable nasal atomizers (CRNA in lung transplant recipients. Procedural costs were reduced by 0.34€ per

Fospropofol Disodium for Sedation in Elderly Patients Undergoing Flexible Bronchoscopy.

Science.gov (United States)

Silvestri, Gerard A; Vincent, Brad D; Wahidi, Momen M

2011-01-01

BACKGROUND: Fospropofol disodium is a water-soluble prodrug of propofol. A subset analysis was undertaken of elderly patients (≥65 y) undergoing flexible bronchoscopy, who were part of a larger multicenter, randomized, double-blind study. METHODS: Patients received fentanyl citrate (50 mcg) followed by fospropofol at initial (4.88mg/kg) and supplemental (1.63mg/kg) doses. The primary end point was sedation success (3 consecutive Modified Observer's Assessment of Alertness/Sedation scores of ≤4 and procedure completion without alternative sedative or assisted ventilation). Treatment success, time to fully alert, patient and physician satisfaction, and safety/tolerability were also evaluated. RESULTS: In the elderly patients subset (n=61), sedation success was 92%, the mean time to fully alert was 8.0±10.9 min, and memory retention was 72% during recovery, and these were comparable with the younger patients subgroup (age, Sedation-related adverse events occurred in 23% of the elderly and 18% of the younger patients (age, sedation, rapid time to fully alert, and high satisfaction in this elderly subset undergoing flexible bronchoscopy, which was comparable with outcomes in younger patients.

Patient-specific bronchoscopy visualization through BRDF estimation and disocclusion correction.

Science.gov (United States)

Chung, Adrian J; Deligianni, Fani; Shah, Pallav; Wells, Athol; Yang, Guang-Zhong

2006-04-01

This paper presents an image-based method for virtual bronchoscope with photo-realistic rendering. The technique is based on recovering bidirectional reflectance distribution function (BRDF) parameters in an environment where the choice of viewing positions, directions, and illumination conditions are restricted. Video images of bronchoscopy examinations are combined with patient-specific three-dimensional (3-D) computed tomography data through two-dimensional (2-D)/3-D registration and shading model parameters are then recovered by exploiting the restricted lighting configurations imposed by the bronchoscope. With the proposed technique, the recovered BRDF is used to predict the expected shading intensity, allowing a texture map independent of lighting conditions to be extracted from each video frame. To correct for disocclusion artefacts, statistical texture synthesis was used to recreate the missing areas. New views not present in the original bronchoscopy video are rendered by evaluating the BRDF with different viewing and illumination parameters. This allows free navigation of the acquired 3-D model with enhanced photo-realism. To assess the practical value of the proposed technique, a detailed visual scoring that involves both real and rendered bronchoscope images is conducted.

[Virtual bronchoscopy: the correlation between endoscopic simulation and bronchoscopic findings].

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Salvolini, L; Gasparini, S; Baldelli, S; Bichi Secchi, E; Amici, F

1997-11-01

We carried out a preliminary clinical validation of 3D spiral CT virtual endoscopic reconstructions of the tracheobronchial tree, by comparing virtual bronchoscopic images with actual endoscopic findings. Twenty-two patients with tracheobronchial disease suspected at preliminary clinical, cytopathological and plain chest film findings were submitted to spiral CT of the chest and bronchoscopy. CT was repeated after endobronchial therapy in 2 cases. Virtual endoscopic shaded-surface-display views of the tracheobronchial tree were reconstructed from reformatted CT data with an Advantage Navigator software. Virtual bronchoscopic images were preliminarily evaluated with a semi-quantitative quality score (excellent/good/fair/poor). The depiction of consecutive airway branches was then considered. Virtual bronchoscopies were finally submitted to double-blind comparison with actual endoscopies. Virtual image quality was considered excellent in 8 cases, good in 14 and fair in 2. Virtual exploration was stopped at the lobar bronchi in one case only; the origin of segmental bronchi was depicted in 23 cases and that of some subsegmental branches in 2 cases. Agreement between actual and virtual bronchoscopic findings was good in all cases but 3 where it was nevertheless considered satisfactory. The yield of clinically useful information differed in 8/24 cases: virtual reconstructions provided more information than bronchoscopy in 5 cases and vice versa in 3. Virtual reconstructions are limited in that the procedure is long and difficult and needing a strictly standardized threshold value not to alter virtual findings. Moreover, the reconstructed surface lacks transparency, there is the partial volume effect and the branches < or = 4 pixels phi and/or meandering ones are difficult to explore. Our preliminary data are encouraging. Segmental bronchi were depicted in nearly all cases, except for the branches involved by disease. Obstructing lesions could be bypassed in some cases

[Hybrid 3-D rendering of the thorax and surface-based virtual bronchoscopy in surgical and interventional therapy control].

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Seemann, M D; Gebicke, K; Luboldt, W; Albes, J M; Vollmar, J; Schäfer, J F; Beinert, T; Englmeier, K H; Bitzer, M; Claussen, C D

2001-07-01

The aim of this study was to demonstrate the possibilities of a hybrid rendering method, the combination of a color-coded surface and volume rendering method, with the feasibility of performing surface-based virtual endoscopy with different representation models in the operative and interventional therapy control of the chest. In 6 consecutive patients with partial lung resection (n = 2) and lung transplantation (n = 4) a thin-section spiral computed tomography of the chest was performed. The tracheobronchial system and the introduced metallic stents were visualized using a color-coded surface rendering method. The remaining thoracic structures were visualized using a volume rendering method. For virtual bronchoscopy, the tracheobronchial system was visualized using a triangle surface model, a shaded-surface model and a transparent shaded-surface model. The hybrid 3D visualization uses the advantages of both the color-coded surface and volume rendering methods and facilitates a clear representation of the tracheobronchial system and the complex topographical relationship of morphological and pathological changes without loss of diagnostic information. Performing virtual bronchoscopy with the transparent shaded-surface model facilitates a reasonable to optimal, simultaneous visualization and assessment of the surface structure of the tracheobronchial system and the surrounding mediastinal structures and lesions. Hybrid rendering relieve the morphological assessment of anatomical and pathological changes without the need for time-consuming detailed analysis and presentation of source images. Performing virtual bronchoscopy with a transparent shaded-surface model offers a promising alternative to flexible fiberoptic bronchoscopy.

Flexible bronchoscopy and mechanical ventilation in managing Mounier-Kuhn syndrome: a case report

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Aslihan Gürün Kaya

2017-04-01

Full Text Available ABSTRACT CONTEXT: Mounier-Kuhn syndrome is a rare congenital condition with distinct dilatation and diverticulation of the tracheal wall. The symptoms may vary and the treatment usually consists of support. CASE REPORT: The patient was a 60-year-old male with recurrent hospital admission. He was admitted in this case due to dyspnea, cough and sputum production. An arterial blood sample revealed decompensated respiratory acidosis with moderate hypoxemia. A chest computed tomography (CT scan showed dilatation of the trachea and bronchi, tracheal diverticula and bronchiectasis. Flexible bronchoscopy was performed, which revealed enlarged airways with expiratory collapse. Furthermore, orifices of tracheal diverticulosis were also detected. Non-invasive positive pressure ventilation (NPPV was added, along with long-term oxygen therapy. At control visits, the patient’s clinical and laboratory findings were found to have improved. CONCLUSION: Flexible bronchoscopy can be advocated for establishing the diagnosis and non-invasive mechanical ventilation can be used with a high success rate, for clinical wellbeing in Mounier-Kuhn syndrome.

Distributed practice. The more the merrier? A randomised bronchoscopy simulation study

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Bjerrum, Anne Sofie; Eika, Berit; Charles, Peder; Hilberg, Ole

2016-01-01

Introduction: The distribution of practice affects the acquisition of skills. Distributed practice has shown to be more effective for skills acquisition than massed training. However, it remains unknown as to which is the most effective distributed practice schedule for learning bronchoscopy skills through simulation training. This study compares two distributed practice schedules: One-day distributed practice and weekly distributed practice.Method: Twenty physicians in training were randomly...

Effectiveness of bronchoscopy in the diagnosis of bronchial-type mycobacterium avium-intracellulare complex pulmonary disease

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Sato, Kazuhiro; Kourakata, Hiroyo

2004-01-01

Mycobacterium avium-intracellulare complex (MAC) pulmonary disease with associated nodules and bronchiectasis is an increasingly prevalent condition. This condition is often difficult to diagnose in the early stages of the disease, because of the limited effectiveness of sputum culture cytology. The effectiveness of bronchoscopy in the isolation and diagnosis of MAC in respiratory secretions is still unclear. Over a three-year period, we examined the effectiveness of bronchoscopy in 45 non-HIV-infected patients who had clusters of small peripheral lung nodules. These nodules were associated with changes of the draining bronchi detected by high-resolution CT (HRCT). A total of 22 of 45 patients (48.9%) had cultures positive for MAC. In the MAC-positive group, 10 patients tested positive for disease in sputum and 22 tested positive for disease in bronchial washings. A total of 13 of 45 patients (28.9%) fulfilled the American Thoracic Society criteria for pulmonary MAC disease, and 9 (20.0%) others with cultures positive for MAC did not fulfill the criteria. Radiographic measures and sputum cultures of 13 of 16 patients (81.3%) with negative cultures revealed no further disease progression. We found that HRCT was a useful technique in the diagnosis of MAC-pulmonary disease. We also found that bronchoscopy was a more sensitive diagnostic technique than sputum culture, analysis in the differential diagnosis of MAC pulmonary diseases. (author)

Evaluation of a flexible bronchoscope prototype designed for bronchoscopy during mechanical ventilation: a proof-of-concept study.

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Nay, M-A; Auvet, A; Mankikian, J; Herve, V; Dequin, P-F; Guillon, A

2017-06-01

Bronchoscopy during mechanical ventilation of patients' lungs significantly affects ventilation because of partial obstruction of the tracheal tube, and may thus be omitted in the most severely ill patients. It has not previously been possible to reduce the external diameter of the bronchoscope without reducing the diameter of the suction channel, thus reducing the suctioning capacity of the device. We believed that a better-designed bronchoscope could improve the safety of bronchoscopy in patients whose lungs were ventilated. We designed a flexible bronchoscope prototype with a drumstick-shaped head consisting of a long, thin proximal portion; a short and large distal portion for camera docking; and a large suction channel throughout the length of the device. The aims of our study were to test the impact of our prototype on mechanical ventilation when inserted into the tracheal tube, and to assess suctioning capacity. We first tested the efficiency of the suction channel, and demonstrated that the suction flow of the prototype was similar to that of conventional adult bronchoscopes. We next evaluated the consequences of bronchoscopy when using the prototype on minute ventilation and intrathoracic pressures during mechanical ventilation: firstly, in vitro using a breathing simulator; and secondly, in vivo using a porcine model of pulmonary ventilation. The insertion of adult bronchoscopes into the tracheal tube immediately impaired the protective ventilation strategy employed, whereas the prototype preserved it. For the first time, we have developed an innovative flexible bronchoscope designed for bronchoscopy during invasive mechanical ventilation, that both preserved the protective ventilation strategy, and enabled efficient suction flow. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

Follow-up after stent insertion in the tracheobronchial tree: role of helical computed tomography in comparison with fiberoptic bronchoscopy

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Ferretti, G.R.; Kocier, M.; Calaque, O.; Coulomb, M. [Service Central de Radiologie et Imagerie Medicale, INSERM EMI 9924, CHU, BP 217, 38043, Grenoble Cedex 9 (France); Arbib, F.; Pison, C. [Departement de Medecine Aigue Specialisee (DMAS), CHU Grenoble, CHU, BP 217, 38043, Grenoble Cedex 9 (France); Righini, C. [Service d' Oto Rhino Laryngologie, CHU Grenoble, BP 217, 38043, Grenoble Cedex 9 (France)

2003-05-01

The aim of this study was to compare helical CT with fiberoptic bronchoscopy findings to appraise the medium-term results of proximal-airways stenting. Twenty-five patients with 28 endobronchial metallic stents inserted for local advanced malignancy (n=13) or benign diseases (n=12) underwent follow-up CT from 3 days to 50 months (mean 8 months). All studies were obtained using helical CT with subsequent multiplanar reformation and three-dimensional reconstruction including virtual bronchoscopy. The location, shape, and patency of stents and adjacent airway were assessed. The results of CT were compared with the results of fiberoptic bronchoscopy obtained with a mean delay of 2.5 days (SD 9 days) after CT scan. Twelve stents (43%) remained in their original position, patent and without deformity. Sixteen stents were associated with local complications: migration (n=6); external compression with persistent stenosis (n=4); local recurrence of malignancy (n=4); fracture (n=1); and non-congruence between the airway and the stent (n=1). The CT demonstrated all the significant abnormalities demonstrated at fiberoptic bronchoscopy except two moderate stenoses (20%) related to granulomata at the origin of the stent. Ten of 14 stents inserted for benign conditions were without complications as compared with 2 of 14 in malignant conditions (p=0.008). Computed tomography is an accurate noninvasive method for evaluating endobronchial stents. The CT is a useful technique for follow-up of patients who have undergone endobronchial stenting. (orig.)

Follow-up after stent insertion in the tracheobronchial tree: role of helical computed tomography in comparison with fiberoptic bronchoscopy

International Nuclear Information System (INIS)

Ferretti, G.R.; Kocier, M.; Calaque, O.; Coulomb, M.; Arbib, F.; Pison, C.; Righini, C.

2003-01-01

The aim of this study was to compare helical CT with fiberoptic bronchoscopy findings to appraise the medium-term results of proximal-airways stenting. Twenty-five patients with 28 endobronchial metallic stents inserted for local advanced malignancy (n=13) or benign diseases (n=12) underwent follow-up CT from 3 days to 50 months (mean 8 months). All studies were obtained using helical CT with subsequent multiplanar reformation and three-dimensional reconstruction including virtual bronchoscopy. The location, shape, and patency of stents and adjacent airway were assessed. The results of CT were compared with the results of fiberoptic bronchoscopy obtained with a mean delay of 2.5 days (SD 9 days) after CT scan. Twelve stents (43%) remained in their original position, patent and without deformity. Sixteen stents were associated with local complications: migration (n=6); external compression with persistent stenosis (n=4); local recurrence of malignancy (n=4); fracture (n=1); and non-congruence between the airway and the stent (n=1). The CT demonstrated all the significant abnormalities demonstrated at fiberoptic bronchoscopy except two moderate stenoses (20%) related to granulomata at the origin of the stent. Ten of 14 stents inserted for benign conditions were without complications as compared with 2 of 14 in malignant conditions (p=0.008). Computed tomography is an accurate noninvasive method for evaluating endobronchial stents. The CT is a useful technique for follow-up of patients who have undergone endobronchial stenting. (orig.)

Role of flexible bronchoscopy and bronchoalveolar lavage in the diagnosis of pediatric acquired immunodeficiency syndrome-related pulmonary disease.

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Birriel, J A; Adams, J A; Saldana, M A; Mavunda, K; Goldfinger, S; Vernon, D; Holzman, B; McKey, R M

1991-06-01

Flexible fiberoptic bronchoscopy with bronchoalveolar lavage was performed in 16 pediatric patients with the acquired immunodeficiency syndrome (AIDS) and deterioration in pulmonary function suggestive of opportunistic infection. In 62% of the patients Pneumocystis carinii was identified. Culture results showed a pure growth of Pseudomonas aeruginosa for one patient in addition to the Pneumocystis carinii. Bronchoscopy with lavage was well tolerated, with few complications even among patients with significant tachypnea and hypoxia. Because of its relative safety and effectiveness, this procedure should be considered the first invasive measurement used for evaluation of parenchymal lung disease in this population of patients.

Post-bronchoscopy fatal endobronchial hemorrhage in a woman with bronchopulmonary mucormycosis: a case report

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La Licata Francesco

2010-12-01

Full Text Available Abstract Introduction During infection, Mucorales fungi invade major blood vessels, leading to extensive necrosis, and in cases of extensive pulmonary disease, bleeding into the lungs may occur. Case presentation We report an unexpected event of post-bronchoscopy fatal endobronchial hemorrhage in a 62-year-old HIV-negative Italian woman with well controlled diabetes mellitus who presented with diffuse cavitated pulmonary lesions. Fiberoptic bronchoscopy revealed bilateral obstruction of the segmental bronchi. Fatal massive bleeding occurred after standard biopsy procedures. Histologic examination showed that the hyphae were more deeply colored by hematoxylin-eosin (H&E than by other stains for fungi. Culture and autopsy confirmed bronchopulmonary mucormycosis. Conclusion Infection by Mucorales fungi should be considered in the diabetes population regardless of the degree of metabolic control. In these patients, particular caution should be taken during bronchoscopic procedures because of the greater friability of the fungal lesions.

Commentary on “Music Does Not Alter Anxiety in Patients with Suspected Lung Cancer Undergoing Bronchoscopy: A Randomised Controlled Trial” – European Clinical Respiratory Journal

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Jeppesen, Elisabeth; Pedersen, Carsten Michel

2016-01-01

Introduction Not only may the prognosis of lung cancer provoke fear in patients with suspected lung cancer undergoing bronchoscopy, but also the thought of undergoing bronchoscopy may provoke fear [1]. This can be fear of pain, of shortness of breath and also fear of death in connection with the ...

Comparing Patient Satisfaction and Intubating Conditions Using Succinylcholine or Low-Dose Rocuronium for Rigid Bronchoscopy: A Randomized Study.

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Ghezel-Ahmadi, Verena; Ghezel-Ahmadi, David; Mangen, Jacques; Bolukbas, Servet; Welker, Andreas; Kuerschner, Veit Christian; Fischer, Andreas; Schirren, Joachim; Beck, Grietje

2015-09-01

Despite its serious side effects, succinylcholine is commonly used for neuromuscular relaxation in short procedures, such as rigid bronchoscopy and tracheobronchial interventions. The application of low-dose rocuronium reversed by low-dose sugammadex might be a modern alternative. The aim of this study was to compare patient satisfaction, incidence of postoperative myalgia (POM) as well as intubating conditions of these two muscle relaxants for rigid bronchoscopy. A single-center, prospective-randomized, blinded study of 95 patients, scheduled for rigid bronchoscopy and tracheobronchial intervention was conducted. The patients were anesthetized with propofol, remifentanil and either low-dose succinylcholine (S) (0.5 mg/kg) or low-dose rocuronium (0.25 mg/kg) with sugammadex (RS) (0.5 mg/kg). All patients were evaluated on the first and second postinterventional day for their satisfaction with the treatment (rigid bronchoscopy) using a Numeric Analog Rating Scale (NAS 0-10) and the presence and severity of POM (NAS 1-4). Intubating conditions were assessed as excellent, good, or poor on the basis of position of vocal cords and reaction to insertion of the rigid bronchoscope. Patients in the S group were less satisfied with the treatment than patients in RS group (72.7 vs. 93.7%, p = 0.007). The incidence of POM on the first day after intervention was significantly higher in the S group then in the RS group (56.9% vs. 4.3%, p rocuronium in 75% of patients. The anesthetic drug costs were significantly higher in the RS group then in the S group (p rocuronium provided better patient satisfaction and less POM. But with the use of low-dose succinylcholine, the intubating conditions are more comfortable, and it is less expensive than rocuronium/sugammadex. Georg Thieme Verlag KG Stuttgart · New York.

Role of bronchoscopy in evaluation of cases with sputum smear negative pulmonary tuberculosis, interstitial lung disease and lung malignancy: A retrospective study of 712 cases.

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Kumar, Raj; Gupta, Nitesh

2015-01-01

The introduction of flexible bronchoscope has revolutionized the field of pulmonary medicine and is a standard instrument used for diagnostic purpose. A retrospective analysis of the clinico-radiological profile, indication, biopsy procedure and complications, for patients undergoing bronchoscopy at one of the respiratory unit at a tertiary care center in India. Retrospective analysis of 712 bronchoscopies was done in regard to demographic profile, clinical and radiological presentation and diagnostic indication. The results were analyzed on basis of bronchoscopy inspection and histopathological specimen obtained from transbronchial (TBLB), endobronchial biopsy (EBLB) and cytology specimen by transbronchial needle aspiration (TBNA). Furthermore, diagnostic yield of each biopsy procedure and their combination was evaluated. Of 712 patients undergoing bronchoscopy, the pathological diagnosis was achieved in 384 (53.93%). Of 384 diagnosed cases, the clinic-radio-pathological diagnosis of pulmonary tuberculosis in 88 (22.19%), interstitial lung disease (ILDs) in 226 (58.85%), and lung cancer in 70 (18.22%) cases. Of 116 sputum smear negative tuberculosis patients, 88 (75.86%) were diagnosed to be pulmonary tuberculosis; the contribution of BAL being 71.59%. Of 226 ILDs, sarcoidosis was most common 148/226 (65.48%). Among 70 lung cancer diagnosed cases, squamous cell carcinoma was most common (54.28%). The results from current study reemphasizes on the diagnostic utility as well as safety of the bronchoscopy procedure. Copyright © 2015 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.

Methylene Blue-Aided In Vivo Staining of Central Airways during Flexible Bronchoscopy

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Sabine Zirlik

2012-01-01

Full Text Available Background. The early diagnosis of malignant and premalignant changes of the bronchial mucosa remains a major challenge during bronchoscopy. Intravital staining techniques are not new. Previous small case series suggested that analysis of the bronchial mucosal surface using chromoendoscopy allows a prediction between neoplastic and nonneoplastic lesions. Objectives. The aim of the present study was to evaluate chromobronchoscopy as a method to identify malignant and premalignant lesions in the central airways in a prospective manner. Methods. In 26 patients we performed chromoendoscopy with 0.1% methylene blue during ongoing flexible white light bronchoscopy. Circumscribed lesions in central airways were further analyzed by biopsies and histopathologic examination. Results. In the majority of cases neither flat nor polypoid lesions in the central airways were stained by methylene blue. In particular, exophytic growth of lung cancer did not show any specific pattern in chromobronchoscopy. However, a specific dye staining was detected in one case where exophytic growth of metastatic colorectal cancer was present in the right upper lobe. In two other cases, a circumscribed staining was noted in unsuspicious mucosa. But histology revealed inflammation only. Conclusions. In contrast to previous studies, the present findings clearly indicate that chromobronchoscopy is not useful for early detection of malignant or premalignant lesions of the central airways.

Lung abscess following bronchoscopy due to multidrug-resistant Capnocytophaga sputigena adjacent to lung cancer with high PD-L1 expression.

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Migiyama, Yohei; Anai, Moriyasu; Kashiwabara, Kosuke; Tomita, Yusuke; Saeki, Sho; Nakamura, Kazuyoshi; Okamoto, Shinichiro; Ichiyasu, Hidenori; Fujii, Kazuhiko; Kohrogi, Hirotsugu

2018-04-24

Lung abscess following flexible bronchoscopy is a rare and sometimes fatal iatrogenic complication. Here, we report the first case of a lung abscess caused by multidrug-resistant Capnocytophaga sputigena following bronchoscopy. A 67-year-old man underwent bronchoscopy to evaluate a lung mass. Seven days after transbronchial lung biopsy, he presented with an abscess formation in a lung mass. Empirical antibiotic therapy, including with garenoxacin, ampicillin/sulbactam, clindamycin and cefepime, was ineffective. Percutaneous needle aspiration of lung abscess yielded C. sputigena resistant to multiple antibiotics but remained susceptible to carbapenem. He was successfully treated by the combination therapy with surgery and with approximately 6 weeks of intravenous carbapenem. Finally he was diagnosed with a lung abscess with adenocarcinoma expressing high levels of programmed cell death ligand 1. The emergence of multidrug-resistant Capnocytophaga species is a serious concern for effective antimicrobial therapy. Clinicians should consider multidrug-resistant C. sputigena as a causative pathogen of lung abscess when it is refractory to antimicrobial treatment. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The Effect of Dextromethorphan Premedication on Cough and Patient Tolerance During Flexible Bronchoscopy: A Randomized, Double-blind, Placebo-controlled Trial.

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Amini, Shahideh; Peiman, Soheil; Khatuni, Mahdi; Ghalamkari, Marziyeh; Rahimi, Besharat

2017-10-01

Patients undergoing bronchoscopy can experience problems such as anxiety and cough, requiring various doses of sedatives and analgesics. The purposes of this study were to investigate the effect of premedication with dextromethorphan on patients' cough and anxiety, and the use of analgesics/sedatives during flexible bronchoscopy (FB). A randomized, double-blind, placebo-controlled, prospective study was performed to assess the effect of dextromethorphan premedication on patients who underwent diagnostic bronchoscopy. Seventy patients included in this study were randomly allocated into 2 groups: group A consisted of 35 patients who received dextromethorphan before FB; and group B consisted of 35 patients who received a placebo. A questionnaire was given to the patients and bronchoscopist about perception of cough, anxiety, and discomfort. The amount of sedative medication and lidocaine use during the procedure and the procedure time were recorded. The group that was premedicated with dextromethorphan had lower complaint scores, significantly less coughing, significantly less stress assessed by the patient and the physician evaluation, shorter total procedure time, and fewer midazolam requirements during FB (P-value dextromethorphan premedication is an effective approach to facilitate the performance of FB for the physician, and could improve patient comfort.

Sedation during bronchoscopy: data from a nationwide sedation and monitoring survey.

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Gaisl, Thomas; Bratton, Daniel J; Heuss, Ludwig T; Kohler, Malcolm; Schlatzer, Christian; Zalunardo, Marco P; Frey, Martin; Franzen, Daniel

2016-08-05

There is limited knowledge on practice patterns in procedural sedation and analgesia (PSA), the use of propofol, and monitoring during flexible bronchoscopy (FB). The purpose of this study was to assess the current practice patterns of FBs and to focus on the use of propofol, the education of the proceduralist, and the involvement of anaesthesiologists during FB. An anonymous questionnaire was sent to 299 pulmonologists. Only respondents who were active physicians in adult respiratory medicine performing FB were subsequently analysed. The response rate was 78 % and 27,149 FB in the previous 12 months were analysed. The overall sedation-related morbidity rate was 0.02 % and mortality was 7/100'000 FB. Sedation was used in 95 % of bronchoscopies. The main drugs used for PSA were propofol (77 %) and midazolam (46 %). In 84 % of PSAs propofol was used without the attendance of an anaesthesiologist. The use of propofol was associated with high volume bronchoscopists (p vital parameters has become standard practice, pulmonologists reported a very low rate of systematic basic education and training in the field of PSA (50 %). In Switzerland, PSA during FB is mostly performed with propofol without the attendance of an anaesthesiologist and the use of this drug is expected to increase in the future. While monitoring standards are very high there is need for policies to improve education, systematic training, and support for pulmonologists for PSA during FB.

Indication for fiberoptic bronchoscopy in HIV-infected patients suspected for Pneumocystis carinii pneumonia

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Orholm, M; Lundgren, Jens Dilling; Nielsen, T L

1990-01-01

During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations...... did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed...

Hybrid rendering of the chest and virtual bronchoscopy [corrected].

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Seemann, M D; Seemann, O; Luboldt, W; Gebicke, K; Prime, G; Claussen, C D

2000-10-30

Thin-section spiral computed tomography was used to acquire the volume data sets of the thorax. The tracheobronchial system and pathological changes of the chest were visualized using a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures, thus producing a hybrid rendering. The hybrid rendering technique exploit the advantages of both rendering methods and enable virtual bronchoscopic examinations using different representation models. Virtual bronchoscopic examinations with a transparent color-coded shaded-surface model enables the simultaneous visualization of both the airways and the adjacent structures behind of the tracheobronchial wall and therefore, offers a practical alternative to fiberoptic bronchoscopy. Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images.

COMPARISON STUDY OF COUGH SUPPRESSION DURING FLEXIBLE BRONCHOSCOPY USING LOCAL ANAESTHESIA IN DIFFERENT TECHNIQUES- (10% LIGNOCAINE SPRAY + 2% LIGNOCAINE AS YOU GO VERSUS (4% LIGNOCAINE NEBULISATION + 2% LIGNOCAINE AS YOU GO

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Koushik Muthu Raja Mathivanan

2017-08-01

Full Text Available BACKGROUND Anaesthesia for bronchoscopy poses unique challenges for the pulmonologist. By definition, bronchoscopy is an endoscopic technique to visualise the inside of the airways, it is a pivotal diagnostic and therapeutic tool in Pulmonary Medicine. Rigid bronchoscopy is usually done for diagnosis and treatment of intra and/or extra luminal obstruction in the airway for adults and children. With the development of fibreoptic and advanced electronic technology, the flexible bronchoscope has replaced the rigid bronchoscope for most diagnostic and some therapeutic indications. Rigid bronchoscopy requires general anaesthesia, however, flexible bronchoscopy can be performed with conscious sedation supplemented with local anaesthesia. The aim of the study is to- 1. Assess the effect of local anaesthesia on cough suppression during flexible bronchoscopy, when given by two different methods. 2. Compare the degree of cough and patient comfort while using “10% lignocaine spray + 2% lignocaine as you go technique, versus 4% lignocaine nebulisation + 2% lignocaine as you go technique.” MATERIALS AND METHODS It is a prospective study done on 50 consecutive patients undergoing diagnostic flexible bronchoscopy from December 2016 to February 2017. The study groups were assembled by block randomisation technique to receive lignocaine (local anaesthesia as either “as you go” and “spray” or “as you go” and “nebulisation”. Institutional Ethics Committee clearance was obtained prior to commencement of the study. RESULTS The study involving 50 patients and statistical analysis illustrated that in 2% lignocaine as you go + 10% lignocaine spray “no cough” and “mild cough” is 18 out of sample 25, which is 72%. Hence, “10% lignocaine spray + 2% lignocaine as you go” is better than “4% lignocaine nebulisation + 2% lignocaine as you go” technique. There was no significant arrhythmias in any of the patients. The dose of lidocaine is

Repeated Bronchoscopy - Treatment of Severe Respiratory Failure in a Fire Victim

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Petris Ovidiu Rusalim

2017-10-01

Full Text Available A case of respiratory failure in a domestic fire victim presenting with 1-3-degree skin burns on 10% of the total body surface, is reported. Forty-eight hours after admission to hospital, the patient developed severe respiratory failure that did not respond to mechanical ventilation. Severe obstruction of the airway had resulted from secretions and deposits of soot forming bronchial casts. The patient required repeated bronchoscopies to separate and remove the bronchial secretions and soot deposits. An emergency bronchial endoscopic exam was crucial in the patient’s survival and management. The patient was discharged from the hospital after twenty-four days.

Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

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Alka Chandra

2011-01-01

Full Text Available Aim: The aim of the study was to compare transcricoid injection with "spray as you go" technique for diagnostic fibreoptic bronchoscopy, to perform the procedure without sedation and to record any complication or side effects. Methods: Sixty patients belonging to the age group 20-70 years, undergoing diagnostic bronchoscopy over a period of 6 months, were randomly selected and divided into two groups alternatively to receive 3 ml of 4% lignocaine by a single transcricoid puncture (group I or 2 ml of 4% lignocaine instilled through the bronchoscope on to the vocal cords and further 1 ml of 2% lignocaine into each main bronchus (group II. Additional dose of lignocaine as required was given in both the groups. All patients were given intramuscular atropine 0.6 mg, 20 min before the procedure. Nebulisation with 3 ml of 4% lignocaine was given to all patients. The time from nasal insertion of the bronchoscope to reach the carina was recorded, and the total dose of lignocaine required in both the groups was calculated and compared. The cough episodes during the procedure, systolic blood pressure, and pulse rate were compared before the procedure and 5 min after the procedure in both the groups. A 0-10 visual analogue scale (VAS was used to assess discomfort 30 min after the procedure. Results: The time to reach carina was more in group II (P<0.02, and cough episodes were also more in group II (P<0.05 than in group I. The vitals before the procedure were comparable in both the groups, but 5 min after the procedure the vitals were more stable in group I than in group II, and the total dose of lignocaine required in group II was more than in group I (P<0.001. However, the VAS score was comparable in both the groups. Conclusion: Transcricoid puncture for diagnostic bronchoscopies without sedation was associated with no complication and discomfort and required lesser dose of local anaesthetic with more stable vitals and good conditions for bronchoscopists.

Utility of multidetector row computed tomography and virtual bronchoscopy in evaluation of hemoptysis due to lung cancer

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Sherif A.A. Mohamed

2016-01-01

Conclusion: MDCT angiography is a useful and non invasive method that allows a rapid and detailed identification of abnormal vasculature responsible for hemoptysis in patients with lung cancer. MDCT-generated virtual bronchoscopy is an accurate, and non invasive method for evaluating obstructions, endoluminal masses, and external compressions in patients with hemoptysis due to lung cancer.

Therapeutic bronchoscopy vs. standard of care in acute respiratory failure

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Ellekjaer, K L; Meyhoff, T S; Møller, M H

2017-01-01

) according to the Cochrane Handbook and GRADE methodology, including a predefined protocol (PROSPERO no. CRD42016046235). We included randomized clinical trials (RCTs) comparing therapeutic bronchoscopy to standard of care in critically ill patients with ARF. Two reviewers independently assessed trials...... for inclusion, extracted data and assessed risk of bias. Risk ratios (RR) with 95% confidence intervals (CI) were estimated by conventional meta-analysis. The risk of random errors was assessed by TSA. Exclusively patient-important outcomes were evaluated. RESULTS: We included five trials (n = 212); all were....... A shorter duration of mechanical ventilation was suggested by conventional meta-analysis, however TSA highlighted that only 42% of the required information size had been accrued, indicating high risk of random errors. No trials reported data on adverse events, hospital length of stay, quality of life...

Multidetector CT evaluation of central airways stenoses: Comparison of virtual bronchoscopy, minimal-intensity projection, and multiplanar reformatted images

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Dinesh K Sundarakumar

2011-01-01

Full Text Available Aims: To evaluate the diagnostic utility of virtual bronchoscopy, multiplanar reformatted images, and minimal-intensity projection in assessing airway stenoses. Settings and Design: It was a prospective study involving 150 patients with symptoms of major airway disease. Materials and Methods: Fifty-six patients were selected for analysis based on the detection of major airway lesions on fiber-optic bronchoscopy (FB or routine axial images. Comparisons were made between axial images, virtual bronchoscopy (VB, minimal-intensity projection (minIP, and multiplanar reformatted (MPR images using FB as the gold standard. Lesions were evaluated in terms of degree of airway narrowing, distance from carina, length of the narrowed segment and visualization of airway distal to the lesion. Results: MPR images had the highest degree of agreement with FB (Κ = 0.76 in the depiction of degree of narrowing. minIP had the least degree of agreement with FB (Κ = 0.51 in this regard. The distal visualization was best on MPR images (84.2%, followed by axial images (80.7%, whereas FB could visualize the lesions only in 45.4% of the cases. VB had the best agreement with FB in assessing the segment length (Κ = 0.62. Overall there were no statistically significant differences in the measurement of the distance from the carina in the axial, minIP, and MPR images. MPR images had the highest overall degree of confidence, namely, 70.17% (n = 40. Conclusion: Three-dimensional reconstruction techniques were found to improve lesion evaluation compared with axial images alone. The technique of MPR images was the most useful for lesion evaluation and provided additional information useful for surgical and airway interventions in tracheobronchial stenosis. minIP was useful in the overall depiction of airway anatomy.

[Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis].

Science.gov (United States)

Jalilie, Alfredo; Carvajal, Juan Carlos; Aparicio, Rodrigo; Meneses, Manuel

2016-11-01

Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Diagnostic capabilities of the virtual bronchoscopy at advanced neoplastic process of esophagus with formation of tracheobronchial fistula: Description of a case

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M. A. Mitev

2017-09-01

Full Text Available The relevance of the problem is related to the continued increase in the neoplastic processes, and at the same time also to the development and improvement of the endoscopic and CT equipment, and thus expanding the diagnostic capabilities. Purpose: The presented research examines the results of the study of a rare case of ruptured trachea as a result of cancer of the esophagus. Methods: Fiberoptic esophagoscopy (FOE and CT of the chest followed by virtual bronchoscopy on a patient with a ruptured trachea, a 63 year-old man, were performed. Result: Performing MDCT with virtual bronchoscopy, according to this study, is crucial as the sole and complex methodology for the described case in connection with the finding of the trachea-oesophageal fistula and evaluation of the mediastinum and the pulmonary parenchyma. Conclusion: The VB is a successful method equally effective compared to the FB, to diagnose of advanced neoplastic processes.

Optical coherence tomography in conjunction with bronchoscopy

International Nuclear Information System (INIS)

Rodrigues, Ascedio Jose; Takimura, Celso Kiyochi; Lemos Neto, Pedro Alves; Figueiredo, Viviane Rossi

2012-01-01

To evaluate the feasibility of and the potential for using optical coherence tomography in conjunction with conventional bronchoscopy in the evaluation of the airways. Methods: This was a pilot study based on an ex vivo experimental model involving three animals: one adult New Zealand rabbit and two Landrace pigs. An optical coherence tomography imaging catheter was inserted through the working channel of a flexible bronchoscope in order to reach the distal trachea of the animals. Images of the walls of the trachea were systematically taken along its entire length, from the distal to the proximal portion. Results: The imaging catheter was easily adapted to the working channel of the bronchoscope. High-resolution images of cross sections of the trachea were taken in real time, precisely delineating microstructures, such as the epithelium, submucosa, and cartilage, as well as the adventitia of the anterior and lateral tracheal walls. The corresponding layers of the epithelium, mucosa, and cartilage were clearly differentiated. The mucosa, submucosa, and trachealis muscle were clearly identified in the posterior wall. Conclusions: It is feasible to use an optical coherence tomography imaging catheter in combination with a flexible bronchoscope. Optical coherence tomography produces high resolution images that reveal the microanatomy of the trachea, including structures that are typically seen only on images produced by conventional histology. (author)

Optical coherence tomography in conjunction with bronchoscopy

Energy Technology Data Exchange (ETDEWEB)

Rodrigues, Ascedio Jose; Takimura, Celso Kiyochi; Lemos Neto, Pedro Alves; Figueiredo, Viviane Rossi, E-mail: ascedio@gmail.com [Servico de Endoscopia Respiratoria, Hospital das Clinicas, Universidade de Sao Paulo (FM/USP), SP (Brazil)

2012-07-01

To evaluate the feasibility of and the potential for using optical coherence tomography in conjunction with conventional bronchoscopy in the evaluation of the airways. Methods: This was a pilot study based on an ex vivo experimental model involving three animals: one adult New Zealand rabbit and two Landrace pigs. An optical coherence tomography imaging catheter was inserted through the working channel of a flexible bronchoscope in order to reach the distal trachea of the animals. Images of the walls of the trachea were systematically taken along its entire length, from the distal to the proximal portion. Results: The imaging catheter was easily adapted to the working channel of the bronchoscope. High-resolution images of cross sections of the trachea were taken in real time, precisely delineating microstructures, such as the epithelium, submucosa, and cartilage, as well as the adventitia of the anterior and lateral tracheal walls. The corresponding layers of the epithelium, mucosa, and cartilage were clearly differentiated. The mucosa, submucosa, and trachealis muscle were clearly identified in the posterior wall. Conclusions: It is feasible to use an optical coherence tomography imaging catheter in combination with a flexible bronchoscope. Optical coherence tomography produces high resolution images that reveal the microanatomy of the trachea, including structures that are typically seen only on images produced by conventional histology. (author)

Routine examination for tuberculosis is still indicated during bronchoscopy for pulmonary infiltrates

DEFF Research Database (Denmark)

Laub, Rasmus Rude; Sivapalan, Pradeesh; Wilcke, Torgny

2015-01-01

INTRODUCTION: Tuberculosis (TB) can present in numerous ways and can be radiological indistinguishable from cancer. In several guidelines for bronchoscopy (FOB) in low-incidence areas, a Mycobacterium tuberculosis test is only recommended when TB is clinically suspected. Due to the expenses...... associated with M. tuberculosis cultures, we did an analysis of tests obtained by FOB and other invasive procedures (endoscopic ultrasound (EUS)-guided needle biopsy via the oesophagus or trachea and percutaneous needle lung biopsy (PNLB)). METHODS: All patients tested positive for M. tuberculosis by culture...... and with samples obtained by FOB, EUS or PNLB in the 2008-2012 period were identified retrospectively in two centres in a low-incidence area (Copenhagen, Denmark). Patient records and radiological reports were reviewed. RESULTS: A total of 57 (1.2%) patients out of the 4,680 tested were M. tuberculosis culture...

[How practical guidelines can be applied in poor countries? Example of the introduction of a bronchoscopy unit in Cambodia].

Science.gov (United States)

Couraud, S; Chan, S; Avrillon, V; Horn, K; Try, S; Gérinière, L; Perrot, É; Guichon, C; Souquet, P-J; Ny, C

2013-10-01

According to UN, Cambodia is one of the poorest countries in the World. Respiratory diseases are current public health priorities. In this context, a new bronchoscopy unit (BSU) was created in the respiratory medicine department of Preah Kossamak hospital (PKH) thanks to a tight cooperation between a French and a Cambodian team. Aim of this study was to describe conditions of introduction of this equipment. Two guidelines for practice are available. They are respectively edited by the French and British societies of pulmonology. These guidelines were reviewed and compared to the conditions in which BS was introduced in PKH. Each item from guidelines was combined to a categorical value: "applied", "adapted" or "not applied". In 2009, 54 bronchoscopies were performed in PKH, mainly for suspicion of infectious or tumour disease. In total, 52% and 46% of the French and British guideline items respectively were followed in this Cambodian unit. Patient safety items are those highly followed. By contrast "staff safety" items were those weakly applied. Implementation of EBS in developing countries seems feasible in good conditions of quality and safety for patients. However, some recommendations cannot be applied due to local conditions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The diagnostic value of multi-slice spiral CT virtual bronchoscopy in tracheal and bronchial disease

International Nuclear Information System (INIS)

Han Ying; Ma Daqing

2006-01-01

Objective: To assess the diagnostic value of multi-slice spiral CT virtual bronchoscopy (CTVB) in tracheal and bronchial disease. Methods: Forty-two patients including central lung cancer (n=35), endobronchial tuberculosis (n=3), intrabronchial benign tumor (n=3), and intrabronchial foreign body (n=1) were examined by using multi-slice spiral CT examinations. All the final diagnosis were proved by pathology except 1 patient with endoluminal foreign body was proved by clinic. All patients were scanned on GE Lightspeed 99 scanner, using 10 mm collimation, pitch of 1.35, and reconstructed at 1 mm intervals and 1.25 mm thickness. The chest images of transverse CT and virtual bronchoscopy were viewed by two separate radiologists who were familiar with the tracheal and bronchial anatomy. Results: Among the 42 patients, the tumor of trachea and bronchial lumen appeared as masses in 22 of 35 patients with central lung cancer and bronchial stenosis was found in 13 of 35 patients with central lung cancer, and bronchial wall thickening was revealed on transverse CT in all 35 cases. 3 patients of endobronchial tuberculosis showed bronchial lumen narrowing on CTVB, the bronchial wall thickening was revealed on transverse CT, and the length of the wall thickening was long. 3 patients with intrabronchial benign tumor showed nodules in trachea and bronchial lumen on CTVB, and without wall thickening on transverse CT. CTVB could detect the occlusion of bronchial lumen in 1 patient with intrabronchial foreign body and CTVB was able to visualize the areas beyond stenosis, and the bronchial wall was without thickening on transverse CT. Conclusion: Multi- slice spiral CTVB could reflect the morphology of tracheal and bronchial disease. Combined with transverse CT, it could provide diagnostic reference value for bronchial disease. (authors)

Ultrathin bronchoscopy for solitary pulmonary lesions in a region endemic for tuberculosis: a randomised pilot trial.

Science.gov (United States)

Franzen, Daniel; Diacon, Andreas H; Freitag, Lutz; Schubert, Pawel T; Wright, Colleen A; Schuurmans, Macé M

2016-04-27

The evaluation of solitary pulmonary lesions (SPL) requires a balance between procedure-related morbidity and diagnostic yield, particularly in areas where tuberculosis (TB) is endemic. Data on ultrathin bronchoscopy (UB) for this purpose is limited. To evaluate feasibility and safety of UB compared to SB for diagnosis of SPL in a TB endemic region. In this prospective randomised trial we compared diagnostic yield and adverse events of UB with standard-size bronchoscopy (SB), both combined with fluoroscopy, in a cohort of patients with SPL located beyond the visible range of SB. We included 40 patients (mean age 55.2 years, 45 % male) with malignant SPL (n = 16; 40 %), tuberculous SPL (n = 11; 27.5 %) and other benign SPL (n = 13; 32.5 %). Mean procedure time in UB and SB was 30.6 and 26.0 min, respectively (p = 0.15). By trend, adverse events were recorded more often with UB than with SB (30.0 vs. 5.0 %, p = 0.091), including extensive coughing (n = 2), blocked working channel (n = 2), and arterial hypertension requiring therapeutic intervention (n = 1), all with UB. The overall diagnostic yield of UB compared to SB was 55.0 % vs. 80.0 %, respectively (p = 0.18). Sensitivity for the diagnosis of malignancy of UB and SB was 50.0 % and 62.5 %, respectively (p = 0.95). UB is not superior to SB for the evaluation of SPL in a region endemic with tuberculosis, when combined with fluoroscopic guidance only. ClinicalTrials.gov (Identifier: NCT02490059 ).

Pleural Dye Marking Using Radial Endobronchial Ultrasound and Virtual Bronchoscopy before Sublobar Pulmonary Resection for Small Peripheral Nodules.

Science.gov (United States)

Lachkar, Samy; Baste, Jean-Marc; Thiberville, Luc; Peillon, Christophe; Rinieri, Philippe; Piton, Nicolas; Guisier, Florian; Salaun, Mathieu

2018-01-01

Minimally invasive surgery of pulmonary nodules allows suboptimal palpation of the lung compared to open thoracotomy. The objective of this study was to assess endoscopic pleural dye marking using radial endobronchial ultrasound (r-EBUS) and virtual bronchoscopy to localize small peripheral lung nodules immediately before minimally invasive resection. The endoscopic procedure was performed without fluoroscopy, under general anesthesia in the operating room immediately before minimally invasive surgery. Then, 1 mL of methylene blue (0.5%) was instilled into the guide sheath, wedged in the subpleural space. Wedge resection or segmentectomy were guided by visualization of the dye on the pleural surface. Contribution of dye marking to the surgical procedure was rated by the surgeon. Twenty-five nodules, including 6 ground glass opacities, were resected in 22 patients by video-assisted thoracoscopic wedge resection (n = 11) or robotic-assisted thoracoscopic surgery (10 segmentectomies and 1 wedge resection). The median greatest diameter of nodules was 8 mm. No conversion to open thoracotomy was needed. The endoscopic procedure added an average 10 min to surgical resection. The dye was visible on the pleural surface in 24 cases. Histological diagnosis and free margin resection were obtained in all cases. Median skin-to-skin operating time was 90 min for robotic segmentectomy and 40 min for video-assisted wedge resection. The same operative precision was considered impossible by the surgeon without dye marking in 21 cases. Dye marking using r-EBUS and virtual bronchoscopy can be easily and safely performed to localize small pulmonary nodules immediately before minimally invasive resection. © 2018 S. Karger AG, Basel.

Papel da fibrobroncoscopia no diagnóstico de pacientes com suspeita de tuberculose pulmonar Role of the fiberoptic bronchoscopy in the diagnosis of patients with suspected pulmonary

Directory of Open Access Journals (Sweden)

Anna Luiza Summers Caymmi

2004-02-01

que representam diagnósticos diferenciais.BACKGROUND: Pulmonary tuberculosis is an infectious disease of high prevalence and incidence. The use of sputum bacilloscopy is a sure and speedy way of reaching a diagnosis. However as 30% to 50% of the bearers of pulmonary tuberculosis have a negative sputum smear or have no sputum the fiber bronchoscopy acquires a special importance. OBJECTIVES: To evaluate the sensitivity of the specimens collected by means of the fiber bronchoscopy (brochoalveolar lavage and transbronchial biopsy for the diagnosis of patients suspected of having pulmonary tuberculosis, without confirmation by sputum bacilloscopy. METHOD: By review of the ledgers of fiber bronchoscopies carried out from March 1997 to March 2001, we identified and included in the study patients over 18 years of age and referred with suspicion of tuberculosis and at least three negative sputum smears. Data regarding age, gender, changes detected at thorax imaging and endoscopy were collected. RESULTS: Fifty-two patients with ages ranging from 19 to 77 years (median of 39, were included, 58% were of the male gender and 37% were patients from the Official Health System. Prevailing finding at chest X-ray was the alveolar infiltrate (80%. In 35 patients tuberculosis was the final diagnosis (one with associated neoplasia; in 28 patients (80% diagnosis was achieved by bronchoscopy. Other diagnoses disclosed by bronchoscopy were neoplasias, histoplasmosis chronic eosinophil alvelolitis, pneumonia by Pneumocystis carinii and pulmonary fibrosis. CONCLUSION: results of this study point to the use of fiber bronchoscopy in patients suspect of tuberculosis, not diagnosed thorough sputum bacilloscopy, not only for pulmonary tuberculosis but also of those that represent differential diagnoses.

Broncoscopia flexível como primeira opção para a remoção de corpo estranho das vias aéreas em adultos Flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults

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Ascedio José Rodrigues

2012-06-01

Full Text Available OBJETIVO: Determinar a taxa de sucesso da broncoscopia flexível como primeira opção na remoção de corpos estranhos das vias aéreas em adultos. MÉTODOS: Estudo retrospectivo de todos os pacientes adultos (acima de 18 anos com aspiração de corpo estranho submetidos a broncoscopia no Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, em São Paulo (SP. RESULTADOS: A amostra foi constituída por 40 pacientes adultos, com média de idade de 52 anos (variação: 18-88 anos. A mediana do tempo de permanência do corpo estranho na via aérea foi de 15 dias (variação: 12 h a 10 anos. Todos os pacientes foram submetidos primeiramente a broncoscopia flexível diagnóstica. A retirada do corpo estranho por meio de broncoscopia flexível foi bem-sucedida em 33 dos pacientes (82,5%. Em 1 paciente, um objeto metálico alojado na árvore brônquica distal requereu o uso de fluoroscopia. Seis pacientes (15% foram submetidos a broncoscopia rígida devido a dispneia induzida por corpo estranho traqueal, em 2, e porque o corpo estranho era muito grande para as pinças flexíveis, em 4. A broncoscopia falhou em apenas 1 paciente, que portanto necessitou de broncotomia. CONCLUSÕES: Embora a broncoscopia rígida seja considerada o padrão ouro na remoção de corpos estranhos na via aérea, nossa experiência mostrou que a broncoscopia flexível pode ser utilizada segura e eficientemente no diagnóstico e tratamento de pacientes adultos estáveis.OBJECTIVE: To determine the success rate of flexible bronchoscopy as the first-choice method of removing foreign bodies from the airways of adults. METHODS: This was a retrospective study of all adult patients (over 18 years of age with foreign body aspiration submitted to bronchoscopy between January of 2009 and January of 2011 at the University of São Paulo School of Medicine Hospital das Clínicas, located in São Paulo, Brazil. RESULTS: The study sample comprised 40 adult patients

The utility of the fiberoptic bronchoscopy in the esophageal cancer

International Nuclear Information System (INIS)

Reyes O, Leonardo; Garcia-Herreros, Plutarco; Rivas P, Pilar; Posso, Hector; Sandoval Rafael L

1998-01-01

The paper establishes the utility of the fiber- optic bronchoscopy (FOB) studies performed in patients with esophageal cancer (EC) and confirm the possibility of tracheo-bronchial compromise. We carry out a descriptive study in 226 patients with esophageal cancer during 1991 to 1996 in the Instituto Nacional de Cancerologia of Colombia (INC). We excluded the patients with previous treatments: radiotherapy or surgery, and others primary cancers with metastases on the esophagus. We analyzed gastric, intestinal and general symptoms, smoking habits, primary cancer location, histological types, radiologic findings, fob findings, micro and macroscopes, and results of the samples: transbronchial, endobronchial biopsies, bronchi alveolar lavage and brush. We included 158 patients, 110 male and 48 female, with age between 32 and 83 years, symptoms duration average of 5,2 months. The most significant were cough, dysphonia and sputum. The location of EC was statistics significance only in the upper third escamocelular type. The significant radiological findings were: parenchymal nodules and interstitial infiltrates, the significant fob findings were: fistula endobronchial infiltration endobronchial mass and vocal cords palsy. The zones with more compromise were trachea, principal bronchi and vocal cords. Only 17 patients were positives in the samples; comparing the histopathologic findings (biopsies) as the gold standard with fob findings the sensitivity was 100%, specificity 35%, positive predictive value 15.6% and negative predictive value 100%

Utilization of low-dose multidetector CT and virtual bronchoscopy in children with suspected foreign body aspiration

International Nuclear Information System (INIS)

Adaletli, Ibrahim; Kurugoglu, Sebuh; Ulus, Sila; Ozer, Harun; Kantarci, Fatih; Mihmanli, Ismail; Akman, Canan; Elicevik, Mehmet

2007-01-01

Foreign body aspiration is common in children, especially those under 3 years of age. Chest radiography and CT are the main imaging modalities for the evaluation of these children. Management of children with suspected foreign body aspiration (SFBA) mainly depends on radiological findings. To investigate the potential use of low-dose multidetector CT (MDCT) and virtual bronchoscopy (VB) in the evaluation and management of SFBA in children. Included in the study were 37 children (17 girls, 20 boys; age 4 months to 10 years, mean 32 months) with SFBA. Chest radiographs were obtained prior to MDCT in all patients. MDCT was performed using a low-dose technique. VB images were obtained in the same session. Conventional bronchoscopy (CB) was performed within 24 h on patients in whom an obstructive abnormality had been found by MDCT and VB. Obstructive pathology was found in 16 (43.25%) of the 37 patients using MDCT and VB. In 13 of these patients, foreign bodies were detected and removed via CB. The foreign bodies were located in the right main bronchus (n = 5), in the bronchus intermedius (n = 6), in the medial segment of the middle lobe bronchus (n = 1), and in the left main bronchus (n = 1). In the remaining three patients, the diagnosis was false-positive for an obstructive pathology by MDCT and VB; the final diagnoses were secretions (n = 2) and schwannoma (n = 1), as demonstrated by CB. In 21 patients in whom no obstructive pathology was detected by MDCT and VB, CB was not performed. These patients were followed for 5-20 months without any recurrent obstructive symptomatology. Low-dose MDCT and VB are non-invasive radiological modalities that can be used easily in the investigation of SFBA in children. MDCT and VB provide the exact location of the obstructive pathology prior to CB. If obstructive pathology is depicted with MDCT and VB, CB should be performed either for confirmation of the diagnosis or for the diagnosis of an alternative cause for the obstruction

A novel needle-type sampling device for flexible ultrathin bronchoscopy

International Nuclear Information System (INIS)

Suda, Yuji; Hayashi, Katsutoshi; Shindoh, Yuriko; Iijima, Hideya; Tanaka, Akiko

2008-01-01

Diagnosis of suspected cancer in the periphery of the lung is difficult. A flexible ultrathin bronchoscope has been developed for the diagnosis of peripherally located pulmonary lesions that cannot be reached with the sampling devices for standard flexible bronchoscopes. The diagnostic yield with forceps and a brush for ultrathin bronchoscopes, however, is not adequate, especially when a lesion is not exposed to the bronchial lumen. We have thus developed a novel needle-type sampling device and tested its yield in transbronchial cytology. The device consists of an elongated dental H-file (0.4 mm in diameter and 110 cm in length), a housing sheath (1.0 mm in outer diameter), and a novel handle, which enables rapid out-and-in motion of the needle. Ten consecutive patients with a peripheral pulmonary lesion who had an indication for diagnostic procedure with a flexible ultrathin bronchoscope were enrolled. The optimal bronchial route to the lesion was analyzed with virtual bronchoscopy in a data set obtained with high-resolution computed tomography, and a novel bronchial route labeling system (prior-ridge-based relative orientation nomenclature) was employed to guide insertion of the bronchoscope. Sampling with the novel needle was performed prior to use of the forceps and brush under conventional fluoroscopy. In all the cases, sampling with the needle was successful and the amount of the specimen was sufficient for cytology. Our novel sampling system with flexible ultrathin bronchoscopes may contribute to accurate and minimally invasive diagnosis of peripheral pulmonary lesions. (author)

Virtual bronchoscopy, importance of the method, application and prospects for tumors of the trachea and bronchi

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M. A. Mitev

2017-09-01

Full Text Available Virtual bronchoscopy (VB is 3-dimensional computer-generated technology, creating endobronchial images from spiral CT data. The study aims to present summarized results from researches of different foreign authors about the advantages of VB, the possibilities for its application and the effectiveness of its use in routine practice in the diagnosis of tumors of the trachea and bronchi. The three-dimensional model of the tracheobronchial tree allows assessment of the airways from inside. The majority of the examined studies relate to the diagnosis of new formations of the respiratory tract, preparation for surgery, assessment of the results of surgery, etc. VB is a noninvasive method allowing to examine the smallest bronchi. Relatively few studies in Bulgaria as well as the ensured during recent years new modern equipment for VB and MDCT, provide great opportunities for making VB examinations to study the effectiveness and its wide application in daily X-ray practice.

Uso da broncoscopia virtual em pacientes pediátricos com suspeita de aspiração de corpo estranho Use of virtual bronchoscopy in children with suspected foreign body aspiration

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Tiago Neves Veras

2009-09-01

Full Text Available A aspiração de corpo estranho (ACE para o trato respiratório é um problema comum em pacientes pediátricos, em especial abaixo dos três anos de idade. Na avaliação radiológica inicial, cerca de 30% dos pacientes apresentam radiograma de tórax normal. A tomografia com broncoscopia virtual (BV pode auxiliar no diagnóstico precoce desse quadro e seu pronto manejo. O tratamento definitivo se dá com a retirada do corpo estranho através de broncoscopia rígida e mediante anestesia geral. O objetivo deste trabalho foi descrever o uso da BV na abordagem de dois pacientes com suspeita de ACE e realizar uma revisão da literatura sobre este tópico. Os dois pacientes tiveram início súbito de sintomas respiratórios e relato de tosse ou engasgo com alimentos antecedendo o quadro. Os pacientes foram submetidos à BV, e foi detectada a presença de corpo estranho endobrônquico em ambos os casos, com remoção posterior por broncoscopia rígida convencional em um caso. A BV é um método não-invasivo recente e com potencial para detectar a presença de corpo estranho na via respiratória em crianças. Em casos selecionados, BV pode auxiliar na localização correta do corpo estranho e até mesmo evitar o procedimento de broncoscopia rígida na ausência de corpo estranho.Foreign body aspiration (FBA into the tracheobronchial tree is a common problem in children, especially in those under three years of age. Preliminary radiological evaluation reveals normal chest X-rays in nearly 30% of such patients. Tomography-generated virtual bronchoscopy (VB can facilitate the early diagnosis and rapid management of these cases. The definitive treatment is the removal of the foreign body by means of rigid bronchoscopy under general anesthesia. The objective of this study was to describe the use of VB in two patients with suspicion of FBA, as well as to review the literature regarding this topic. The two patients presented with sudden onset of respiratory

Usefulness of computed tomography virtual bronchoscopy in the evaluation of bronchi divisions

International Nuclear Information System (INIS)

Adamczyk, Michał; Tomaszewski, Grzegorz; Naumczyk, Patrycja; Kluczewska, Ewa; Walecki, Jerzy

2013-01-01

Since introduction of multislice CT scanners into clinical practice, virtual brochoscopy has gained a lot of quality and diagnostic potential. Nevertheless it does not have established place in diagnostics of tracheal and bronchi disorders and its potential has not been examined enough. Nowadays a majority of bronchial tree variants and lesions are revealed by bronchofiberoscopy, which is an objective and a relatively safe method, but has side effects, especially in higher-risk subjects. Therefore noninvasive techniques enabling evaluation of airways should be consistently developed and updated. Material consisted of 100 adults (45 female, 55 male) aged between 18 and 65 years (mean 40 years, median 40.5 years, SD 14.02), who underwent chest CT examination by means of a 16-slice scanner. Every patient had normal appearance of chest organs, with the exception of minor abnormalities that did not alter airways route. Divisions of bronchial tree to segmental level were evaluated and assigned to particular types by means of virtual bronchoscopy projection. In case of difficulties MPR or MinIP projection was used. The frequency of lobar bronchi divisions other than the typical ones was in: right upper lobar bronchi 45%, left 55%; middle lobar bronchi 21%, lingula 26%; right lower lobar bronchi 28%, left 29%. Subsuperior bronchus or bronchi were found on the right side in 44% and on the left side in 37%. No dependency between types of bronchial divisions on different levels was found

Anatomy and bronchoscopy of the porcine lung. A model for translational respiratory medicine.

LENUS (Irish Health Repository)

Judge, Eoin P

2014-09-01

The porcine model has contributed significantly to biomedical research over many decades. The similar size and anatomy of pig and human organs make this model particularly beneficial for translational research in areas such as medical device development, therapeutics and xenotransplantation. In recent years, a major limitation with the porcine model was overcome with the successful generation of gene-targeted pigs and the publication of the pig genome. As a result, the role of this model is likely to become even more important. For the respiratory medicine field, the similarities between pig and human lungs give the porcine model particular potential for advancing translational medicine. An increasing number of lung conditions are being studied and modeled in the pig. Genetically modified porcine models of cystic fibrosis have been generated that, unlike mouse models, develop lung disease similar to human cystic fibrosis. However, the scientific literature relating specifically to porcine lung anatomy and airway histology is limited and is largely restricted to veterinary literature and textbooks. Furthermore, methods for in vivo lung procedures in the pig are rarely described. The aims of this review are to collate the disparate literature on porcine lung anatomy, histology, and microbiology; to provide a comparison with the human lung; and to describe appropriate bronchoscopy procedures for the pig lungs to aid clinical researchers working in the area of translational respiratory medicine using the porcine model.

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results

Directory of Open Access Journals (Sweden)

Márcia Jacomelli

2012-04-01

Full Text Available OBJETIVO: Avaliar a acurácia diagnóstica da broncoscopia em pacientes com suspeita clínica ou radiológica de tuberculose, com baciloscopia negativa ou incapazes de produzir escarro. MÉTODOS: Estudo transversal prospectivo de 286 pacientes com suspeita clínica/radiológica de tuberculose pulmonar e submetidos à broncoscopia - LBA e biópsia transbrônquica (BTB. As amostras de LBA foram testadas por pesquisas diretas e culturas de BAAR e de fungos, e as de BTB por exame histopatológico. RESULTADOS: Dos 286 pacientes estudados, a broncoscopia contribuiu para o diagnóstico em 225 (79%: tuberculose pulmonar em 127 (44%; inflamações crônicas inespecíficas em 51 (18%; pneumocistose, infecções fúngicas ou nocardiose em 20 (7%; bronquiolite obliterante com pneumonia em organização, alveolites ou pneumoconioses em 14 (5%; neoplasias pulmonares ou metastáticas em 7 (2%; e micobacterioses não tuberculosas em 6 (2%. Para o diagnóstico de tuberculose, o LBA mostrou sensibilidade e especificidade de 60% e 100% respectivamente, havendo um aumento importante da sensibilidade quando associado à biópsia (84% e à baciloscopia após a broncoscopia (94%. Complicações controláveis decorrentes do procedimento ocorreram em 5,6% dos casos. CONCLUSÕES: A broncoscopia representa um método diagnóstico confiável para pacientes com tuberculose pulmonar, apresentando baixos índices de complicações. A associação de biópsia transbrônquica ao lavado broncoalveolar elevou a sensibilidade diagnóstica do método e permitiu o diagnóstico diferencial com outras doenças.OBJECTIVE: To evaluate the diagnostic accuracy of bronchoscopy in patients with clinical or radiological suspicion of tuberculosis who were unable to produce sputum or with negative sputum smear microscopy results. METHODS: A prospective cross-sectional study involving 286 patients under clinical or radiological suspicion of having pulmonary tuberculosis and submitted to

Sedation with midazolam in flexible bronchoscopy – A prospective study

Directory of Open Access Journals (Sweden)

R. Rolo

2012-09-01

Full Text Available Introduction: Sedatives have been increasingly used to improve patient comfort during flexible bronchoscopy (FOB. Due to its rapid-onset, anxiolytic and amnestic properties, midazolam is one of the most commonly used sedatives. Objectives: To evaluate the effect of sedation with midazolam, including patient tolerance, complications and its potential use on a daily routine basis. Methods: A multi-centre, prospective, randomized, placebo-controlled study was made on 100 patients submitted to FOB in two Pulmonology Departments. Midazolam (0.05 mg/kg was administered to patients in Group 1 and saline solution (0.9% NaCl to patients in Group 2, 5 min before the procedure. The Hospital Anxiety and Depression Scale (HADS-A was used to determine patient anxiety level. Subjective questionnaires concerning main fears and complaints were answered before and after FOB. Results: Mean age was 56.0 ± 14.1 years; 66% were male. Most (65% patients had low score ( 0.05 and pain (4% vs 12%; p > 0.05 were not statistically different.Willingness to repeat the exam was reported in all patients in Group 1 and in 82% in Group 2 (p = 0.003. Conclusion: Sedation with midazolam in FOB improved patient's comfort and decreased complaints, without significant haemodynamic changes. It should be offered to the patient on a routine basis. Resumo: Introdução: Os agentes sedativos têm vindo a ser cada vez mais utilizados na broncofibroscopia (BF para melhorar o conforto do doente. Devido à sua rápida ação, propriedades ansiolíticas e amnésicas, o midazolam é um dos sedativos mais frequentemente usados. Objetivos: Avaliar o efeito da sedação com midazolam na BF, incluindo a tolerância do doente, complicações e a sua potencial aplicação na prática clínica diária. Material e Métodos: Estudo multicêntrico, prospetivo, randomizado, controlado com placebo, com inclusão de 100 indiv

Pneumocystis carinii pneumonia in AIDS patients: clinical course in relation to the parasite number found in routine specimens obtained by fiberoptic bronchoscopy

DEFF Research Database (Denmark)

Orholm, M; Nielsen, T L; Holten-Andersen, W

1992-01-01

The aim of this study was to evaluate whether the amount of Pneumocystis carinii organisms found at fiberoptic bronchoscopy (FB) performed on HIV-positive patients correlated to the character of the P. carinii pneumonia (PCP). A consecutive series of 105 patients presented with 131 episodes...... of pulmonary symptoms requiring FB, and in 75 of these episodes a diagnosis of PCP was made. Specimens were stained with Giemsa and methenamine silver nitrate and the number of parasites found was given as: numerous, many, few or none. The following signs and symptoms were registered: cough, dyspnoea, fever......, loss of weight, chest radiograph, haemoglobin, WBC, CD4 cell count, PO2 and HIV p24 antigen. The PCP was characterized by the clinical course: mild, moderate, severe, and by the outcome: pulmonary healthy, pulmonary insufficiency and death. No correlations between the number of P. carinii organisms...

The concentrations of clinafloxacin in alveolar macrophages, epithelial lining fluid, bronchial mucosa and serum after administration of single 200 mg oral doses to patients undergoing fibre-optic bronchoscopy.

Science.gov (United States)

Honeybourne, D; Andrews, J M; Cunningham, B; Jevons, G; Wise, R

1999-01-01

The concentrations of clinafloxacin were measured in serum, bronchial mucosa, alveolar macrophages and epithelial lining fluid after single 200 mg oral doses of clinafloxacin had been administered to 15 subjects who were undergoing bronchoscopy. Concentrations were measured using a microbiological assay method. Mean concentrations in serum, bronchial mucosa, alveolar macrophages and epithelial lining fluid at a mean of 1.27 h post-dose were 1.54, 2.65, 15.60 and 2.71 mg/L respectively. These site concentrations exceeded the MIC90 for common respiratory pathogens and indicate that clinafloxacin is likely to be effective in the treatment of a wide range of respiratory tract infections.

Virtual bronchoscopy-guided transbronchial biopsy for aiding the diagnosis of peripheral lung cancer

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Iwano, Shingo, E-mail: iwano45@med.nagoya-u.ac.jp [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan); Imaizumi, Kazuyoshi [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Okada, Tohru [Research Center for Charged Particle Therapy, National Institute of Radiological Science, 4-9-1 Anagawa, Inage-ku, Chiba 2638555 (Japan); Hasegawa, Yoshinori [Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550 (Japan); Naganawa, Shinji [Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Shouwa-ku, Nagoya 4668550, Aichi (Japan)

2011-07-15

Objective: The aim of this study was to evaluate the clinical value of virtual bronchoscopy (VB) in aiding diagnosis of peripheral lung cancer by transbronchial biopsy (TBB). In addition, we sought to systematically analyze the factors that affect the diagnostic sensitivity of VB-guided TBB for the evaluation of peripheral lung cancers. Materials and methods: A hundred and twenty-two peripheral lung cancers from 122 patients (82 men and 40 women, 38-84 years; median 68.5 years) who were performed VB-guided TBB were evaluated retrospectively. VB was reconstructed from 1- or 0.5-mm slice thickness images of multi-detector CT (MDCT). Experienced pulmonologists inserted the conventional and ultrathin bronchoscopes into the target bronchus under direct vision following the VB image. Results: A definitive diagnosis was established by VB-guided TBB in 96 lesions (79%). The diagnostic sensitivity of small pulmonary lesions {<=}30 mm in maximal diameter (71%) was significantly lower than that of lesions >30 mm (91%, p = 0.008). For small pulmonary lesions {<=}30 mm (n = 76), internal opacity of the lesion was the independent predictor of diagnostic sensitivity by VB-guided TBB, and the non-solid type lung cancers were significantly lower than the solid type and part-solid type lung cancers for diagnostic sensitivity (odds ratio = 0.161; 95% confidence interval = 0.033-0.780; p = 0.023). Conclusion: Use of an ultrathin bronchoscope and simulation with VB reconstructed by high quality MDCT images is thought to improve pathological diagnosis of peripheral lung cancers, especially for solid and partly solid types. For small pulmonary lesions {<=}30 mm, the lesion internal opacity is a significant factor for predicting the diagnostic sensitivity, and the sensitivity was low for small non-solid type of lung cancers.

Discomfort during bronchoscopy performed after endobronchial intubation with fentanyl and midazolam: a prospective study.

Science.gov (United States)

Minami, Daisuke; Takigawa, Nagio; Kano, Hirohisa; Ninomiya, Takashi; Kubo, Toshio; Ichihara, Eiki; Ohashi, Kadoaki; Sato, Akiko; Hotta, Katsuyuki; Tabata, Masahiro; Tanimoto, Mitsune; Kiura, Katsuyuki

2017-05-01

Although endobronchial intubation during a bronchoscopic examination is useful for invasive procedures, it is not routine practice in Japan. The present study evaluated discomfort due to endobronchial intubation using fentanyl and midazolam sedation during bronchoscopy. Thirty-nine patients were enrolled prospectively from November 2014 to September 2015 at Okayama University Hospital. Fentanyl (20 µg) was administered to the patients just before endobronchial intubation, and fentanyl (10 µg) and midazolam (1 mg) were added as needed during the procedure. A questionnaire survey was administered 2 h after the examination. In the questionnaire, patient satisfaction was scored using a visual analog scale as follows: excellent (1 point), good (2 points), normal (3 points), uncomfortable (4 points) and very uncomfortable (5 points). An additional question ('Do you remember the bronchoscopic examination?') was also asked. Predefined parameters (blood pressure, heart rate, oxygen saturation and complications) were recorded. The enrolled patients included 22 males and 17 females; their median age was 70 (range: 28-88) years. The patients received a mean dose of 47.9 µg of fentanyl (range: 30-90 µg) and 2.79 mg of midazolam (range: 1-7 mg). In total, 28 patients (71.7%) agreed to undergo a second bronchoscopic examination; the mean levels of discomfort and for the re-examination were 2.07 points each. About 41% of the patients remembered the bronchoscopic examination. No severe complications were reported. Endobronchial intubation using fentanyl and midazolam sedation during an invasive bronchoscopic procedure might be recommended. UMIN000015578 in the UMIN Clinical Trials Registry. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease.

Science.gov (United States)

Noppen, Marc; Poppe, Kris; D'Haese, Jan; Meysman, Marc; Velkeniers, Brigitte; Vincken, Walter

2004-02-01

Surgery is the treatment of choice for symptomatic tracheal obstruction due to benign or malignant thyroid disease. In case of inoperability, or when surgery is refused, few therapeutic alternatives are available. Interventional bronchoscopic procedures have only been reported anecdotally. The objective of this study is to evaluate the results of interventional bronchoscopic procedures in the treatment of severe tracheal obstruction due to thyroid disease. Retrospective cohort analysis. University hospital, tertiary referral center. Thirty consecutive patients referred for bronchoscopic treatment of benign (n = 17) or malignant (n = 13) thyroid-related upper airway obstruction due to tracheomalacia, extrinsic compression, and/or tracheal ingrowth. Indications for bronchoscopic treatment were medical or surgical inoperability, prevention or treatment of tracheomalacia, and refusal of surgery. There were no procedure-related complications. Rigid bronchoscopy with dilatation, stenting and/or Nd-YAG laser treatment, and clinical follow-up. Subjective improvement, pulmonary function tests, early and late complications, and survival. In the benign group, immediate (100% relief of dyspnea) and long-term (88% relief of dyspnea) results were excellent after airway stenting (21 stents used in 17 patients). There was one unrelated death 1 week after stenting in a 98-year-old patient. There were 6% and 30% short-term and long-term complications, respectively, that could be managed endoscopically. In the malignant group, Nd-YAG laser treatment (n = 3) and stenting (n = 13) yielded immediate and long-term success in 92% of patients. There were 15% short-term and 8% long-term complications. Median survival time was 540 days. Interventional bronchoscopic procedures including Nd-YAG laser treatment and stenting are valuable alternatives to surgery in inoperable thyroid-induced tracheal obstruction, or when surgery is refused.

Therapeutic bronchoscopy in a child with sand aspiration and respiratory failure from near drowning--case report and literature review.

Science.gov (United States)

Kapur, N; Slater, A; McEniery, J; Greer, M L; Masters, I B; Chang, A B

2009-10-01

Foreign matter aspiration occurs relatively commonly in drowning and near-drowning events. In most cases, stomach contents are aspirated. Sand aspiration rarely occurs and there are no reported cases in children with near drowning. Limited data are available on clinical presentation and management of sand aspiration with accidental burial. We report a 3-year-old boy who nearly drowned while swimming in brackish waters and was found face down in sand. Sand aspiration was suspected when the child continued to have persistent wheezing and high ventilatory requirement despite intensive bronchodilator and corticosteroids therapy with an inability to wean after 4 days post-near-drowning event. Radiology was non-specific in the absence of sand bronchogram. Presence of sand in the airways was confirmed when a bronchoscopy was undertaken and sand seen in the bronchoalveolar lavage fluid. Sequential lung washing followed by exogenous surfactant administration (3 ml/kg) was undertaken and lead to significant improvement such that within 12 hr post-therapeutic lavage, his ventilatory requirements reduced substantially. The child was extubated 4 days post-lavage and on review 2 months post-event, was clinically well with airway resistance within normal predicted values measured on forced oscillatory spirometry (IOS).

Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study.

Science.gov (United States)

Bhatt, Kavita M; Tandon, Yasmeen K; Graham, Ruffin; Lau, Charles T; Lempel, Jason K; Azok, Joseph T; Mazzone, Peter J; Schneider, Erika; Obuchowski, Nancy A; Bolen, Michael A

2018-03-01

Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P guided sampling (P guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.

Defining a Ventilation Strategy for Flexible Bronchoscopy on Mechanically Ventilated Patients in the Medical Intensive Care Unit.

Science.gov (United States)

Greenstein, Yonatan Y; Shakespeare, Eric; Doelken, Peter; Mayo, Paul H

2017-07-01

Flexible bronchoscopy (FB) in intubated patients on mechanical ventilation increases airway resistance. During FB, two ventilatory strategies are possible: maintaining tidal volume (VT) while maintaining baseline CO2 or allowing reduction of VT. The former strategy carries risk of hyperinflation due to expiratory flow limitation with FB. The aim of the authors was too study end expiratory lung volume (EELV) during FB of intubated subjects while limiting VT. We studied 16 subjects who were intubated on mechanical ventilation and required FB. Changes in EELV were measured by respiratory inductance plethysmography. Ventilator mechanics, EELV, and arterial blood gases, were measured. FB insertions decreased EELV in 64% of cases (-325±371 mL) and increased it in 32% of cases (65±59 mL). Suctioning decreased EELV in 76% of cases (-120±104 mL) and increased it in 16% of cases (29±33 mL). Respiratory mechanics were unchanged. Pre-FB and post-FB, PaO2 decreased by 61±96 mm Hg and PaCO2 increased by 15±7 mm Hg. There was no clinically significant increase in EELV in any subject during FB. Decreases in EELV coincided with FB-suctioning maneuvers. Peak pressure limiting ventilation protected the subject against hyperinflation with a consequent, well-tolerated reduction in VT, and hypercapnea. Suctioning should be limited, especially in patients vulnerable to derecruitment effect.

Blinded evaluation of interrater reliability of an operative competency assessment tool for direct laryngoscopy and rigid bronchoscopy.

Science.gov (United States)

Ishman, Stacey L; Benke, James R; Johnson, Kaalan Erik; Zur, Karen B; Jacobs, Ian N; Thorne, Marc C; Brown, David J; Lin, Sandra Y; Bhatti, Nasir; Deutsch, Ellen S

2012-10-01

OBJECTIVES To confirm interrater reliability using blinded evaluation of a skills-assessment instrument to assess the surgical performance of resident and fellow trainees performing pediatric direct laryngoscopy and rigid bronchoscopy in simulated models. DESIGN Prospective, paired, blinded observational validation study. SUBJECTS Paired observers from multiple institutions simultaneously evaluated residents and fellows who were performing surgery in an animal laboratory or using high-fidelity manikins. The evaluators had no previous affiliation with the residents and fellows and did not know their year of training. INTERVENTIONS One- and 2-page versions of an objective structured assessment of technical skills (OSATS) assessment instrument composed of global and a task-specific surgical items were used to evaluate surgical performance. RESULTS Fifty-two evaluations were completed by 17 attending evaluators. The instrument agreement for the 2-page assessment was 71.4% when measured as a binary variable (ie, competent vs not competent) (κ = 0.38; P = .08). Evaluation as a continuous variable revealed a 42.9% percentage agreement (κ = 0.18; P = .14). The intraclass correlation was 0.53, considered substantial/good interrater reliability (69% reliable). For the 1-page instrument, agreement was 77.4% when measured as a binary variable (κ = 0.53, P = .0015). Agreement when evaluated as a continuous measure was 71.0% (κ = 0.54, P formative feedback on operational competency.

Concentrations of moxifloxacin in serum and pulmonary compartments following a single 400 mg oral dose in patients undergoing fibre-optic bronchoscopy.

Science.gov (United States)

Soman, A; Honeybourne, D; Andrews, J; Jevons, G; Wise, R

1999-12-01

The concentrations of moxifloxacin achieved after a single 400 mg dose were measured in serum, epithelial lining fluid (ELF), alveolar macrophages (AM) and bronchial mucosa (BM). Concentrations were determined using a microbiological assay. Nineteen patients undergoing fibre-optic bronchoscopy were studied. Mean serum, ELF, AM and BM concentrations at 2.2, 12 and 24 h were as follows: 2.2 h: 3.2 mg/L, 20.7 mg/L, 56.7 mg/L, 5.4 mg/kg; 12 h: 1.1 mg/L, 5.9 mg/L, 54.1 mg/L, 2.0 mg/kg; 24 h: 0.5 mg/L, 3.6 mg/L, 35.9 mg/L, 1.1 mg/kg, respectively. These concentrations exceed the MIC(90)s for common respiratory pathogens such as Streptococcus pneumoniae (0.25 mg/L), Haemophilus influenzae (0.03 mg/L), Moraxella catarrhalis (0.12 mg/L), Chlamydia pneumoniae (0.12 mg/L) and Mycoplasma pneumoniae (0. 12 mg/L) and indicate that moxifloxacin should be effective in the treatment of community-acquired, lower respiratory tract infections.

Feasibility of bispectral index-guided propofol infusion for flexible bronchoscopy sedation: a randomized controlled trial.

Directory of Open Access Journals (Sweden)

Yu-Lun Lo

Full Text Available There are safety issues associated with propofol use for flexible bronchoscopy (FB. The bispectral index (BIS correlates well with the level of consciousness. The aim of this study was to show that BIS-guided propofol infusion is safe and may provide better sedation, benefiting the patients and bronchoscopists.After administering alfentanil bolus, 500 patients were randomized to either propofol infusion titrated to a BIS level of 65-75 (study group or incremental midazolam bolus based on clinical judgment to achieve moderate sedation. The primary endpoint was safety, while the secondary endpoints were recovery time, patient tolerance, and cooperation.The proportion of patients with hypoxemia or hypotensive events were not different in the 2 groups (study vs. control groups: 39.9% vs. 35.7%, p = 0.340; 7.4% vs. 4.4%, p = 0.159, respectively. The mean lowest blood pressure was lower in the study group. Logistic regression revealed male gender, higher American Society of Anesthesiologists physical status, and electrocautery were associated with hypoxemia, whereas lower propofol dose for induction was associated with hypotension in the study group. The study group had better global tolerance (p<0.001, less procedural interference by movement or cough (13.6% vs. 36.1%, p<0.001; 30.0% vs. 44.2%, p = 0.001, respectively, and shorter time to orientation and ambulation (11.7±10.2 min vs. 29.7±26.8 min, p<0.001; 30.0±18.2 min vs. 55.7±40.6 min, p<0.001, respectively compared to the control group.BIS-guided propofol infusion combined with alfentanil for FB sedation provides excellent patient tolerance, with fast recovery and less procedure interference.ClinicalTrials. gov NCT00789815.

The utility of the fiberoptic bronchoscopy in the esophageal cancer; Utilidad de la fibrobroncoscopia en el cancer de esofago

Energy Technology Data Exchange (ETDEWEB)

Reyes O, Leonardo; Garcia-Herreros, Plutarco; Rivas P, Pilar; Posso, Hector; L, Sandoval Rafael

1998-04-01

The paper establishes the utility of the fiber- optic bronchoscopy (FOB) studies performed in patients with esophageal cancer (EC) and confirm the possibility of tracheo-bronchial compromise. We carry out a descriptive study in 226 patients with esophageal cancer during 1991 to 1996 in the Instituto Nacional de Cancerologia of Colombia (INC). We excluded the patients with previous treatments: radiotherapy or surgery, and others primary cancers with metastases on the esophagus. We analyzed gastric, intestinal and general symptoms, smoking habits, primary cancer location, histological types, radiologic findings, fob findings, micro and macroscopes, and results of the samples: transbronchial, endobronchial biopsies, bronchi alveolar lavage and brush. We included 158 patients, 110 male and 48 female, with age between 32 and 83 years, symptoms duration average of 5,2 months. The most significant were cough, dysphonia and sputum. The location of EC was statistics significance only in the upper third escamocelular type. The significant radiological findings were: parenchymal nodules and interstitial infiltrates, the significant fob findings were: fistula endobronchial infiltration endobronchial mass and vocal cords palsy. The zones with more compromise were trachea, principal bronchi and vocal cords. Only 17 patients were positives in the samples; comparing the histopathologic findings (biopsies) as the gold standard with fob findings the sensitivity was 100%, specificity 35%, positive predictive value 15.6% and negative predictive value 100%.

Concentrations of levofloxacin (HR 355) in the respiratory tract following a single oral dose in patients undergoing fibre-optic bronchoscopy.

Science.gov (United States)

Andrews, J M; Honeybourne, D; Jevons, G; Brenwald, N P; Cunningham, B; Wise, R

1997-10-01

Concentrations of levofloxacin were measured in bronchial biopsies, alveolar macrophages (AM), epithelial lining fluid (ELF) and serum following a single oral dose. Concentrations were measured by a microbiological assay method. A total of 35 patients undergoing fibre-optic bronchoscopy were studied. Mean serum, AM, ELF and biopsy concentrations were as follows. 0.5 h: 4.73 mg/L, 19.1 mg/L, 4.74 mg/L and 4.3 mg/kg; 1 h: 6.6 mg/L, 32.5 mg/L, 10.8 mg/L and 8.3 mg/kg; 2 h: 4.9 mg/L, 41.9 mg/L, 9.0 mg/L and 6.5 mg/kg; 4 h: 4.1 mg/L, 27.7 mg/L, 10.9 mg/L and 6.0 mg/kg; and 6-8 h: 4.0 mg/L, 38.4 mg/L, 9.6 mg/L and 4.0 mg/kg respectively. Mean serum and AM concentrations at 12-24 h were 1.2 and 13.9 mg/L respectively (concentrations in biopsy and ELF were only measurable in three of the six patients). These concentrations exceed the MIC90s of the common respiratory pathogens, Haemophilus influenzae (0.015 mg/L), Moraxella catarrhalis (0.06 mg/L) and Streptococcus pneumoniae (1 mg/L) and suggest that levofloxacin should be efficacious in the treatment of community- and hospital-acquired respiratory infection.

Cramers Court Nursing Home, Belgooly, Cork.

LENUS (Irish Health Repository)

Marathe, N

2016-02-01

The study illustrates advantages of Fiberoptic Bronchoscopy, a new service started at St. Luke’s General Hospital in patient care since April 2014. Retrospective review of Bronchoscopies and referrals to Tertiary care unit for Bronchoscopy, prior and after initiation of service at St. Luke’s Hospital were studied. In total, 106 procedures were performed out of which 103(98%) were for diagnostic purpose. Common indications for bronchoscopy were functional airway assessment in 38 cases (35%) of chronic cough, 26 cases (24.8%) of suspected malignancy. The average time taken for procedure was 15 + 1 minute with overall rate of complication recorded in 1 case (0.95%). 32(30%) inpatients were referred before bronchoscopy services were started locally. Fifteen (14%) patients were referred for Endobronchial Ultrasound (EBUS) after diagnostic procedure performed at St. Luke’s Hospital. To conclude, Bronchoscopy is a safe procedure used for diagnosis of various Lung conditions. The services offered locally reduced the time and cost involved in referrals. The diagnostic bronchoscopies performed for malignancy at St. Luke’s Hospital have rightly increased references for EBUS at Tertiary care Unit

Airway segmentation and centerline extraction from thoracic CT : Comparison of a new method to state of the art commercialized methods

NARCIS (Netherlands)

Reynisson, P.J.; Scali, M.; Smistad, E.; Hofstad, E.F.; Leira, H.O.; Lindseth, F.; Nagelhus Hernes, T.A.; Amundsen, T.; Sorger, H.; Lango, T.

2015-01-01

Our motivation is increased bronchoscopic diagnostic yield and optimized preparation, for navigated bronchoscopy. In navigated bronchoscopy, virtual 3D airway visualization is often used to guide a bronchoscopic tool to peripheral lesions, synchronized with the real time video bronchoscopy.

Virtual reality simulation of basic pulmonary procedures

DEFF Research Database (Denmark)

Konge, Lars; Arendrup, Henrik; von Buchwald, Christian

2011-01-01

Background: Virtual reality (VR) bronchoscopy simulators have been available for more than a decade, and have been recognized as an important aid in bronchoscopy training. The existing literature has only examined the role of VR simulators in diagnostic bronchoscopy. The aim of this study...

Fluoroscence bronhoscopy

Directory of Open Access Journals (Sweden)

Tomić Ilija

2003-01-01

Full Text Available Background. Fluorescence bronchoscopy is one of the methods of the early detection of lung cancer that involves the large airways. The method is based on the detection of the altered autofluorescence of malignantly transformed tissue, and confirmed by biopsy and histopathologic examination. Method. Fluorescence bronchoscopy was performed in 18 patients, mean age of 51.2 years (male n=12, female n=6 due to the suspected lung cancer. Fluorescence bronchoscopy was performed using the Xillix LIFE-Lung System Vancouver, Canada. After conventional white-light bronchoscopy, the tracheobronchial tree was illuminated by blue light (442 nm using helium-cadmium laser, and the results of autofluorescence were classified into three classes. Normal mucosa was of green fluorescence (Class I abnormal mucosa was red or dark brown fluorescence (Class II and II, which was the indication for performing biopsy. Results. Normal endoscopy findings were established in 15 patients by conventional bronchoscopy. In the same group, by fluorescence bronchoscopy, Class I of fluorescence (normal finding was found in 9 patients, while Class II changes occured in 6 patients. Histopathologic analysis of bronchial mucosa with Class II changes was performed detecting planocellular carcinoma in situ in one patient. Tumor-like changes were detected in 3 patients by conventional bronchoscopy and were determined as Class III changes by fluorescence bronchoscopy. By the biopsy of these chages carcinoma was documented in 2 patients while in one patient metaplasia of epithelium and granulation tissue around aspirated foreign body was detected. Conclusion. Fluorescence bronchoscopy is one of the methods for detecting metaplasia, carcinoma in situ and cancerous changes of bronchial epithelium in the large airways. However, the high rate of falsely positive findings represents a limitation of this method.

[Argon plasma coagulation combined with cryotherapy via bronchoscopy for the treatment of one child with severe post-intubation tracheal stenosis and literature review].

Science.gov (United States)

Zhou, Kuo; Liang, Jun; Cui, Ai-hua; Fu, Ai-xia; Yang, Qiao-zhi

2013-10-01

To observe the short term effect of argon plasma coagulation (APC) combined with cryotherapy via bronchoscopy for treatment of severe post-intubation tracheal stenosis in a child. A 3-year old boy was admitted for cephalothorax abdominal compound trauma and dyspnea, who had severe post-incubation tracheal stenosis. The agreement about the operation risk was signed by the parents. Endotracheal APC procedure was performed with a bronchoscope under general anesthesia. The APC probe was put into the working channel of the bronchoscope. The stenotic lesion was endoscopically visualized and then coagulated by argon plasma. Such coagulation was carried out several times at the stenotic site until it gradually became dilated. The devitalized tissue was mechanically removed with grasping forceps. Thereafter, bronchoscopic cryosurgery was repeatedly performed at the stenotic site. Clinical symptoms, signs and bronchoscopic manifestations were observed right after operation, after 1 day, 10 days, 1 month and 6 months separately. Tracheal tissue hyperplasia and cyanosis disappeared, laryngeal stridor and dyspnea improved obviously right after the operation. General condition of the patient was well, there was no laryngeal stridor and dyspnea 10 days after operation. The mucosa of the surgical site was smooth and no tracheostenosis was seen under bronchoscope at 1 month and 6 months after the operation. Argon plasma coagulation combined with cryotherapy via bronchoscope is an effective method to treat tracheal stenosis of children, which needs further exploration for the application.

A prospective study to evaluate the utility of bronchoalveolar lavage by fiberoptic bronchoscopy in sputum smear negative patients with high suspicion of pulmonary tuberculosis

Directory of Open Access Journals (Sweden)

Ritesh Kamal

2012-01-01

Full Text Available Aim: To evaluate the utility of bronchoalveolar lavage (BAL by flexible fiberoptic bronchoscopy (FOB in sputum smear negative patients with clinical and radiological characteristics of pulmonary tuberculosis (PTB. Materials and Methods: This prospective study was carried out in 30 sputum smear negative patients of age group 20 to 70 years, who were highly suspicious for PTB by clinical and radiographic criteria. All patients were subjected to sputum culture, BAL stains and cultures, and cytopathology. Patients with moderate to massive pleural effusion, obvious accessible lymph node, history of antitubercular therapy (ATT, and contraindication to FOB were excluded. Results: Sputum culture for acid fast bacilli (AFB was positive in four (12% patients, BAL fluid was positive for Ziehl-Neelsen (ZN stain in nine (27% patients, including four sputum culture patients, while BAL culture for AFB on Lowenstein-Jensen (LJ medium was positive in 18 (60%, including 9 BAL fluid ZN stain positive patients. Six (20% patients had growth on pyogenic culture, while two (7% patients had malignant cell on cytological examination of BAL fluid. Remaining four (13% patients were empirically started on ATT. They had complete response to ATT at 2 months and were retrospectively diagnosed with pulmonary tuberculosis (PTB. All the bacteriologically confirmed PTB patients were given ATT for 6 months and all patients had complete response. Conclusion: We concluded that FOB guided BAL is extremely useful for establishing diagnosis of PTB or other pulmonary diseases in sputum smear negative patients, who have high suspicion for PTB by clinical and radiographic criteria.

Bronchoscopic guidance of endovascular stenting limits airway compression.

Science.gov (United States)

Ebrahim, Mohammad; Hagood, James; Moore, John; El-Said, Howaida

2015-04-01

Bronchial compression as a result of pulmonary artery and aortic arch stenting may cause significant respiratory distress. We set out to limit airway narrowing by endovascular stenting, by using simultaneous flexible bronchoscopy and graduated balloon stent dilatation, or balloon angioplasty to determine maximum safe stent diameter. Between August 2010 and August 2013, patients with suspected airway compression by adjacent vascular structures, underwent CT or a 3D rotational angiogram to evaluate the relationship between the airway and the blood vessels. If these studies showed close proximity of the stenosed vessel and the airway, simultaneous bronchoscopy and graduated stent re-dilation or graduated balloon angioplasty were performed. Five simultaneous bronchoscopy and interventional catheterization procedures were performed in four patients. Median age/weight was 33 (range 9-49) months and 14 (range 7.6-24) kg, respectively. Three had hypoplastic left heart syndrome, and one had coarctation of the aorta (CoA). All had confirmed or suspected left main stem bronchial compression. In three procedures, serial balloon dilatation of a previously placed stent in the CoA was performed and bronchoscopy was used to determine the safest largest diameter. In the other two procedures, balloon testing with simultaneous bronchoscopy was performed to determine the stent size that would limit compression of the adjacent airway. In all cases, simultaneous bronchoscopy allowed selection of an ideal caliber of the stent that optimized vessel diameter while minimizing compression of the adjacent airway. In cases at risk for airway compromise, flexible bronchoscopy is a useful tool to guide endovascular stenting. Maximum safe stent diameter can be determined without risking catastrophic airway compression. © 2014 Wiley Periodicals, Inc.

Congestive cardiomyopathy and endobronchial granulomas as manifestations of Churg-Strauss syndrome.

Science.gov (United States)

Alvarez-Sala, R.; Prados, C.; Armada, E.; Del Arco, A.; Villamor, J.

1995-01-01

Churg-Strauss syndrome is a systemic vasculitis. Its most frequent complications are heart diseases and asthma. Usually, cardiological manifestations are pericarditis, cardiac failure and myocardial infarction. Endobronchial granulomas identified by bronchoscopy are unusual. We present the case of a man with congestive cardiomyopathy and endobronchial granulomas macroscopically visible at bronchoscopy. After a review of medical literature, we found one case of congestive cardiomyopathy and no cases of endobronchial granulomas observed by bronchoscopy associated with Churg-Strauss syndrome. Images Figure PMID:7644400

Tracheal rupture

Science.gov (United States)

... that may be done include: Neck CT scan Chest x-ray Bronchoscopy ... People who have had a trauma will need to have their injuries ... who have breathed a foreign body into the airways, bronchoscopy ...

AFB (Acid-Fast Bacillus) Smear and Culture

Science.gov (United States)

... of Conditions Not Listed? Not Listed? Acidosis and Alkalosis Adrenal Insufficiency and Addison Disease Alcoholism Allergies Alzheimer ... to produce sputum, a health practitioner may collect respiratory samples using a procedure called a bronchoscopy. Bronchoscopy ...

Posterior pharyngeal candidiasis in the absence of clinically overt oral involvement: a cross-sectional study.

Science.gov (United States)

Glavey, Siobhan V; Keane, Niamh; Power, Maria; O'Regan, Anthony W

2013-12-01

Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy. We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy. Median age was 54.7 (27-84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage. This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at

Variations of cytology, IL-8 and TNF-α of bronchoalveolar lavaage fluid after fiberoptic bronchoscopy in the patients with severe traumatic brain injury

International Nuclear Information System (INIS)

Zhu Weibing; Chu Chengchun; Zhang Yongjun; Gao Xiang; Liu Yajun; Tang Yanfen

2007-01-01

Objective: To investigate variations of cytology, IL-8 and TNF-α of bronchoalveolar lavage fluid (BALF) after fiberoptic bronchoscopy (FOB) in patients with severe traumatic brain injury. Methods: Sixty-eight patients with severe traumatic brain injury were divided into two groups: the FOB group and the control group. variations of cytology in BALF were observed by microscope, and the levels of IL-8 and TNF-α were analyzed by radioimmunoassay (RIA). Results: Compared with the control group, the counts of cells of BALF were significantly lower at the 7th and 9th day after treatment in the FOB group (P<0.01, respectively); the percentage of polymorphonuclear neutrophils (PMN) were significantly lower at the 5th, 7th, 9th day in the FOB group (P<0.01, respectively); the level of IL-8 was significantly lower at the 5th, 7th, 9th day in the FOB group (P<0.01, respectively); the level of TNF-α was significantly lower at the 5th , 7th, 9th day in the FOB group (P<0.01, respectively). Moreover, the level of IL-8 was positively correlated with the count of cells and the percentage of PMN of BALF (r=0.979, 0.982, P<0.01, respectively), and the level of TNF-α was also positively correlated with the count of cells and the percentage of PMN of BALF(r=0.953, 0.949, P<0.01, respectively). Conclusion: FOB could play an important role in ameliorating the inflammation of airway in the patients with severe traumatic brain injury, moreover, the level of IL-8 and TNF-α could reflect the status of inflammation of airway. (authors)

Virtual reality simulation of basic pulmonary procedures

DEFF Research Database (Denmark)

Konge, Lars; Arendrup, Henrik; von Buchwald, Christian

2011-01-01

Background: Virtual reality (VR) bronchoscopy simulators have been available for more than a decade, and have been recognized as an important aid in bronchoscopy training. The existing literature has only examined the role of VR simulators in diagnostic bronchoscopy. The aim of this study......, the physicians answered a questionnaire regarding the realism of the simulator. Results: The realism of the anatomy and the appearance of the scope were rated higher than the movement of the scope, feeling of resistance, and performances of bronchoalveolar lavages and biopsies. Overall, the simulator was judged...

Uventet fund af endobronkial lungetumor ved bronkoskopi hos en storryger

DEFF Research Database (Denmark)

Gottlieb, Magnus; Clementsen, Paul Frost; Håkansson, Kåre

2014-01-01

A 60-year-old male heavy smoker surprisingly presented with a squamous cell carcinoma in the right upper lobe at bronchoscopy. Combined PET-CT classified the lung cancer as T1aN0M0. However, the endoscopic classification was T2a, which radically reversed the treatment schedule. Conclusions: 1......) A careful bronchoscopy is important even in cases where lung cancer is not expected. 2) Accurate endobronchial classification can be crucial. 3) There is need for training requirements to obtain a satisfactory level of competence in bronchoscopy....

Uventet fund af endobronkial lungetumor ved bronkoskopi hos en storryger

DEFF Research Database (Denmark)

Gottlieb, Magnus; Clementsen, Paul Frost; Håkansson, Kåre

2014-01-01

A 60-year-old male heavy smoker surprisingly presented with a squamous cell carcinoma in the right upper lobe at bronchoscopy. Combined PET-CT classified the lung cancer as T1aN0M0. However, the endoscopic classification was T2a, which radically reversed the treatment schedule. Conclusions: 1) A ......) A careful bronchoscopy is important even in cases where lung cancer is not expected. 2) Accurate endobronchial classification can be crucial. 3) There is need for training requirements to obtain a satisfactory level of competence in bronchoscopy....

Bronchoscopic resection of a tracheobronchial leiomyoma in a pregnant patient.

Science.gov (United States)

Falce, K; Guy, E; Hyman, D; Hotze, T; Lazarus, D; Bandi, V; Parchem, J; Davidson, C; Munnur, U

2018-04-10

Flexible bronchoscopy, therapeutic bronchoscopy and other procedures requiring anesthesia are generally avoided in pregnancy and postponed until after delivery if possible. We report a case of a parturient with an abnormal chest radiograph and mild obstructive symptoms of unknown etiology. At bronchoscopy, a tumor associated with post-obstructive suppuration was found and excised using electrocautery snare and cryotherapy, for restoration of airway patency. Coordination between pulmonary, obstetric, anesthesia, neonatology and thoracic surgery services was essential in ensuring success and the safety of the mother and fetus. Copyright © 2018 Elsevier Ltd. All rights reserved.

The potential regimen of target-controlled infusion of propofol in flexible bronchoscopy sedation: a randomized controlled trial.

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Ting-Yu Lin

Full Text Available Target-controlled infusion (TCI provides precise pharmacokinetic control of propofol concentration in the effect-site (Ce, eg. brain. This pilot study aims to evaluate the feasibility and optimal TCI regimen for flexible bronchoscopy (FB sedation.After alfentanil bolus, initial induction Ce of propofol was targeted at 2 μg/ml. Patients were randomized into three titration groups (i.e., by 0.5, 0.2 and 0.1 μg/ml, respectively to maintain stable sedation levels and vital signs. Adverse events, frequency of adjustments, drug doses, and induction and recovery times were recorded.The study was closed early due to significantly severe hypoxemia events (oxyhemoglobin saturation <70% in the group titrated at 0.5 μg/ml. Forty-nine, 49 and 46 patients were enrolled into the 3 respective groups before study closure. The proportion of patients with hypoxemia events differed significantly between groups (67.3 vs. 46.9 vs. 41.3%, p = 0.027. Hypotension events, induction and recovery time and propofol doses were not different. The Ce of induction differed significantly between groups (2.4±0.5 vs. 2.1±0.4 vs. 2.1±0.3 μg/ml, p = 0.005 and the Ce of procedures was higher at 0.5 μg/ml titration (2.4±0.5 vs. 2.1±0.4 vs. 2.2±0.3 μg/ml, p = 0.006. The adjustment frequency tended to be higher for titration at 0.1 μg/ml but was not statistically significant (2 (0∼6 vs. 3 (0∼6 vs. 3 (0∼11. Subgroup analysis revealed 14% of all patients required no further adjustment during the whole sedation. Comparing patients requiring at least one adjustment with those who did not, they were observed to have a shorter induction time (87.6±34.9 vs. 226.9±147.9 sec, p<0.001, a smaller induction dose and Ce (32.5±4.1 vs. 56.8±22.7 mg, p<0.001; 1.76±0.17 vs. 2.28 ±0.41, p<0.001, respectively, and less hypoxemia and hypotension (15.8 vs.56.9%, p = 0.001; 0 vs. 24.1%, p = 0.008, respectively.Titration at 0.5 μg/ml is risky for FB sedation. A

Spirometer-controlled Cine-Magnetic Resonance Imaging for Diagnosis of Tracheobronchomalacia in Pediatric Patients

NARCIS (Netherlands)

Ciet, P.; Wielopolski, P.; Manniesing, R.; Lever, S.; Bruijne, M. de; Morana, G.; Muzzio, P.C.; Lequin, M.H.; Tiddens, H.A.W.M.

2014-01-01

Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard to diagnose TBM, but bronchoscopy has major disadvantages, such as general anaesthesia. Cine-CT is a non-invasive alternative to diagnose TBM, but its use in children is

Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

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Yu Zhang

2013-06-01

Full Text Available Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods: The clinical features of 2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results: The ratio of male/female was 4.8:1 and the peak onset age was 60 - 69 years old. The major pathological type was squamous cell carcinoma (44.5%, then adenocarcinoma (25.9% and small cell lung cancer (18.3%. The incidence of squamous cell carcinoma was the highest in males (50.6%, while that of adenocarcinoma in females (56.2%. The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can significantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

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African Journals Online (AJOL)

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2017-07-01

Jul 1, 2017 ... respondents identified the lack of formal training in the art of bronchoscopy as the foremost challenge facing its ... bronchoscopic training programme is imperative to enhance the trainees' proficiency for the furtherance of ..... A. Evaluation of virtual reality bronchoscopy as a learning and assessment tool.

Missed Distal Tracheal Foreign Body in Consecutive ...

African Journals Online (AJOL)

2017-05-18

May 18, 2017 ... Since invention, bronchoscopy has become the gold standard in the diagnosis and extraction of airway FB.[4]. Foreign bodies may be missed at ... Since the discovery by Gustav Killian,[9] extraction of tracheobronchial FB has been accomplished with rigid bronchoscopy which is still considered as the gold.

Management of dogs and cats with endotracheal tube tracheal foreign bodies

Science.gov (United States)

Nutt, Laura K.; Webb, Jinelle A.; Prosser, Kirsten J.; Defarges, Alice

2014-01-01

Two cats and 3 dogs were treated for an endotracheal tube tracheal foreign body (ETFB) during recovery from general anesthesia. Bronchoscopy was used to remove the ETFB. Animals were clinically normal at discharge. While rare, ETFB can occur upon recovery from anesthesia. Bronchoscopy is an effective way to remove ETFB. PMID:24891640

Bronchoscopic management of a rare benign endobronchial tumor

Directory of Open Access Journals (Sweden)

K. Madan

2012-09-01

Full Text Available Benign endobronchial tumors are uncommon. Bronchoscopic removal is the preferred modality of treatment although surgery may be required in some cases. Rigid bronchoscopy is usually recommended in the management of these tumors. However, flexible bronchoscopy is also used in many centers. We present a case of endobronchial lipoma, where an unusual complication during flexible bronchoscopic resection using snare forceps necessitated urgent rigid bronchoscopy. This case highlights the importance of rigid bronchoscopy in the management of endobronchial tumors. We believe that with a large benign endobronchial tumor in tracheal or main-stem bronchus, physicians should initially employ rigid bronchoscopy, switching to flexible if more peripheral treatment is required. Resumo: Os tumores endobrônquicos benignos são raros. A remoção broncoscópica é a modalidade de tratamento preferida, embora a cirurgia possa ser necessária em alguns casos. A broncoscopia rígida é geralmente considerada a modalidade preferencial na abordagem destes tumores. No entanto, a broncoscopia flexível também é utilizada em muitos centros. Apresentamos um caso de lipoma endobrônquico, onde uma complicação invulgar durante a ressecção broncoscópica flexível utilizando pinças de laço necessitou de uma urgente broncoscopia rígida. Neste caso, destaca-se a importância da broncoscopia rígida na abordagem dos tumores endobrônquicos. Acreditamos que com um tumor endobrônquico benigno de grandes dimensões da traqueia ou do brônquio principal, os médicos devem inicialmente utilizar a broncoscopia rígida, alternando para a flexível, se for necessário um tratamento mais periférico. Keywords: Bronchoscopy, Lipoma, Endobronchial tumor, Electrocautery, Interventional pulmonology, Palavras-chave: Broncoscopia, Lipoma, Tumor endobrônquico, Electrocautério, Pneumologia interventiva

A Study to Determine the Best Method of Caring for Certain Short-Stay Surgical Patients at Reynolds Army Community Hospital

Science.gov (United States)

1988-09-01

herniorrhaphy Umbilical sinus, excision Venectomy Ventral hernia GYNECOLOGIC Adhesions of clitoris, release Cervical polypectomy Condylomata acuminata...window Arch bars, removal and placement Branchial arch appendages, excision Bronchoscopy (Rigid) Caldwell-Luc operation Cervical node biopsy Closed...Breast mass, excision Bronchoscopy with operative procedure Cervical node biopsy Debridement of wound, infection, or burn Debridement of chest wall

Fatal invasive aspergillosis: a rare co-infection with an unexpected image presentation in a patient with dengue shock syndrome.

Science.gov (United States)

Wang, Hui-Ching; Chang, Ko; Lu, Po-Liang; Tsai, Kun-Bow; Chen, Huang-Chi

2017-03-01

Pulmonary infiltration and pleural effusion caused by permeability syndrome are the hallmark of pulmonary manifestation of dengue cases. We report a 95-year-old chronic obstructive pulmonary disease case having dengue shock syndrome. Chest X-ray examination revealed diffuse lung infiltration. However, bilateral pneumotoceles were unexpectedly found in computed tomography (CT) images. Dengue virus type 2 infection was confirmed by virus culture, serology and reverse transcriptase-polymerase chain reaction. Profound shock with bilateral lung infiltration developed rapidly in 2 days with supportive care and empirical ampicillin/ sulbactam. Bronchoscopy revealed a whitish plaque over bilateral upper bronchi. Biopsy via bronchoscopy revealed moulds with vascular invasion. Culture of bronchial alveolar lavage yielded Aspergillus flavus. The patient died despite amphotericin B treatment, which was started since finding the whitish plaque with bronchoscopy examination. Besides to considering capillary leakage syndrome, our case report and literature review alert clinicians that CT and bronchoscopy may help to identify the true pathogen though all cases with concurrent dengue and Aspergillus infections had fatal outcomes. © 2015 John Wiley & Sons Ltd.

Utility of 67Ga scintigraphy and bronchial washings in the diagnosis and treatment of Pneumocystis carinii pneumonia in patients with the acquired immune deficiency syndrome

International Nuclear Information System (INIS)

Tuazon, C.U.; Delaney, M.D.; Simon, G.L.; Witorsch, P.; Varma, V.M.

1985-01-01

Twenty patients with the acquired immune deficiency syndrome (AIDS) and suspected Pneumocystis carinii pneumonia were evaluated by 67 Ga scintigraphy and fiberoptic bronchoscopy for initial diagnosis and response to therapy. Lung uptake of 67 Ga was demonstrated in 100% of AIDS patients with P. carinii pneumonia, including those with subclinical infection. Fiberoptic bronchoscopy identified P. carinii in the bronchial washings of 100% of cases (19 patients), whereas only 13 of 16 (81%) patients had P. carinii in lung tissue obtained by transbronchial biopsy. Repeat fiberoptic bronchoscopy was performed in 16 of 20 patients. After 2 to 4 wk of therapy, P. carinii was identified in bronchial washings in 8 of 16 (50%) patients and in transbronchial biopsy in 1 of 10 (10%) patients examined. Bronchial washing has a higher yield than transbronchial biopsy in demonstrating P. carinii in patients with AIDS and may evolve as the procedure of choice in such patients. Based on the clinical course and results of 67 Ga scintigraphy and fiberoptic bronchoscopy in AIDS patients with P. carinii pneumonia, optimal therapy may require at least 3 wk of treatment

Airway exploration in children

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Fernando GÓMEZ-SÁEZ

2018-03-01

Full Text Available Introduction and objective: The management of the airways represents a constant challenge in pediatric practice. In the last years, bronchoscopy has become an essential technique in the diagnosis and treatment of various abnormalities of the child's respiratory system. The special characteristics of the pediatric airway and the differentiated pathology it presents give pediatric bronchoscopy its own entity. Pediatric bronchoscopy is a safe technique with many applications, both diagnostic and therapeutic. The use of both types of bronchoscopes (flexible and rigid allows to take advantage of each one of them. Flexible bronchoscopy in pediatrics is a relatively simple and low-risk procedure that provides anatomical and dynamic information on the airways, as well as cytological and microbiological studies. The simplicity and low risk of this technique, in addition to not requiring general anesthesia, allows it to be performed even at the head of the patient, which has led to an increasingly extensive field of indications. The purpose of this article is to provide a review on the timeliness of the pediatric bronchoscopy procedure, especially about its indications. Method: Narrative review. Conclusion: The endoscopic examination of the airway is a cost-effective technique in pediatrics, with little complications and can offer very valuable diagnostic information, as well as perform certain therapeutic procedures. It is recommended that all professionals involved in the management of patients with airway pathology should know their indications, contraindications, complications, as well as their therapeutic applications.

Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.

LENUS (Irish Health Repository)

Martin-Smith, James D

2009-01-01

BACKGROUND: The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. CASE PRESENTATION: A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula CONCLUSIONS: This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report

LENUS (Irish Health Repository)

Martin-Smith, James D

2009-12-24

Abstract Background The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. Case presentation A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula Conclusions This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

SU-C-BRA-07: Virtual Bronchoscopy-Guided IMRT Planning for Mapping and Avoiding Radiation Injury to the Airway Tree in Lung SAbR

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Sawant, A; Modiri, A; Bland, R; Yan, Y; Ahn, C; Timmerman, R [University of Texas SouthWestern Medical Center, Dallas, TX (United States)

2015-06-15

Purpose: Post-treatment radiation injury to central and peripheral airways is a potentially important, yet under-investigated determinant of toxicity in lung stereotactic ablative radiotherapy (SAbR). We integrate virtual bronchoscopy technology into the radiotherapy planning process to spatially map and quantify the radiosensitivity of bronchial segments, and propose novel IMRT planning that limits airway dose through non-isotropic intermediate- and low-dose spillage. Methods: Pre- and ∼8.5 months post-SAbR diagnostic-quality CT scans were retrospectively collected from six NSCLC patients (50–60Gy in 3–5 fractions). From each scan, ∼5 branching levels of the bronchial tree were segmented using LungPoint, a virtual bronchoscopic navigation system. The pre-SAbR CT and the segmented bronchial tree were imported into the Eclipse treatment planning system and deformably registered to the planning CT. The five-fraction equivalent dose from the clinically-delivered plan was calculated for each segment using the Universal Survival Curve model. The pre- and post-SAbR CTs were used to evaluate radiation-induced segmental collapse. Two of six patients exhibited significant segmental collapse with associated atelectasis and fibrosis, and were re-planned using IMRT. Results: Multivariate stepwise logistic regression over six patients (81 segments) showed that D0.01cc (minimum point dose within the 0.01cc receiving highest dose) was a significant independent factor associated with collapse (odds-ratio=1.17, p=0.010). The D0.01cc threshold for collapse was 57Gy, above which, collapse rate was 45%. In the two patients exhibiting segmental collapse, 22 out of 32 segments showed D0.01cc >57Gy. IMRT re-planning reduced D0.01cc below 57Gy in 15 of the 22 segments (68%) while simultaneously achieving the original clinical plan objectives for PTV coverage and OAR-sparing. Conclusion: Our results indicate that the administration of lung SAbR can Result in significant injury to

Foreign body in children?s airways

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Cassol Vitor

2003-01-01

Full Text Available OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. METHOD: Time series of children who underwent bronchoscopies for foreign bodies aspirated into the airway between March 1993 and July 2002. Each patient was analyzed for age, sex, initial clinical diagnosis, nature and location of the foreign body, duration of symptoms between aspiration and bronchoscopy, radiological findings, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Thirty-four children, 20 (59% boys, ages ranging from nine months to nine years (median = 23 months. In 32 (94% children the foreign body was removed by rigid bronchoscope, and two resulted in thoracotomy. Foreign bodies were more frequent in children under three years of age (66%. A clinical history of foreign body inhalation was obtained in 27 (80% cases. Most of the foreign bodies removed were organic (65% and more frequently found in the right bronchial tree (59%. Foreign bodies were removed within 24 hours in 18 (53% cases. The most frequent radiographic findings were: unilateral air trapping, atelectasis and radiopac foreign body. Major bronchoscopy complications occurred in seven children (22%, and there were no deaths. CONCLUSIONS: More attention is necessary to the respiratory symptoms of aspirations, mainly in boys at early ages, with clinical history and compatible radiological findings. Most foreign bodies removed were of organic nature. In this case series, therapeutic rigid bronchoscopy was effective with few complications.

Alveolar cell carcinoma: diagnostic pitfalls in evaluating the chest roentgenogram

International Nuclear Information System (INIS)

Shin, M.S.; Bailey, W.C.

1985-01-01

A report is given of two patients with initial symptoms of congestive heart failure who had an extensive work-up that failed to reveal any signs of pulmonary malignancy. Subsequent biopsy by fiberoptic bronchoscopy confirmed alveolar cell carcinoma in both cases, suggesting that bronchoscopy with biopsy should be considered in patients with congestive heart failure if pulmonary edema does not resolve with appropriate therapy. 11 references, 2 figures

Review of adult tracheomalacia and its relationship with chronic obstructive pulmonary disease.

Science.gov (United States)

Kandaswamy, Chitra; Balasubramanian, Vijay

2009-03-01

This review summarizes the literature on adult or acquired tracheobronchomalacia (TBM) and explores its association with chronic obstructive pulmonary disease (COPD). Dynamic imaging of central airways, a noninvasive test as effective as bronchoscopy to diagnose TBM, has increased the recognition of this disorder. Airway stabilization techniques using stents placed via bronchoscopy have also furthered the interest in TBM. The association of TBM with COPD is of growing interest particularly in the face of worldwide rise in COPD incidence. The pathobiology behind this condition may share significant common ground with COPD. Despite the lack of uniformly accepted diagnostic criteria and the uncertain correlation to clinical manifestations and course, technologic advances in imaging and interventional bronchoscopy have spurred clinicians' interest in TBM. In exploring the association of TBM and COPD, an intriguing consideration is whether TBM could be an extension of peripheral airway disease.

Diagnostic Value of Multidetector CT and Its Multiplanar Reformation, Volume Rendering and Virtual Bronchoscopy Postprocessing Techniques for Primary Trachea and Main Bronchus Tumors.

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Mingyue Luo

Full Text Available To evaluate the diagnostic value of multidetector CT (MDCT and its multiplanar reformation (MPR, volume rendering (VR and virtual bronchoscopy (VB postprocessing techniques for primary trachea and main bronchus tumors.Detection results of 31 primary trachea and main bronchus tumors with MDCT and its MPR, VR and VB postprocessing techniques, were analyzed retrospectively with regard to tumor locations, tumor morphologies, extramural invasions of tumors, longitudinal involvements of tumors, morphologies and extents of luminal stenoses, distances between main bronchus tumors and trachea carinae, and internal features of tumors. The detection results were compared with that of surgery and pathology.Detection results with MDCT and its MPR, VR and VB were consistent with that of surgery and pathology, included tumor locations (tracheae, n = 19; right main bronchi, n = 6; left main bronchi, n = 6, tumor morphologies (endoluminal nodes with narrow bases, n = 2; endoluminal nodes with wide bases, n = 13; both intraluminal and extraluminal masses, n = 16, extramural invasions of tumors (brokethrough only serous membrane, n = 1; 4.0 mm-56.0 mm, n = 14; no clear border with right atelectasis, n = 1, longitudinal involvements of tumors (3.0 mm, n = 1; 5.0 mm-68.0 mm, n = 29; whole right main bronchus wall and trachea carina, n = 1, morphologies of luminal stenoses (irregular, n = 26; circular, n = 3; eccentric, n = 1; conical, n = 1 and extents (mild, n = 5; moderate, n = 7; severe, n = 19, distances between main bronchus tumors and trachea carinae (16.0 mm, n = 1; invaded trachea carina, n = 1; >20.0 mm, n = 10, and internal features of tumors (fairly homogeneous densities with rather obvious enhancements, n = 26; homogeneous density with obvious enhancement, n = 1; homogeneous density without obvious enhancement, n = 1; not enough homogeneous density with obvious enhancement, n = 1; punctate calcification with obvious enhancement, n = 1; low density

Diagnostic Value of Multidetector CT and Its Multiplanar Reformation, Volume Rendering and Virtual Bronchoscopy Postprocessing Techniques for Primary Trachea and Main Bronchus Tumors.

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Luo, Mingyue; Duan, Chaijie; Qiu, Jianping; Li, Wenru; Zhu, Dongyun; Cai, Wenli

2015-01-01

To evaluate the diagnostic value of multidetector CT (MDCT) and its multiplanar reformation (MPR), volume rendering (VR) and virtual bronchoscopy (VB) postprocessing techniques for primary trachea and main bronchus tumors. Detection results of 31 primary trachea and main bronchus tumors with MDCT and its MPR, VR and VB postprocessing techniques, were analyzed retrospectively with regard to tumor locations, tumor morphologies, extramural invasions of tumors, longitudinal involvements of tumors, morphologies and extents of luminal stenoses, distances between main bronchus tumors and trachea carinae, and internal features of tumors. The detection results were compared with that of surgery and pathology. Detection results with MDCT and its MPR, VR and VB were consistent with that of surgery and pathology, included tumor locations (tracheae, n = 19; right main bronchi, n = 6; left main bronchi, n = 6), tumor morphologies (endoluminal nodes with narrow bases, n = 2; endoluminal nodes with wide bases, n = 13; both intraluminal and extraluminal masses, n = 16), extramural invasions of tumors (brokethrough only serous membrane, n = 1; 4.0 mm-56.0 mm, n = 14; no clear border with right atelectasis, n = 1), longitudinal involvements of tumors (3.0 mm, n = 1; 5.0 mm-68.0 mm, n = 29; whole right main bronchus wall and trachea carina, n = 1), morphologies of luminal stenoses (irregular, n = 26; circular, n = 3; eccentric, n = 1; conical, n = 1) and extents (mild, n = 5; moderate, n = 7; severe, n = 19), distances between main bronchus tumors and trachea carinae (16.0 mm, n = 1; invaded trachea carina, n = 1; >20.0 mm, n = 10), and internal features of tumors (fairly homogeneous densities with rather obvious enhancements, n = 26; homogeneous density with obvious enhancement, n = 1; homogeneous density without obvious enhancement, n = 1; not enough homogeneous density with obvious enhancement, n = 1; punctate calcification with obvious enhancement, n = 1; low density without

Bronchoscopic management of patients with symptomatic airway stenosis and prognostic factors for survival.

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Okiror, Lawrence; Jiang, Li; Oswald, Nicola; Bille, Andrea; Rajesh, Pala; Bishay, Ehab; Steyn, Richard; Naidu, Babu; Kalkat, Maninder

2015-05-01

Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival. This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method. Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death. Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Management of benign stenoses of the large airways in the university hospital in Prague, Czech Republic, in 1998-2003.

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Marel, Miloslav; Pekarek, Zdenek; Spasova, Irena; Pafko, Pavel; Schutzner, Jan; Betka, Jan; Pospisil, Ronald

2005-01-01

Clinically significant benign stenoses of the large airways develop in about 1% of patients after intubation. The management of benign stenoses is not unified around the world, nor are there any accepted methods for their screening. The purpose of this study is to describe and compare results of interventional bronchoscopy and surgical therapy of benign stenoses as well as to propose an algorithm for the management of this airways disorder. Prospective study on 80 consecutive patients with benign stenoses of the large airways admitted to the Pulmonary Department of the University Hospital of Prague-Motol. Sixty-two patients developed stenoses after endotracheal intubation or tracheostomy, in 18 patients the stenosis was caused by other diseases or pathological situations. Thirty-eight patients were sent for surgical resection of the stenotic part of the airways. 2 surgically treated patients developed recurrence of the stenosis and had to be reoperated on. Narrowing of the trachea at the site of end-to-end anastomosis developed in 6 other patients and was cured by interventional bronchoscopy. The remaining 42 patients were treated by interventional bronchoscopy (Nd-YAG laser, electrocautery, stent) which was curative in 35 patients. Sixty-five patients were alive at the time of evaluation, 15 patients died. Five of them died between 3 and 14 (median 4) months after surgery from a disease other than airway stenosis. Ten nonresected patients also died, with 1 exception, due to a disease other than airway stenosis; the median survival was 9 months. We recommend to assess the patient for surgery after the initial diagnosis and therapeutic bronchoscopy with dilatation of the stenosis. If the patient is not a suitable candidate for resection, interventional bronchoscopy is an appropriate alternative for the management of benign stenoses of the large airways. Copyright (c) 2005 S. Karger AG, Basel.

Complications of long-standing foreign body in the airway and their outcomes after endoscopic management: an experience of 20 cases.

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Aggarwal, Satish Kumar; Sinha, Shandip Kumar; Ratan, Simmi K; Dhua, Anjan; Sethi, Gulshan Rai

2015-01-01

To study the outcomes after endoscopic treatment of chronic foreign bodies (FBs) in the airway. A retrospective study (2008-2013) of 20 cases with chronic airway FBs (>2 weeks) was done with emphasis on endoscopic management. All cases were initially evaluated by the pediatric pulmonologist. Flexible and rigid bronchoscopy was done for diagnosis and retrieval, respectively. The techniques of FB retrieval, problems encountered, and their solutions were analyzed. Follow-up flexible bronchoscopy was done in symptomatic cases. Outcomes were assessed in terms of successful removal of the FB, clinical recovery, lung expansion, and need for further procedures. Twenty cases (16 boys, 4 girls) with a mean age of 7 years had a chronic airway FB diagnosed on chest X-ray (n=6) and flexible bronchoscopy (n=14). Six cases had computed tomography evaluation. On rigid bronchoscopy, the FB was successfully retrieved in 16 cases. Two cases required open surgery for FB-induced tracheoesophageal fistula. One case required pneumonectomy because of a battery eroding into the lung parenchyma. One patient died. Of the 16 who had successful retrieval, 11 recovered with full lung expansion. Four recovered after additional bronchoscopic procedures (cauterization of granulation [n=2] and balloon dilatation of bronchial stenoses [n=2]). One case required pneumonectomy for persistent collapse despite multiple dilatations. An airway FB producing chronic respiratory symptoms may be missed because of lack of definite history of an inhaled FB. Clinical suspicion and flexible bronchoscopy are instrumental in diagnosis. Treatment is challenging because of chronicity-related complications and requires innovative ideas to make best use of the available urologic and bronchoscopic equipment. Addition of tracheotomy provides safety in difficult cases. Bronchoscopic removal leads to clinical and radiological recovery in most cases.

Spirometer-controlled cine magnetic resonance imaging used to diagnose tracheobronchomalacia in paediatric patients.

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Ciet, Pierluigi; Wielopolski, Piotr; Manniesing, Rashindra; Lever, Sandra; de Bruijne, Marleen; Morana, Giovanni; Muzzio, Pier Carlo; Lequin, Maarten H; Tiddens, Harm A W M

2014-01-01

Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard for diagnosing TBM; however it has major disadvantages, such as general anaesthesia. Cine computed tomography (CT) is a noninvasive alternative used to diagnose TBM, but its use in children is restricted by ionising radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine magnetic resonance imaging (MRI) as an alternative to cine-CT in a retrospective study. 12 children with a mean age (range) of 12 years (7-17 years), suspected of having TBM, underwent cine-MRI. Static scans were acquired at end-inspiration and expiration covering the thorax using a three-dimensional spoiled gradient echo sequence. Three-dimensional dynamic scans were performed covering only the central airways. TBM was defined as a decrease of the trachea or bronchi diameter >50% at end-expiration in the static and dynamic scans. The success rate of the cine-MRI protocol was 92%. Cine-MRI was compared with bronchoscopy or chest CT in seven subjects. TBM was diagnosed by cine-MRI in seven (58%) out of 12 children and was confirmed by bronchoscopy or CT. In four patients, cine-MRI demonstrated tracheal narrowing that was not present in the static scans. Spirometer controlled cine-MRI is a promising technique to assess TBM in children and has the potential to replace bronchoscopy.

Indicações da Broncofibroscopia em Unidade de Cuidados Intensivos

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Ema Sacadura Leite

1997-05-01

Full Text Available RESUMO: A deterioração respiratória é um problema comum em U.C.I., para a qual a broncofibroscopia constitui um método auxiliar diagnóstico e terapêutico importante. Trata-se contudo de um método invasivo, pelo que é importante avaliar as vantagens da sua utilização. Este trabalho de revisão pretende estudar algumas das situações correntes em U.C. I. onde a broncofibroscopia poderá ser útil. SUMMARY: Respiratory failure is a common problem in I.C.U., for which fiberoptic bronchoscopy is an important auxiliar diagnostic and therapeutic method. This is however an agressive method, so it is important to assess the advantage of its use. The purpose of this work is to study various current problems in I.C.U. where fiberoptic bronchoscopy may be useful. Palavras-chave: Unidade de Cuidados Intensivos, Broncofibroscopia, Key-words: Intensive Care Unit, Fiberoptic bronchoscopy

Association between follicular tracheitis and gastroesophageal reflux.

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Duval, Melanie; Meier, Jeremy; Asfour, Fadi; Jackson, Daniel; Grimmer, J Fredrik; Muntz, Harlan R; Park, Albert H

2016-03-01

Follicular tracheitis (also known as tracheal cobblestoning) is an entity that is poorly described and of unclear significance. The objective of this study was to better define follicular tracheitis and determine the association between the clinical finding of follicular tracheitis on bronchoscopy and objective evidence of gastroesophageal reflux disease. Retrospective chart review of children with recurrent croup having undergone a rigid bronchoscopy and an investigation for gastroesophageal reflux between 2001 and 2013. 117 children with recurrent croup children age 6-144 months were included in the study. Follicular tracheitis was noted on 41% of all bronchoscopies. Fifty-nine percent of all children who underwent bronchoscopy were diagnosed with gastroesophageal reflux on at least one investigation. Forty-nine of 117 children underwent a pH probe study, and 51% were found to have evidence of reflux on this study. Nine children were diagnosed with eosinophilic esophagitis. Three patients underwent a biopsy of the follicular tracheitis lesions, which revealed chronic inflammation. There was no evidence of an association between findings of follicular tracheitis and a positive test for gastroesophageal reflux (p=0.52) or a positive pH probe study (p=0.64). There was no association between follicular tracheitis and subglottic stenosis (p=0.33) or an history of asthma and/or atopy (p=0.19). In children with recurrent croup, follicular tracheitis remains an unspecific finding associated with an inflammatory disorder of unknown etiology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Turban pin aspiration: new fashion, new syndrome.

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Ilan, Ophir; Eliashar, Ron; Hirshoren, Nir; Hamdan, Kasem; Gross, Menachem

2012-04-01

Turban pin aspiration syndrome is a new clinical entity afflicting young Islamic girls wearing a turban.The goal of this study was to present our experience in diagnosis and treatment of this new entity, define its clinical and epidemiologic features, and shed a new light on the role of fashion in the increased incidence. A retrospective study in a tertiary university hospital. Review of clinical parameters and epidemiologic features of 26 patients diagnosed with turban pin aspiration syndrome admitted to the Hadassah-Hebrew University Hospitals in Jerusalem from 1990 to 2010. All patients were Muslim females with an average age of 16 years. In all cases, the history was positive for accidental aspiration. Most of the pins were located in the trachea (42%). In 20 cases, the pins were extracted by rigid bronchoscopy without major complications. Fluoroscopy-assisted rigid bronchoscopy was used successfully in three cases. In one case, the object was self-ejected by coughing before the bronchoscopy, and two patients were referred to the chest unit for thoracotomy. Clinicians should be aware of this distinct form of foreign body aspiration, its method of diagnosis, and extraction techniques. A cultural investigation showed a difference in the turban-fastening technique of young girls as compared with their mothers. Removal by rigid bronchoscopy is a safe method with a high success rate and should be considered as the preferred extraction method of choice. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Tracheobronchial foreign bodies in children: importance of accurate history and plain chest radiography in delayed presentation

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Tokar, B. E-mail: btokar@ogu.edu.trbarantokar@hotmail.com; Ozkan, R.; Ilhan, H

2004-07-01

AIM: To evaluate the factors associated with delayed diagnosis of foreign body aspiration (FBA) in children and to compare clinical, radiological and bronchoscopic findings in the patients with suspected FBA. MATERIAL AND METHODS: The medical records of 214 children who underwent bronchoscopy for suspected FBA were reviewed. The data were analysed in three groups: the patients with negative bronchoscopy for FBA (group I), early (group II) and delayed diagnosis (group III). RESULTS: The majority of the patients with FBA were between 1 and 3 years of age. Choking episodes, coughing and decreased breath sounds were determined in a significantly higher number of the patients with FBA. The plain chest radiography revealed radio-opaque foreign bodies (FBs) in 19.7% of all patients with FBA. Emphysema was more common in children with FBA. Clinical and radiological findings of pneumonia and atelectasis were significantly more common in the groups with negative bronchoscopy and with delayed diagnosis (p<0.01). The FBs were most frequently of vegetable origin, such as seeds and peanuts. A significant tissue reaction with inflammation was more common in the delayed cases. CONCLUSION: To prevent delayed diagnosis, characteristic symptoms, signs and radiological findings of FBA should be checked in all suspected cases. As clinical and radiological findings of FBA in delayed cases may mimic other disorders, the clinician must be aware of the likelihood of FBA. Regardless of radiological findings, bronchoscopy should be considered in patients with an appropriate history.

Does cytomegalovirus predict a poor prognosis in Pneumocystis carinii pneumonia treated with corticosteroids? A note for caution

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Jensen, A M; Lundgren, Jens Dilling; Benfield, T

1995-01-01

treated with adjunctive CS who had CMV cultured from BAL fluid had a two times higher mortality within 3 months from bronchoscopy than others (p = 0.08). This difference could not be explained by differences in CD4 count, PO2 or PCO2 at time of bronchoscopy. CONCLUSION: With the accepted usage...... of adjunctive CS in severe PCP, the role of CMV as a pulmonary copathogen may have changed. Active CMV infection may be an important cause of failing treatment of severe PCP in those treated with adjunctive CS....

Foreign Body Aspiration in Pregnancy

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Andrew L. Atkinson

2012-01-01

Full Text Available A 24-year-old morbidly obese African American gravida 1, with a history of severe asthma complicated by multiple inpatient admissions, presents at 30 weeks gestation with a foreign body in her left main stem bronchus. After a failed bronchoscopy postpartum, the patient slipped into respiratory failure and was subsequently intubated, spending two weeks in the intensive care unit. After two more attempts of trying to retrieve the foreign object from her lung via bronchoscopy, she eventually contracted a postobstructive pneumonia and underwent a left lower lung lobectomy for curative treatment.

Spirometer-controlled cine magnetic resonance imaging to diagnose tracheobronchomalacia in pediatric patients

DEFF Research Database (Denmark)

Ciet, Pierluigi; Wielopolski, Piotr; Manniesing, Rashindra

2014-01-01

is restricted by ionizing radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine-MRI as alternative to cine-CT in a retrospective study.12 children (mean 12 years, range 7-17), suspected to have TBM, underwent cine-MRI. Static scans were acquired at end-inspiration and expiration......Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard to diagnose TBM, but bronchoscopy has major disadvantages, such as general anaesthesia. Cine-CT is a non-invasive alternative to diagnose TBM, but its use in children...

Medical image of the week: granulation tissue

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Ganesh A

2014-03-01

Full Text Available A 57 year old woman presented with a tickling sensation in the back of throat and intermittent bleeding from the healing stoma one month after decannulation of her tracheostomy tube. On bronchoscopy a granuloma with surrounding granulation tissue was present in the subglottic space (Figure 1. Argon plasma coagulation (APC was performed to cauterize the granulation tissue (Figure 2. Formation of granulation tissue after tracheostomy is a common complication which can result in tracheal stenosis. APC and electrocautery using flexible bronchoscopy has been shown to safely and effectively remove the granulation tissue.

Hybrid 3D visualization of the chest and virtual endoscopy of the tracheobronchial system: possibilities and limitations of clinical application.

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Seemann, M D; Claussen, C D

2001-06-01

A hybrid rendering method which combines a color-coded surface rendering method and a volume rendering method is described, which enables virtual endoscopic examinations using different representation models. 14 patients with malignancies of the lung and mediastinum (n=11) and lung transplantation (n=3) underwent thin-section spiral computed tomography. The tracheobronchial system and anatomical and pathological features of the chest were segmented using an interactive threshold interval volume-growing segmentation algorithm and visualized with a color-coded surface rendering method. The structures of interest were then superimposed on a volume rendering of the other thoracic structures. For the virtual endoscopy of the tracheobronchial system, a shaded-surface model without color coding, a transparent color-coded shaded-surface model and a triangle-surface model were tested and compared. The hybrid rendering technique exploit the advantages of both rendering methods, provides an excellent overview of the tracheobronchial system and allows a clear depiction of the complex spatial relationships of anatomical and pathological features. Virtual bronchoscopy with a transparent color-coded shaded-surface model allows both a simultaneous visualization of an airway, an airway lesion and mediastinal structures and a quantitative assessment of the spatial relationship between these structures, thus improving confidence in the diagnosis of endotracheal and endobronchial diseases. Hybrid rendering and virtual endoscopy obviate the need for time consuming detailed analysis and presentation of axial source images. Virtual bronchoscopy with a transparent color-coded shaded-surface model offers a practical alternative to fiberoptic bronchoscopy and is particularly promising for patients in whom fiberoptic bronchoscopy is not feasible, contraindicated or refused. Furthermore, it can be used as a complementary procedure to fiberoptic bronchoscopy in evaluating airway stenosis and

The characteristics of patients with pulmonary Mycobacterium avium-intracellulare complex disease diagnosed by bronchial lavage culture compared to those diagnosed by sputum culture.

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Maekawa, Koichi; Naka, Megumi; Shuto, Saki; Harada, Yuka; Ikegami, Yumiko

2017-09-01

The utility of bronchoscopy for the diagnosis of pulmonary Mycobacterium avium-intracellulare complex (MAC) disease has been reported; however, which patients require bronchoscopy remains unclear. Our objective was to identify the characteristics of the patients in whom bronchoscopy is needed for the diagnosis of MAC disease. Fifty-four patients with pulmonary MAC disease were divided into two groups according to established diagnostic criteria: 39 patients were diagnosed by sputum culture and 15 patients were diagnosed by bronchial lavage culture. We analysed the differences in demographic and clinical characteristics as well as microbiological and radiological data between the two groups. There were no significant differences in age, sex, smoking status, MAC species, underlying diseases, or steroid use. Significantly more patients diagnosed by sputum culture than bronchial lavage culture had a positive sputum smear for acid-fast bacilli (79.5% vs. 0.0%, respectively; p disease, bronchiectasis, and cavities. However, more patients diagnosed by sputum culture than bronchial lavage culture had abnormalities in the left upper division (48.7% vs. 13.3%, respectively; p = 0.017) and higher numbers of affected lobes (4.3 ± 1.4 vs. 3.3 ± 1.6, respectively; p = 0.034). If patients suspected of having pulmonary MAC disease have a negative sputum smear, no symptoms, no abnormal findings in the left upper division, or fewer affected lobes on computed tomography, bronchoscopy might be needed for the diagnosis. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Endobronchial metastasis: CT findings and its usefulness in bronchoscopic correlation

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Ko, Ji Ho; Jung, Gyoo Sik; Kim, Seong Min; Huh Jin Do; Joh, Young Duk; Jang, Tae Weon

2000-01-01

To evaluate the CT findings of bronchial abnormalities in patients with endobronchial metastasis from extrapulmonary tumors, and to correlate these with the bronchoscopic findings. The authors retrospectively reviewed the CT and bronchoscopic findings of 17 patients (M:F =3D 9:8; mean age, 56 years) with histologically proven endobronchial metastasis from extrapulmonary primary tumors. Carcinoma of the uterine cervix (n=3D5) was the most common primary site for endobronchial metastasis. CT findings of bronchial abnormalities with associated peribronchial and lung parenchymal lesions were analyzed and compared with the bronchoscopic findings. Among the 17 patients, 20 sites of bronchial abnormalities were visualized bronchoscopically. CT findings of bronchial abnormalities were smooth narrowing (n=3D11), occlusion (n=3D3), intraluminal mass (n=3D4), and normal (n=3D2). Peribronchial lesions (lymph node enlargement or parenchymal mass) were found in 12 cases. Bronchoscopy revealed bronchial narrowing due to a mucosal nodule or intraluminal polypoid mass in 16 cases, and total obstruction of the bronchus in four. With regard to the identification of bronchial abnormalities, the findings of CT and of bronchoscopy agreed in 17 cases and disagreed in three. While bronchoscopy was advantageous for detecting early mucosal abnormality, CT effectively evaluated the extent of a lesion beyond the stenosis or bronchial obstruction. CT was also useful for predicting the causes of bronchial abnormalities. CT is relatively accurate in evaluating bronchial abnormalities, and in patients with endobronchial metastases may be used as a complementary procedure to bronchoscopy for evaluating the extent of the lesion. (author)

An audit of morbidity and mortality associated with foreign body aspiration in children from a tertiary level hospital in Northern India

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Aparna Williams

2014-01-01

Full Text Available Background: There is paucity of data regarding the morbidity and mortality of rigid bronchoscopy in children for foreign body (FB retrieval from India. The aim was to audit data regarding anaesthetic management of rigid bronchoscopy in children and associated morbidity and mortality. Materials and Methods: Hospital records of all patients below 18 years of age undergoing rigid bronchoscopy for suspected FB aspiration (FBA between January 1, 2002 and December 31, 2011 were audited to assess their demographic profile, anaesthetic management, complications, and postoperative outcomes. The children were divided into early and late diagnosis groups depending on whether they presented to the hospital within 24 hours of FBA, or later. Results: One hundred and forty children, predominantly male (75%, with an average age of 1-year and 8 months, presented to our hospital for rigid bronchoscopy during the study period. Majority of children presented in the late diagnosis group (59.29% vs. 40.71%. The penetration syndrome was observed in 22% of patients. Majority of patients aspirated an organic FB (organic: Inorganic FB = 3:1, with peanuts being the most common (49.28%. A significantly higher number of children presented with cough (P = 0.0001 and history of choking (P = 0.0022 in the early diagnosis group and crepitations (P = 0.0011 in the late diagnosis group. Major complications included cardiac arrest (2.1%, pneumothorax (0.7%, and laryngeal oedema (9.3%. The average duration of hospitalization in our series was 3.08 ± 0.7 days. Conclusions: Foreign body aspiration causes considerable morbidity, especially when diagnosis is delayed.

Pulmonary carcinoma. Diagnosis and bronchoscopy treatment

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Caballero Duran, Hugo

1998-01-01

The paper makes reference to the pulmonary carcinoma in USA, it relates the detection resources like the x-ray, tomography and magnetic resonance, laser, Brachytherapy, fluorescence, cryotherapy between other techniques and topics

Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

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Elif Tanrıverdi

2016-01-01

Full Text Available Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC, and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important.

Bronchoalveolar lavage in patients with interstitial lung diseases: side effects and factors affecting fluid recovery.

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Dhillon, D P; Haslam, P L; Townsend, P J; Primett, Z; Collins, J V; Turner-Warwick, M

1986-05-01

One hundred and seventy patients with interstitial lung diseases undergoing bronchoalveolar lavage (BAL), were contrasted with 51 patients undergoing fibreoptic bronchoscopy alone to define the factors which predispose to post-lavage side-effects. Transient post-bronchoscopy fall in the peak expired flow (PEF) greater than or equal to 20% occurred in both groups (24% and 23% respectively), and thus was probably related to the bronchoscopy procedure. Post-lavage pyrexia (greater than or equal to 1 degree C) occurred only in the patients undergoing BAL (26%), p less than 0.001. Only 4% with pyrexia required antibiotics, and only 2% with falls in PEF needed bronchodilator therapy. The only significant clinical association was more frequent pyrexia in patients on treatment with prednisolone, particularly in women (p less than 0.01). Pyrexia was also associated with higher lavage fluid introduction volumes (greater than 240 ml). Side effects did not relate to the percentages of lavage fluid recovered, although smokers had lower recoveries and, recoveries tended to be higher in sarcoidosis than cryptogenic fibrosing alveolitis. Serial lavages in 25 patients caused no significant increase in side effects.

Cushing's like syndrome in typical bronchial carcinoid a case report and review of the literature.

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Pedicelli, Ilaria; Patriciello, Giuseppina; Scala, Giovanni; Sorrentino, Antonietta; Gravino, Gennaro; Patriciello, Pasquale; Zeppa, Pio; Di Crescenzo, Vincenzo; Vatrella, Alessandro

2016-01-01

Cushing's syndrome occurred in 1-5% of cases of bronchial carcinoids. In this paper we describe a case of typical bronchial carcinoid in a nonsmoker young male with clinical manifestations mimicking a Cushing's syndrome. The patient performed chest radiograph and computed tomography. Fiberoptic bronchoscopy revealed the presence of an endobronchial mass occluding the bronchus intermedius. A rigid bronchoscopy was necessary for the conclusive diagnosis and for partial resection of the intraluminal tumor. Despite of the presence of Cushingoid features, the normal blood levels of ACTH and cortisol excluded the coexistence of a Cushing's syndrome. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Tracheomalacia.

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Kugler, Christian; Stanzel, Franz

2014-02-01

Tracheomalacia is excessive collapsibility of the trachea, typically during expiration. Congenital forms are associated with severe symptoms. Milder forms often present after the neonatal period. Adult malacia is mostly associated with chronic obstructive pulmonary disease. Functional bronchoscopy is still not standardized. Dynamic airway CT is a promising tool for noninvasive diagnosis. Bronchoscopy and stent insertion lead to significant improvement, but with a high complication rate. Surgical lateropexia, tracheal resection, and surgical external stabilization are options. Tracheoplasty seems to be the best choice for selected cases of adult malacia. The most commonly performed surgery in children is aortopexy. Copyright © 2014 Elsevier Inc. All rights reserved.

A Case of Pulmonary Foreign Body Reviewed as Mass

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Sayed Javad Sayedi

2016-08-01

Full Text Available Foreign Body Aspiration (FBA is a common and sometimes life-threatening problem in children and in higher age groups. FBA highest incidence rate is during the second year in children and the sixth decade of life in adults, and often foreign bodies due to their shape and size pass through larynx and trachea and place in bronchi. The most common aspirated body by children are nuts. Symptoms of aspiration can be asphyxia, cough, or cyanosis. Although in some cases patients may have no symptoms, an accurate and positive history even without clinical signs must be suspected doctor to a foreign body aspiration. However, in some cases, radiological intervention is normal and helps to diagnose and should be performed in all suspected cases to FBA. FBA definite diagnosis is by bronchoscopy, and to prevent complications and possibly death, timely removing of foreign body is vital and necessary. Most of the complications of delayed diagnosis and treatment and early detection are associated with few complications. FBA potential complications include pneumomediastinum, pneumothorax, atelectasis, bronchiectasis, lung abscess, and recurrent pneumonia. Most of these complications are irreversible in people with problems diagnosed too late. Technological advances and clinical application of bronchoscopy have caused the majority of foreign bodies are removed from the respiratory system are without sequela. The removal of foreign body through undergone rigid bronchoscopy is the preferred method of treatment, but in certain cases may require surgical intervention to remove the foreign body. This report is a case of 17-month-old infant with fever, coryza, and cough symptoms with a diagnosis of pneumonia was hospitalized due to suspected pulmonary mass by chest x-ray or chest CT scan and bronchoscopy was performed and the seed was removed from the right lung.

Fractura brônquica: Tratamento broncoscópico com colocação de prótese e broncoplastia com balão

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Daniela Ferreira

2008-05-01

Full Text Available Resumo: A fractura brônquica é uma lesão rara, de mortalidade elevada, e geralmente secundária a traumatismos torácicos fechados. O seu diagnóstico exige alto índice de suspeição, na medida em que as manifestações são variáveis e não específicas. A broncoscopia desempenha um papel primordial no diagnóstico e, em casos seleccionados, no tratamento das fracturas brônquicas.Os autores apresentam o caso clínico de um doente politraumatizado com um traumatismo torácico grave após um acidente de trabalho. A broncoscopia revelou fractura extensa do brônquio principal esquerdo, tendo sido realizado tratamento conservador com colocação de prótese e broncoplastia com balão.Apresentase uma revisão da literatura da fractura brônquica e o papel diagnóstico e terapêutico da broncoscopia.Rev Port Pneumol 2008; XIV (3: 409-414 Abstract: Bronchial fracture is a rare, life-threatening injury usually associated with blunt chest trauma. It represents a great task in diagnosis, as its manifestations are various and nonspecific.Bronchoscopy has a primordial role to diagnose and, in selective cases, to treat bronchial fractures.The authors present the case report of a patient with a thoracic trauma after an accident in the workplace. The bronchoscopy revealed a fracture of the left main bronchus. Conservative treatment was performed with endobronchial stenting and balloon dilatation.In conclusion, a review of the literature on bronchial fracture and the role of bronchoscopy is presented.Rev Port Pneumol 2008; XIV (3: 409-414 Palavras-chave: Fractura brônquica, traumatismo, broncoscopia, prótese brônquica, broncoplastia com balão, Key-words: Bronchial fracture, trauma, bronchoscopy, endobronchial stent, balloon bronchoplasty

Characterization of the upper pouch tracheo-oesophageal fistula in oesophageal atresia.

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Summerour, Virginia; Stevens, Paul S; Lander, Anthony D; Singh, Michael; Soccorso, Giampiero; Arul, G Suren

2017-02-01

A small proportion of infants with oesophageal atresia (OA) are thought to have a proximal tracheoesophageal fistula (TOF). Failure to recognize these can hamper mobilization of the upper pouch and lead to life-threatening episodes of aspiration once oral feeding starts. We reviewed our experience of upper pouch fistulae to identify characteristic features of proximal TOF. A retrospective review of TOF/OA patient notes and bronchoscopy photographs and videos, identified from our database from 01/01/2006 to 12/31/2015, was performed. Eight (6.1%) infants were identified (M:F 5:3) from a total population of 131 newly diagnosed TOF/OA infants during the period. Their median gestational age was 33 (range 28-39) weeks, and median birth weight was 1647g (range 1100-3400g). Five were initially diagnosed with pure OA and 3 with a distal TOF. All patients underwent rigid bronchoscopy at the initial surgery but only one proximal fistula was identified. The 7 missed proximal fistulae were subsequently found either during on-table oesophagograms for gap assessment (n=2), at the time of thoracotomy when mobilizing the upper pouch (n=3), or during subsequent bronchoscopy for symptoms post OA repair (n=2). Two patients needed a further operation to divide the fistula. Review of the bronchoscopy videos identified four characteristic differences between upper and lower pouch fistulae. Proximal fistulae are found just distal to the vocal cords, are very small, often no more than a pit, do not open and close with ventilation, and are best identified by insufflation of the esophagus. Upper pouch fistulae are relatively easy to miss because of different characteristics compared with H-type or distal fistulae that have not previously been mentioned in the literature. level IV. Copyright © 2016. Published by Elsevier Inc.

Diagnosis of tracheal instability: inspiratory and expiratory spiral CT and cine CT

International Nuclear Information System (INIS)

Heussel, C.P.; Thelen, M.; Kauczor, H.U.; Hafner, B.; Lill, J.

2000-01-01

Purpose: In tracheo- and bronchomalacia, localization and determination of collapse is necessary for planning a surgical procedure. We compared inspiratory and spiral CT, cine CT, and bronchoscopy and evaluated the relevance of each method. Methods: Seventeen patients with suspected or verified tracheal stonosis or collapse underwent paired inspiratory and exspiratory spiral CT and cine CT during continuous respiration (temporal increment 100 ms). The tracheal cross-sectional area was calculated and compared. Results: In addition to bronchoscopy, further information concerning localization, extent, collapse, stability of the tracheal wall, distal portions of the stenosis, and extraluminal compressions was obtained. A significantly higher degree of tracheal collapse was seen using cine CT compared to paired spiral CT (p [de

Airway obstruction due to tracheomalacia caused by innominate artery compression and a kyphotic cervical spine.

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Liu, Chia-Hsin; Huang, Wen-Sheng; Wang, Hong-Hau; Wu, Chin-Pyng; Chian, Chih-Feng; Perng, Wann-Cherng; Tsai, Chen-Liang

2015-02-01

Tracheomalacia can cause variable degrees of intrathoracic airway obstruction and is an easily overlooked cause of respiratory distress in adults. Here, we report a case of acute respiratory failure in which subglottic stenosis was accidentally identified during endotracheal intubation. Subsequent bronchoscopy and computed tomography of the thorax and neck revealed tracheal compression with tracheomalacia caused by a tortuous innominate artery and a kyphotic cervical spine. The patient underwent rigid bronchoscopy with metal stent implantation, and her symptoms were alleviated. These findings outline the importance of precise diagnosis and interventions for preventing recurrent life-threatening respiratory failure in such cases. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

"Detachment of the carinal hook following endobronchial intubation with a double lumen tube"

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Rocha Ana C

2011-10-01

Full Text Available Abstract Background Carinal hooks increases difficulty at endotracheal intubation. Amputation of the carinal hook during passage and malpositioning of the tube to the hook are some of the potential problems related with left-sided Carlens double lumen tube (DLT. This article reports an amputation of the hook during a difficult selective intubation and aimed at calling the attention to complications associated with DLTs and the importance of fiberoptic bronchoscopy. Case presentation A 68 year-old woman was scheduled for right-sided thoracotomy in whom blind DLT insertion was performed. Narrowed trachea causes difficulty in rotating the DLT 90° counter-clockwise. After carinal hook was noticed upon visual inspection of the DLT, fiberoptic bronchoscopy was used to remove the missing part (with the use of forceps from the right mainstem bronchus. Conclusion Insertion of DLTs with carinal hook is associated with technical problems and potentially life-threatening hazards have discouraged their use. Fiberoptic evaluation and repositioning solves most of the problems. Although amputation of the carinal hook has not been previously reported, clinicians should be alert. This case report emphasizes the utility of the fiberoptic bronchoscopy in the operating theatre for placement, positioning and inspection of the carinal hook DLT.

The role of CT in the diagnosis of bronchogenic carcinoma not detected by plain radiograph

International Nuclear Information System (INIS)

Choi, Byoung Wook; Choe, Kyu Ok; Lee, Je Hyuk; Ryu, Seok Jong

2000-01-01

To evaluate the role of CT and CT features in the diagnosis of bronchogenic carcinomas not detected by plain radiography. Eighteen patients [19 primary cancer lesions, M:F=16:2, aged 43-75 (mean, 56.3) years] with lung cancer initially not detected by plain radiography were involved in this study. CT scanning was performed in all cases, and fibrobronchoscopy, and sputum cytology, each in 17. Lesions were divided into two groups: the central type, if on or proximal to the segmental bronchus, and the peripheral type, if distal to this. Plain radiographs were analysed for possible causes of occultness and for clinical characteristics including cell type, location, and size. We focused on the CT findings, comparing cases undetected by CT with those undetected by bronchoscopy. In the central type, the cause of occultness, as seen on plain radiographs, was small size, no secondary findings, or confusing shadow from hilar vessels. In the peripheral type, the cause was overlapping shadow due to normal structures of the chest, or combined diseases. Eight lesions were first detected by sputum cytology, 6 by bronchoscopy, and 5 by CT. Fourteen lesions were the central type (main bronchus 2, lobar bronchus 7, segmental bronchus 5), and five were peripheral. Central-type lesions were either squamous cell carcinoma (n=11), adenocarcinoma (n=1), small cell carcinoma (n=1), or large cell carcinoma (n=1). The peripheral type were either squamous cell carcinoma (n=2), adenocarcinoma (n=2), or large cell carcinoma (n=1). Size ranged from 0.2 to 4(mean, 2; central 1.7, peripheral 2.8) cm. Surgical resection was possible in 15 patients (16 cancers, including 13 at stage I). Only two were at a stage which rendered them unresectable. CT revealed 13 cancers, including all those which were peripheral. The finding were endobronchial nodule (n=4), bronchial wall thickening (n=1), perihilar mass (n=3), parenchymal mass (n=2), and subpleural mass (n=3). In six central-type cases [endobronchial

Congenital broncho-oesophageal fistula

African Journals Online (AJOL)

1983-04-09

Apr 9, 1983 ... Rigid bronchoscopy performed under general anaesthesia .... Blackburn WR, Armour)' RA. Congenital esophago-pulmonary fistulas without esophageal atresia: an analysis of 260 fistulas in infants, children and adults.

Traumatic bronchial injury

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Ali Cheaito, MD

2016-01-01

Conclusion: A high level of suspicion and the liberal use of bronchoscopy are important in the diagnosis of tracheobronchial injury. A tailored surgical approach is often necessary for definitive repair.

Outcomes after Bronchoscopic Procedures for Primary Tracheobronchial Amyloidosis: Retrospective Study of 6 Cases

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Ihsan Alloubi

2012-01-01

Full Text Available Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion.

Outcomes after bronchoscopic procedures for primary tracheobronchial amyloidosis: retrospective study of 6 cases.

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Alloubi, Ihsan; Thumerel, Matthieu; Bégueret, Hugues; Baste, Jean-Marc; Velly, Jean-François; Jougon, Jacques

2012-01-01

Respiratory amyloidosis is a rare disease which refers to localized aberrant extracellular protein deposits within the airways. Tracheobronchial amyloidosis (TBA) refers to the deposition of localized amyloid deposits within the upper airways. Treatments have historically focused on bronchoscopic techniques including debridement, laser ablation, balloon dilation, and stent placement. We present the outcomes after rigid bronchoscopy to remove the amyloid protein causing the airway obstruction in 6 cases of tracheobronchial amyloidosis. This is the first report of primary diffuse tracheobronchial amyloidosis in our department; clinical features, in addition to therapy in the treatment of TBA, are reviewed. This paper shows that, in patients with TBA causing airway obstruction, excellent results can be obtained with rigid bronchoscopy and stenting of the obstructing lesion.

Pneumonia, lung cancer or Medlar's core?

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Filippo Luciani

2015-01-01

Full Text Available Here, we report a case of 57-year-old previously healthy man with six-months medical history of significant chronic cough and recurring episodes of fever. Cytology, bacteria, fungi and acid fast bacilli in the sputum were negative. CT scan, initially interpreted as suspected lung cancer, detected by chest x-ray, revealed pneumonia. Bronchoscopy is frequently necessary for the diagnosis as well as the treatment as a routine practice and in this case was applied. Our patient underwent to fiberoptic rigid bronchoscopy in the right upper lobe in general anaesthesia. Unexpectedly, a vegetal FB, Medlar's core instead a tumor, was removed. After two-months follow-up the patient was found healthy without any old or other symptoms.

ISSN 2073-9990 East Cent. Afr. J. surg. (Online)

African Journals Online (AJOL)

dell

Bronchoscopy for Removal of Aspirated Tracheobronchial Foreign Bodies at Kenyatta. National Hospital ... developing countries despite recent advances in endoscopic surgery1. This study ... length of hospital stay before the discharge order.

Pulmonary carcinoma. Diagnostic and bronchoscopic treatment

International Nuclear Information System (INIS)

Caballero Duran, Hugo

1997-01-01

A historical recount of the bronchoscopy is made, from its beginnings 100 years ago, in a same way some techniques of diagnostic and treatment are mentioned, as the laser, fluorescence, cryotherapy, etc

SHOX2 DNA Methylation is a Biomarker for the diagnosis of lung cancer based on bronchial aspirates

International Nuclear Information System (INIS)

Schmidt, Bernd; Lewin, Jörn; Tetzner, Reimo; Weickmann, Sabine; Wille, Ulrike; Liloglou, Triantafillos; Raji, Olaide; Walshaw, Martin; Fleischhacker, Michael; Witt, Christian; Field, John K; Liebenberg, Volker; Dietrich, Dimo; Schlegel, Thomas; Kneip, Christoph; Seegebarth, Anke; Flemming, Nadja; Seemann, Stefanie; Distler, Jürgen

2010-01-01

This study aimed to show that SHOX2 DNA methylation is a tumor marker in patients with suspected lung cancer by using bronchial fluid aspirated during bronchoscopy. Such a biomarker would be clinically valuable, especially when, following the first bronchoscopy, a final diagnosis cannot be established by histology or cytology. A test with a low false positive rate can reduce the need for further invasive and costly procedures and ensure early treatment. Marker discovery was carried out by differential methylation hybridization (DMH) and real-time PCR. The real-time PCR based HeavyMethyl technology was used for quantitative analysis of DNA methylation of SHOX2 using bronchial aspirates from two clinical centres in a case-control study. Fresh-frozen and Saccomanno-fixed samples were used to show the tumor marker performance in different sample types of clinical relevance. Valid measurements were obtained from a total of 523 patient samples (242 controls, 281 cases). DNA methylation of SHOX2 allowed to distinguish between malignant and benign lung disease, i.e. abscesses, infections, obstructive lung diseases, sarcoidosis, scleroderma, stenoses, at high specificity (68% sensitivity [95% CI 62-73%], 95% specificity [95% CI 91-97%]). Hypermethylation of SHOX2 in bronchial aspirates appears to be a clinically useful tumor marker for identifying subjects with lung carcinoma, especially if histological and cytological findings after bronchoscopy are ambiguous

Effect of lidocaine 2% on bacterial culture of bronchial fluid

International Nuclear Information System (INIS)

Samet, M.; Meybodi, F.A.A.; Mokarianpour, T.; Fallah, T.; Mongabadi, F.D.; Ayatollahi, J.; Shahcherghi, S.H.; Yazdi, M.H.A

2017-01-01

Objective:To evaluate the action of 2% lidocaine on the culture results of bronchial fluid in patients suspected of having lower respiratory tract infections. Study Design:Cross-sectional analytical study. Place and Duration of Study:Shahid Sadoughi Hospital, Yazd, Iran, from November 2014 to November 2015. Methodology:Patients suspected of lower respiratory tract infections referred to bronchoscopy unit of the Hospital were included. Those with incomplete questionnaire and bronchoscopy contraindication were excluded. Bronchial fluid was aspirated before and after local application of 2% lidocaine and cultured, according to the suspected clinical diagnosis. Finally, statistical analysis was performed using SPSS software, version 17.0. For statistical comparisons, McNemar's test was used. Level of significance was kept at p <0.05. Results:The mean age of the study population was 51.83 +-15.93 with a range of 25 - 80 years. Out of 130 patients, 60 patients had positive culture results. Nineteen (31.7%) cases had positive culture for tuberculosis and 41 (63.3%) cases had positive results for other bacteria before intervention that did not change after using 2% lidocaine (p=1). In 70 (53.84%) cases, results were negative before and after use of 2% lidocaine. Conclusion:No significant difference was found between culture results before and after the use of lidocaine. Therefore, lidocaine can be used during bronchoscopy to increase patient tolerance. (author)

Kasus Serial : Aspirasi Peluit pada Anak

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Aci Mayang Sari

2015-01-01

Full Text Available AbstrakKasus aspirasi benda asing selalu memberikan tantangan bagi dokter spesialis Telinga Hidung TenggorokKepala dan Leher (THT-KL. Aspirasi benda asing lebih sering terjadi pada anak-anak khususnya pada umur 1-3tahun dan jarang terjadi pada dewasa. Aspirasi peluit pada anak merupakan kasus yang banyak terjadi pada golonganbenda asing anorganik. Untuk menegakkan diagnosis aspirasi benda asing diperlukan ketajaman anamnesis,pemeriksaan fisik dan hasil radiografi. Bronkoskopi merupakan teknik yang digunakan sebagai alat diagnostik danterapeutik pada kasus aspirasi benda asing. Kasus aspirasi peluit pada tiga orang anak (2 laki-laki dan 1 perempuantelah dilaporkan dan ditatalaksana menggunakan teknik bronkoskopi kaku.Kata kunci: Aspirasi benda asing, benda asing peluit, bronkoskopiAbstractForeign body aspiration continues to provide challenges for otorhinolaryngologists. Foreign body aspiration ismore common in children, especially at the age of 1-3 years and rarely occurs in adults. Whistle aspiration in childrenis a case that occurs in many inorganic foreign body type. The diagnosis of foreign body aspiration based ondiscernment anamnesis, physical examination and radiographic results. Bronchoscopy is a technique that is used as adiagnostic and therapeutic tool in cases of foreign body aspiration.Cases of whistle aspiration in 3 children (2 malesand 1 femalewas reported and treated using rigid bronchoscopy technique. Arial 9 italicKeywords: foreign body aspiration, a whistle foreign body, bronchoscopy.

SAMJFoRUM

African Journals Online (AJOL)

ventilate him effectively past the tracheobronchial obstruction. ... fibre-optic bronchoscopy, but treatment takes a long time and ... Workers chronically exposed to wood dust have an increased ... sawmill workers exposed to pine and spruce.

ISSN 2073 ISSN 2073-9990 East Cent. Afr. J. surg. (Online) 9990 ...

African Journals Online (AJOL)

Prof Kakande

The hematoma was evacuated and a drain inserted. On the ... measures used to prevent this complication. Rigid and flexible ... suction through endotracheal tubes in patients who cannot withstand bronchoscopy. However the use of.

Ultrasound-Guided Percutaneous Dilational Tracheostomy: A Systematic Review of Randomized Controlled Trials and Meta-Analysis.

Science.gov (United States)

Gobatto, André L N; Besen, Bruno A M P; Cestari, Mino; Pelosi, Paolo; Malbouisson, Luiz M S

2018-01-01

Percutaneous dilational tracheostomy (PDT) is a common and increasingly used procedure in the intensive care unit (ICU). It is usually performed with bronchoscopy guidance. Ultrasound has emerged as a useful tool in order to assist PDT, potentially improving its success rate and reducing procedural-related complications. To investigate whether the ultrasound-guided PDT is equivalent or superior to the bronchoscopy-guided or anatomical landmarks-guided PDT with regard to procedural-related and clinical complications. A systematic review of randomized clinical trials was conducted comparing an ultrasound-guided PDT to the control groups (either a bronchoscopy-guided PDT or an anatomical landmark-guided PDT) in patients undergoing a PDT in the ICU. The primary outcome was the incidence of major procedural-related and clinical complication rates. The secondary outcome was the incidence of minor complication rates. Random-effect meta-analyzes were used to pool the results. Four studies fulfilled the inclusion criteria and they were analyzed. The studies included 588 participants. There were no differences in the major complication rates between the patients who were assigned to the ultrasound-guided PDT when compared to the control groups (pooled risk ratio [RR]: 0.48; 95% confidence interval [CI]: 0.13-1.71, I 2 = 0%). The minor complication rates were not different between the groups, but they had a high heterogeneity (pooled RR: 0.49; 95% CI 0.16-1.50; I 2 = 85%). The sensitivity analyzes that only included the randomized controlled trials that used a landmark-guided PDT as the control group showed lower rates of minor complications in the ultrasound-guided PDT group (pooled RR: 0.55; 95% CI: 0.31-0.98, I 2 = 0%). The ultrasound-guided PDT seems to be safe and it is comparable to the bronchoscopy-guided PDT regarding the major and minor procedural-related or clinical complications. It also seems to reduce the minor complications when compared to the anatomical

Aspiration pneumonia

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... Images Pneumococci organism Bronchoscopy Lungs Respiratory system References Musher DM. Overview of pneumonia. In: Goldman L, Schafer ... University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial ...

Menthol poisoning

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... to treat aches and pains (such as Ben-Gay, Therapeutic Mineral Ice) Peppermint oil Other products may ... ECG (electrocardiogram, or heart tracing) Chest x-ray Tube down the windpipe and lungs (bronchoscopy) to look ...

Pneumocystis jiroveci pneumonia

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... symptoms. Tests that may be ordered include: Blood gases Bronchoscopy (with lavage) Lung biopsy X-ray of ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

Legionnaire disease

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... Tests that may be done include: Arterial blood gases Blood cultures to identify the bacteria Bronchoscopy to ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

Pneumonia - weakened immune system

Science.gov (United States)

... lung ( pleural effusion ). Tests may include: Arterial blood gases Blood chemistries Blood culture Bronchoscopy (in certain cases) ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

What Are Asbestos-Related Lung Diseases?

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... asbestosis include: Fibrotic lung disease Pneumoconiosis (NOO-mo-ko-ne-O-sis) Interstitial (in-ter-STISH-al) ... tissue samples. One way is through bronchoscopy (bron-KOS-ko-pee). For this procedure, your doctor will ...

The mean green popsicle: using cryotherapy to remove aspirated foreign bodies.

Science.gov (United States)

Seaman, Joseph C; Knepler, James L; Bauer, Karen; Rashkin, Mitchell

2010-10-01

Foreign body (FB) aspiration can be a life-threatening event. Although more common in children, FB aspiration can occur at any age. Symptoms related to FB aspiration range from coughing and shortness of breath to asphyxiation. Chest imaging can be nonspecific and infrequently identifies an FB. Herein, we describe a case of a 54-year-old male patient who aspirated an FB and experienced respiratory arrest. He failed to improve with conservative measures and required emergent bronchoscopy. He was found to have an FB in his proximal left mainstem bronchus that could not be removed using standard bronchoscopy and he was referred to our center for definitive care. We used a cryotherapy probe to remove the FB. We propose that cryotherapy is a useful tool to remove FBs that are soft and amenable to freezing.

Unusual cause of respiratory distress misdiagnosed as refractory asthma

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Al-Otair Hadil

2006-01-01

Full Text Available We report a young lady, who was labeled as a case of refractory asthma for a few years, based on history of shortness of breath on minimal exertion, noisy breathing and normal chest radiograph. Repeated upper airway exam by an otolaryngologist and computerized tomography scan, were normal. On presentation to our hospital, she was diagnosed to have fixed upper airway obstruction, based on classical flow-volume loop findings. Fibroptic bronchoscopy revealed a web-shaped subglottic stenosis. The histopathology of a biopsy taken from that area, showed non-specific inflammation. No cause for this stenosis could be identified. The patient was managed with rigid bronchoscopy dilatation, without recurrence. We report this case as idiopathic subglottic stenosis, that was misdiagnosed as refractory bronchial asthma, stressing the importance of performing spirometry in the clinic.

Danish Guidelines 2015 for percutaneous Dilatational Tracheostomy in the Intensive Care Unit

DEFF Research Database (Denmark)

Madsen, Kristian Rørbæk; Guldager, Henrik; Rewers, Mikael

2015-01-01

Percutaneous dilatational tracheostomy is a common procedure in intensive care. This updated Danish national guideline describes indications, contraindications and complications, and gives recommendations for timing, anaesthesia, and technique, use of fibre bronchoscopy and ultrasound guidance...

Helical CT in evaluation of the bronchial tree

International Nuclear Information System (INIS)

Perhomaa, M.; Laehde, S.; Rossi, O.; Suramo, I.

1997-01-01

Purpose: To establish a protocol for and to assess the value of helical CT in the imaging of the bronchial tree. Material and Methods: Noncontrast helical CT was performed in 30 patients undergoing fiberoptic bronchoscopy for different reasons. Different protocols were compared; they included overlapping 10 mm, 5 mm, or 3 mm slices and non-tilted, cephalad or caudal tilted images. Ordinary cross-sectional and multiplanar 2D reformats were applied for visualization of the bronchial branches. The effect of increasing the helical pitch was tested in one patient. Results: A total of 92.1-100% of the segmental bronchi present in the helical acquisitions were identified by the different protocols. The collimation had no significant impact on the identification of the bronchial branches, but utilization of 3-mm overlapping slices made it easier to distinguish the nearby branches and provided better longitudinal visualization of the bronchi in 2D reformats. The tilted scans illustrated the disadvantage of not covering all segmental bronchi in one breath-hold. An increase of the pitch from 1 to 1.5 did not cause noticeable blurring of the images. CT and bronchoscopic findings correlated well in the area accessible to bronchoscopy, but CT detected 5 additional pathological lesions (including 2 cancers) in the peripheral lung. Conclusion: Helical CT supplemented with bronchography-like 2D reformats provides an effective method complementary to bronchoscopy in the examination of the bronchial tree. (orig.)

Tracheal rupture caused by blunt chest trauma: radiological and clinical features

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Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S. [Dept. of Diagnostic Radiology, Justus Liebig Univ., Giessen (Germany); Hoppe, M. [Dept. of Diagnostic Radiology, University Hospital, Philipps University, Marburg (Germany); Popella, C. [Dept. of ENT, Justus Liebig University, Giessen (Germany)

2000-03-01

The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

In vivo microscopic imaging of the bronchial mucosa using an endo-cytoscopy system.

Science.gov (United States)

Shibuya, Kiyoshi; Fujiwara, Taiki; Yasufuku, Kazuhiro; Alaa, Mohamed; Chiyo, Masako; Nakajima, Takahiro; Hoshino, Hidehisa; Hiroshima, Kenzo; Nakatani, Yukio; Yoshino, Ichiro

2011-05-01

We investigated the capabilities of an endo-cytoscopy system (ECS) that enables microscopic imaging of the tracheobronchial tree during bronchoscopy, including normal bronchial epithelium, dysplastic mucosa and squamous cell carcinoma. The newly developed ECS has a 3.2 mm diameter that can be passed through the 4.2 mm working channel of a mother endoscope for insertion of the ECS. It has a high magnification of 570× on a 17 in. video monitor. Twenty-two patients (7 squamous cell carcinoma, 11 squamous dysplasia and 4 after PDT therapies) were underwent white light, NBI light and AFI bronchoscopy. Both abnormal areas of interest and normal bronchial mucosa were stained with 0.5% methylene blue and examined with ECS at high magnification (570×). Histological examinations using haematoxylin and eosin staining were made of biopsied specimens. Analyzed ECS images were compared with the corresponding histological examinations. In normal bronchial mucosa, ciliated columnar epithelial cells were visible. In bronchial squamous dysplasia, superficial cells with abundant cytoplasm were arranged regularly. In squamous cell carcinoma, large, polymorphic tumor cells showed increased cellular densities with irregular stratified patterns. These ECS images corresponded well with the light-microscopic examination of conventional histology. ECS was useful for the discrimination between normal bronchial epithelial cells and dysplastic cells or malignant cells during bronchoscopy in real time. This novel technology has an excellent potential to provide in vivo diagnosis during bronchoscopic examinations. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Tracheal rupture caused by blunt chest trauma: radiological and clinical features

International Nuclear Information System (INIS)

Kunisch-Hoppe, M.; Rauber, K.; Rau, W.S.; Hoppe, M.; Popella, C.

2000-01-01

The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. (orig.)

Resolution of obstructive atelectasis with non-invasive mechanical ventilation.

Science.gov (United States)

Mirambeaux Villalona, Rosa; Mayoralas Alises, Sagrario; Díaz Lobato, Salvador

2014-10-01

Bronchoscopy is a commonly used technique in patients with atelectasis due to mucus plugs. We present here the case of an 82-year-old patient with a history of Meige's syndrome who developed acute respiratory failure due to atelectasis of the right upper lobe associated with hospital-acquired pneumonia. The patient had a severely reduced level of consciousness, significant work-of-breathing and severe hypercapnic acidosis, all of which contraindicated bronchoscopy. Bi-level noninvasive mechanical ventilation (NIMV) was initiated by way of a face mask. Progress was favourable, with clear clinical and gasometric improvement. The chest X-ray performed 12hours later showed complete resolution of the atelectasis. These data suggest that NIMV may be useful in the treatment of atelectasis is some critical patients. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Diagnosis of tracheomalacia using tracheal dynamic respiratory-scan

International Nuclear Information System (INIS)

Matsui, Teruo; Watabe, Hideki; Ikeda, Sadao

1995-01-01

We performed tracheal-dynamic respiratory scan (T-DRS) in 54 cases which were thought to be tracheomalacia clinically. T-DRS was performed by TOSHIBA TCT-900S at the level of the aortic arch under the condition of 120 kV (140 kV), 100 mA, 5 mm of slice width for 20 seconds when the patient was directed to breath rapidly or slowly. In 19 cases, which underwent both T-DRS and bronchoscopy, could evaluate the results. Only one case was overestimated by T-DRS than bronchoscopic findings, while 9 cases were underestimated and 9 cases were equal. Though T-DRS tended to underestimate the degree of the stenosis of tracheomalacia than bronchoscopic finding. T-DRS can do more objective evaluation than bronchoscopy non-invasively and thought to be useful for the evaluation of tracheomalalcia. (author)

Cytomegalovirus Viral Load in Bronchoalveolar Lavage to Diagnose Lung Transplant Associated CMV Pneumonia

DEFF Research Database (Denmark)

Lodding, Isabelle Paula; Schultz, Hans Henrik; Jensen, Jens-Ulrik

2018-01-01

BACKGROUND: The diagnostic yield for cytomegalovirus (CMV) PCR viral load in Bronchoalveolar Lavage (BAL) or in plasma to diagnose CMV pneumonia in lung transplant recipients remains uncertain, and was investigated in a large cohort of consecutive lung transplant recipients. METHODS: Bronchoscopi...

Sensitivity of Computed Tomography‑guided Transthoracic Biopsies ...

African Journals Online (AJOL)

2018-03-05

Mar 5, 2018 ... Introduction: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography‑guided (CT‑guided) biopsy, thoracoscopy or video‑assisted thoracoscopy, and bronchoscopy.

Sensitivity of Computed Tomography‑guided Transthoracic Biopsies ...

African Journals Online (AJOL)

Introduction: The indications for open biopsies for intrathoracic lesions have become almost negligible. This development was made possible by less invasive maneuvers such as computed tomography‑guided (CT‑guided) biopsy, thoracoscopy or video‑assisted thoracoscopy, and bronchoscopy. CT‑guided percutaneous ...

Insertion of a self-expandable endotracheal metal stent using topical anaesthesia and a fibreoptic bronchoscope: a comfortable way to offer palliation.

OpenAIRE

Coolen, D.; Slabbynck, H.; Galdermans, D.; Van Schaardenburg, C.; Mortelmans, L. L.

1994-01-01

A self-expandable stent was used to obtain prolonged relief of stridor resulting from tracheal obstruction by extrinsic tumour compression despite prior external irradiation. The stent was inserted in an easy and comfortable procedure with fibreoptic bronchoscopy under local anaesthesia.

Tracheobroncopathia osteochondroplastica: Three case reports with ...

African Journals Online (AJOL)

Besides, final diagnosis can be established by viewing ossified nodules in trachea and bronchus through the fiberoptic bronchoscopy. Amyloidosis, tuberculosis, sarcoidosis, bronchial carcinoma, and tracheobronchial calcinosis must be remembered in differential diagnosis. Also ossifications in submucosa and proof of ...

Bronchoscopy in children suspected of lower airway aspiration

DEFF Research Database (Denmark)

Holst-Albrechtsen, Sine; Kristensen, Søren; Larsen, Knud

2017-01-01

%) and pulmonary auscultation in 21 patients (73%). Two patients (7%) were in need of post-operative anaesthetic support as a result of respiratory failure, and the over-all complication rate was 28% (eight patients). No fatal outcomes were observed. Conclusions: The majority of the children in our study were...

Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield ...

African Journals Online (AJOL)

2016-03-08

Mar 8, 2016 ... Indications for the procedures, type of bronchoscopic sampling done, final diagnosis, and .... information obtained were bronchoscopic findings, final diagnosis, and ... respectively. About 18 (18.2%) patients had a history of.

[Diagnostic bronchoscopy: contribution of the flexible video endoscopy].

Science.gov (United States)

Labbé, A

2007-12-01

The author describes the use of paediatric flexible videobronchoscopy. Examinations were performed in newborn, infant and child. In neonatal period, the technique is used for the diagnostic of congenital malformation of airway, upper airway obstruction, pre operative evaluation of tracheooesophageal fistula. In children, more frequent indications are airway obstruction with non clear cause, stridor, chronic cough, congenital malformation of airway, tracheomalacia, follow-up of lung transplantation. In intensive care unit, this technique is very useful in the cases of atelectasis, stridor post extubation, follow-up in prolonged intubation and tracheotomy. The possibility of direct visualization of the anomalies in screen and the function of numeric record are important for diagnosis and teaching procedure.

Cough quality in children: a comparison of subjective vs. bronchoscopic findings

Directory of Open Access Journals (Sweden)

Cox Nancy C

2005-01-01

Full Text Available Abstract Background Cough is the most common symptom presenting to doctors. The quality of cough (productive or wet vs dry is used clinically as well as in epidemiology and clinical research. There is however no data on the validity of cough quality descriptors. The study aims were to compare (1 cough quality (wet/dry and brassy/non-brassy to bronchoscopic findings of secretions and tracheomalacia respectively and, (2 parent's vs clinician's evaluation of the cough quality (wet/dry. Methods Cough quality of children (without a known underlying respiratory disease undergoing elective bronchoscopy was independently evaluated by clinicians and parents. A 'blinded' clinician scored the secretions seen at bronchoscopy on pre-determined criteria and graded (1 to 6. Kappa (K statistics was used for agreement, and inter-rater and intra-rater agreement examined on digitally recorded cough. A receiver operating characteristic (ROC curve was used to determine if cough quality related to amount of airway secretions present at bronchoscopy. Results Median age of the 106 children (62 boys, 44 girls enrolled was 2.6 years (IQR 5.7. Parent's assessment of cough quality (wet/dry agreed with clinicians' (K = 0.75, 95%CI 0.58–0.93. When compared to bronchoscopy (bronchoscopic secretion grade 4, clinicians' cough assessment had the highest sensitivity (0.75 and specificity (0.79 and were marginally better than parent(s. The area under the ROC curve was 0.85 (95%CI 0.77–0.92. Intra-observer (K = 1.0 and inter-clinician agreement for wet/dry cough (K = 0.88, 95%CI 0.82–0.94 was very good. Weighted K for inter-rater agreement for bronchoscopic secretion grades was 0.95 (95%CI 0.87–1. Sensitivity and specificity for brassy cough (for tracheomalacia were 0.57 and 0.81 respectively. K for both intra and inter-observer clinician agreement for brassy cough was 0.79 (95%CI 0.73–0.86. Conclusions Dry and wet cough in children, as determined by clinicians and

Airway foreign body in children

Directory of Open Access Journals (Sweden)

Marina GONZÁLEZ-HERRERO

2018-03-01

Full Text Available Introduction and objective: The aspiration of a foreign body in children is a frequent emergency in pediatrics, being potentially lethal. Method: Narrative review. Results: This pathology mainly affects children under 5 years of age with a peak of incidence between the first and third years of life. The clinic will depend on the type of foreign body (size, shape, possibility of breaking, organic or not, the age of the child and the location of the object. In our environment, the most frequent is the aspiration of nuts (peanuts and sunflower seeds. After the initial picture, an asymptomatic period tends to occur, which favors delayed diagnosis and leads to possible errors in the diagnosis. Discussion: An adequate clinical history and a high diagnostic suspicion are fundamental to favor an early treatment. The presence of a normal chest X-ray does not exclude the presence of a foreign body in the airway, so a bronchoscopy is indicated if the diagnostic suspicion is high. The treatment of choice is extraction by rigid bronchoscopy, being controversial the use of flexible fibrobronchoscope. Conclusions: Conclusions: The aspiration of a foreign body is a pediatric emergency that requires a diagnosis and early treatment. The highest incidence occurs in children under 3 years and more frequently in men. The most commonly aspirated material in our environment are nuts, mainly located in the bronchial tree. The initial episode may go unnoticed, delaying the diagnosis and may lead to progressive respiratory distress in the child. A detailed clinical history and suspicion of this pathology are essential in children at risk age who present with cough and dyspnea of sudden onset. The existence of a normal chest radiograph should not postpone bronchoscopy when there is high clinical suspicion. The treatment of choice for the extraction of foreign bodies in airways in children is rigid bronchoscopy, being controversial the use of the flexible fibrobronchoscope

A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers

Energy Technology Data Exchange (ETDEWEB)

Luo, Xiongbiao, E-mail: xiongbiao.luo@gmail.com [Robarts Research Institute, Western University, London, Ontario N6A 5K8 (Canada)

2014-06-15

Purpose: Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. Methods: The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model was designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. Results: The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0–10 min{sup −1}. The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. Conclusions: An

A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers

International Nuclear Information System (INIS)

Luo, Xiongbiao

2014-01-01

Purpose: Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. Methods: The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model was designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. Results: The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0–10 min −1 . The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. Conclusions: An

Pulmonary actinomycosis

Science.gov (United States)

The health care provider will perform a physical exam, and ask about your medical history and symptoms. Tests that may be done include: Bronchoscopy with culture Complete blood count (CBC) Chest x-ray Chest CT scan Lung biopsy Modified AFB smear of sputum ...

Comparison between endobronchial forceps-biopsy and cryo-biopsy by flexible

Directory of Open Access Journals (Sweden)

Sami El-Dahdouh

2016-01-01

Conclusions: We concluded that cryoprobe biopsies were more successful than forceps biopsies in the diagnosis of lung cancer. Nevertheless, further investigations are warranted to determine an efficacy of cryoprobe biopsy procedures and a rationale to use as a part of routine flexible bronchoscopy.

Infection with Crenosoma vulpis lungworm in a dog in the Czech Republic

Czech Academy of Sciences Publication Activity Database

Husník, R.; Sloboda, M.; Kovaříková, S.; Koudela, Břetislav

2011-01-01

Roč. 48, č. 1 (2011), 56-58 ISSN 0440-6605 Institutional research plan: CEZ:AV0Z60220518 Keywords : Crenosoma vulpis * fox lungworm * larvoscopy * chronic cough * bronchoscopy Subject RIV: GJ - Animal Vermins ; Diseases, Veterinary Medicine Impact factor: 0.773, year: 2011

Download this PDF file

African Journals Online (AJOL)

ebutamanya

2016-05-06

May 6, 2016 ... nodosum, fever, arthralgia and sicca syndrome. Biological findings showed an inflammatory syndrome, renal failure, proteinuria (1g / 24h), positive ... functional respiratory tests there was distal obstructive deficit with a normal DLCO. Bronchoscopy showed macroscopically normal bronchi. Bronchial ...

Bronchoscopic diagnosis of pulmonary infiltrates in granulocytopenic patients with hematologic malignancies : BAL versus PSB and PBAL

NARCIS (Netherlands)

Boersma, Wim G.; Erjavec, Zoran; van der Werf, Tjip S.; de Vries-Hosper, Hilly G.; Gouw, Annette S. H.; Manson, Willem L.

Background: Treatment of patients with hematologic malignancies is often complicated by severe respiratory infections. Bronchoscopy is generally to be used as a diagnostic tool in order to find a causative pathogen. Objectives: In a prospective study the combination of protected specimen brush (PSB)

Techniques in human airway inflammation - Quantity and morphology of bronchial biopsy specimens taken by forceps of three sizes

NARCIS (Netherlands)

Aleva, RM; Kraan, J; Smith, M; ten Hacken, NHT; Postma, DS; Timens, W

Background: In recent years, fiberoptic bronchoscopy has been introduced successfully in the research of bronchial asthma. Bronchial biopsy specimens obtained by this procedure are small, and an optimal biopsy technique is necessary to obtain high-quality tissue samples, as sufficient length of

The value of MRI of the thorax in congenital stenosis of the trachea

International Nuclear Information System (INIS)

Vogl, T.; Wilimzig, C.; Lissner, J.; Hofmann, U.; Hofmann, D.; Hecker, W.

1989-01-01

MRI of the thorax was performed in 24 children aged between six weeks and five years, in whom a tracheal stenosis had been demonstrated by bronchoscopy. Since bronchoscopy can only demonstrate the interior of the trachea, various imaging methods, such as CT and angiography, were used to demonstrate the topography and cause of the tracheal stenosis. MRI has shown that the most common cause of a stenosis in the central section of the trachea is focal compression by an aberrant bracheocephalic trunk (10 cases). Stenosis of the distal trachea could be due to anomalies of the aortic arch (5 cases), a dilated pulmonary artery (4 cases) or a soft tissue mass (3 cases). In all these patients, MRI was greatly superior to the conventional methods. By using a special technique, MRI made it possible to clarify the cause and localisation of a tracheal stenosis by a non-invasive examination. (orig.) [de

Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

International Nuclear Information System (INIS)

Fraga, Andrea de Melo Alexandre; Reis, Marcelo Conrado dos; Zambon, Mariana Porto; Toro, Ivan Contrera; Ribeiro, Jose Dirceu; Baracat, Emilio Carlos Elias

2008-01-01

Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusions: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention at children younger than three years of age. (author)

Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

Energy Technology Data Exchange (ETDEWEB)

Fraga, Andrea de Melo Alexandre; Reis, Marcelo Conrado dos; Zambon, Mariana Porto [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Pediatric Emergency Room]. E-mail: andreafrag@gmail.com; Toro, Ivan Contrera [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Thoracic Surgery; Ribeiro, Jose Dirceu; Baracat, Emilio Carlos Elias [Universidade Estadual de Campinas (UNICAMP), Campinas, SP (Brazil). Dept. of Pediatric Pulmonology

2008-02-15

Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusions: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention at children younger than three years of age. (author)

Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

Energy Technology Data Exchange (ETDEWEB)

Park, Jong Woong; Jung, Gyoo Sik; Kim, Seong Min; Lee, Seung Ryong; Kim, Hyun Sook; Huh, Jin Do; Joh, Young Duk [Kosin Medical College, Pusan (Korea, Republic of)

1998-05-01

The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs.

Expandable metallic stents in the palliative treatment of malignant tracheobronchial stenosis

International Nuclear Information System (INIS)

Park, Jong Woong; Jung, Gyoo Sik; Kim, Seong Min; Lee, Seung Ryong; Kim, Hyun Sook; Huh, Jin Do; Joh, Young Duk

1998-01-01

The purpose of this study is to report the outcome of using expandable metallic stent in the management of malignant tracheobronchial stenosis with dyspnea. Under fluoroscopic and bronchoscopic guidance, seven patients with malignant airway stenosis were treated with ten expandable metallic stents. The cause of stenosis was metastasis from esophageal cancer in five patients, recurrent adenoid cystic carcinoma of the trachea in one, and primary lung cancer in one. The major sites of obstruction were the trachea in four patients, the left main bronchus in one, the trachea and left main bronchus in one, and the trachea and both bronchi in one. Chest radiography (n=7), bronchoscopy (n=5), pulmonary function test (PFT)(n=3), and spirometry(n=1) were performed before and after stent placement. In all seven patients, the stent was successfully placed at the lesion sites and dyspnea began to improve immediately. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After the procedure, chest radiography and bronchoscopy showed an increase in airway diameter. After stent placement, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) improved 53% and 56%, respectively. Peak flow velocity also changed from 46 L/min to 200 L/min. During median follow-up of 67 (41-1565) days, one stent migration occurred. In one patient, proximal tumor overgrowth occurred, and in one, tumor ingrowth was treated with balloon dilatation. For in the palliative treatment of malignant tracheobronchial stenosis with dyspnea, placement of expandable metal stents is safe and effective. (author). 21 refs., 1 tabs., 3 figs

Study of the pattern of lower respiratory tract infection within the first year in renal transplant patients

Directory of Open Access Journals (Sweden)

Nasr Affara

2015-07-01

Conclusion: Lower respiratory tract infection is a serious complication after renal transplantation. Bacterial and mixed bacterial infections are the most common etiologies, proper diagnosis using all tools of diagnosis especially bronchoscopy and quantitative culture can help in diagnosis and prevent the overuse of antibiotics.

EXERCISE-INDUCED PULMONARY HEMORRHAGE AFTER RUNNING A MARATHON

Science.gov (United States)

We report on a healthy 26-year-old male who had an exercise-induced pulmonary hemorrhage (EIPH) within 24 hours of running a marathon. There were no symptoms, abnormalities on exam, or radiographic infiltrates. He routinely participated in bronchoscopy research and the EIPH was e...

Bronchoscopic Lung Volume Reduction Coil Treatment of Patients With Severe Heterogeneous Emphysema

NARCIS (Netherlands)

Slebos, Dirk-Jan; Klooster, Karin; Ernst, Armin; Herth, Felix J. F.; Kerstjens, Huib A. M.

Background: The lung volume reduction coil (LVR-coil), a new experimental device to achieve lung volume reduction by bronchoscopy in patients with severe emphysema, works in a manner unaffected by collateral airflow. We investigated the safety and efficacy of LVR-coil treatment in patients with

Oxygen general saturation after bronchography under general ...

African Journals Online (AJOL)

Thirty-six patients undergoing bronchography or bronchoscopy under general anaesthesia were continuously monitored by pulse oximetry for 5 hours after these procedures. Significant falls in oxygen saturation were observed in the first hour and were of most clinical relevance in patients with preexisting pulmonary ...

Tracheal web

International Nuclear Information System (INIS)

Legasto, A.C.; Haller, J.O.; Giusti, R.J.

2004-01-01

Congenital tracheal web is a rare entity often misdiagnosed as refractory asthma. Clinical suspicion based on patient history, examination, and pulmonary function tests should lead to its consideration. Bronchoscopy combined with CT imaging and multiplanar reconstruction is an accepted, highly sensitive means of diagnosis. (orig.)

Aspiration of a perforated pen cap: complete tracheal obstruction ...

African Journals Online (AJOL)

Keywords: children, flexible bronchoscopy, Fogarty catheter, foreign body aspiration, pen cap, rigid ... plastic foreign body with central perforation occluding the trachea in supracarinal ... venous steroids and was discharged home on postoperative day 1 without ... history may not be as reliable, if not witnessed by an adult.

Pneumocystis carinii pneumonia in AIDS patients

DEFF Research Database (Denmark)

Orholm, Marianne; Nielsen, T L; Holten-Andersen, W

1992-01-01

The aim of this study was to evaluate whether the amount of Pneumocystis carinii organisms found at fiberoptic bronchoscopy (FB) performed on HIV-positive patients correlated to the character of the P. carinii pneumonia (PCP). A consecutive series of 105 patients presented with 131 episodes of pu...

Abscess of residual lobe after pulmonary resection for lung cancer.

Science.gov (United States)

Ligabue, Tommaso; Voltolini, Luca; Ghiribelli, Claudia; Luzzi, Luca; Rapicetta, Cristian; Gotti, Giuseppe

2008-04-01

Abscess of the residual lobe after lobectomy is a rare but potentially lethal complication. Between January 1975 and December 2006, 1,460 patients underwent elective pulmonary lobectomy for non-small-cell lung cancer at our institution. Abscess of the residual lung parenchyma occurred in 5 (0.3%) cases (4 bilobectomies and 1 lobectomy). Postoperative chest radiography showed incomplete expansion and consolidation of residual lung parenchyma. Flexible bronchoscopy revealed persistent bronchial occlusion from purulent secretions and/or bronchial collapse. Computed tomography in 3 patients demonstrated lung abscess foci. Surgical treatment included completion right pneumonectomy in 3 patients and a middle lobectomy in one. Complications after repeat thoracotomy comprised contralateral pneumonia and sepsis in 1 patient. Residual lobar abscess after lobectomy should be suspected in patients presenting with fever, leukocytosis, bronchial obstruction and lung consolidation despite antibiotic therapy, physiotherapy and bronchoscopy. Computed tomography is mandatory for early diagnosis. Surgical resection of the affected lobe is recommended.

Intrathoracic Airway Tree Segmentation from CT Images Using a Fuzzy Connectivity Method

Directory of Open Access Journals (Sweden)

Fereshteh Yousefi Rizi

2009-03-01

Full Text Available Introduction: Virtual bronchoscopy is a reliable and efficient diagnostic method for primary symptoms of lung cancer. The segmentation of airways from CT images is a critical step for numerous virtual bronchoscopy applications. Materials and Methods: To overcome the limitations of the fuzzy connectedness method, the proposed technique, called fuzzy connectivity - fuzzy C-mean (FC-FCM, utilized the FCM algorithm. Then, hanging-togetherness of pixels was handled by employing a spatial membership function. Another problem in airway segmentation that had to be overcome was the leakage into the extra-luminal regions due to the thinness of the airway walls during the process of segmentation. Results:   The result shows an accuracy of 92.92% obtained for segmentation of the airway tree up to the fourth generation. Conclusion:  We have presented a new segmentation method that is not only robust regarding the leakage problem but also functions more efficiently than the traditional FC method.

[Anesthetic care for fibrobronchoscopy in patients with chronic terminal respiratory insufficiency undergoing evaluation for isolated lung transplantation].

Science.gov (United States)

Solca, M; Elena, A; Croci, M; Damia, G

1993-01-01

During the first 18 month operation of the isolated lung transplantation program at or Institution, eight patients with terminal chronic respiratory failure underwent fiberoptic bronchoscopy and broncho-alveolar lavage as part of their evaluation for isolated lung transplantation. Four patients had severe obstructive, three restrictive, and one mixed, obstructive and restrictive, disease; all of them were on continuous supplemental oxygen. Procedures were performed under topical anaesthesia, with either light sedation or simple monitored anaesthesia care. Monitoring included non-invasive blood pressure measurement, pulse oximeter and precordial stethoscope. No adverse events were recorded, except in one case, when pulse oximeter reading precipitously dropped below 80%, to a minimum of 68-69%. The procedures was terminated short of its completion, and the patient was briefly assisted with manual bag ventilation on oxygen 100%. Pulse oximeter quickly returned to normal levels (above 90%), and the patient promptly recovered, without complications. The importance of monitored anaesthesia care during fiberoptic bronchoscopy (a usually benign procedure) in critically ill patients is greatly emphasized.

Development of advanced methods for early detection of lung cancer in the uranium miner/worker population

International Nuclear Information System (INIS)

Profio, A.E.; Balchum, O.J.; Saccomanno, G.; Huth, G.C.

1983-01-01

Fluorescence bronchoscopy with a violet laser and image intensifier has been developed for imaging the red fluorescence of a tumor-specific agent, hematoporphyrin derivative, that has been injected before the examination. The instrument was developed to localize carcinoma in situ and early, small bronchogenic tumors diagnosed by sputum cytology but invisible on chest x-ray and conventional bronchoscopy, in underground uranium miners and others at risk for lung cancer. In addition to the imaging devices, a video system including a processor and electronics for digital background image subtraction has been developed to enhance contrast. A ratio fluorometer and a rapid-scan spectrum analyzer have been designed for quantitative measurements of fluorescence intensity and dependence on dosage and time after injection of the fluorescent agent. Clinical trials demonstrate detection of carcinoma in situ, and the true positive rate should be improved by the new instrumentation and optimization of time delay and dosage. 14 references, 6 figures

Endobronchial neurogenic tumor: A combination of traumatic neuroma and neurofibroma

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Amit Tandon

2017-01-01

Full Text Available Traumatic neuromas are uncommon and benign lesions arising from a peripheral nerve injury during surgery. Here we describe a case with histopathologic features of both a traumatic neuroma and neurofibroma in a patient without integumentary physical exam findings nor prior surgical history. A 54 year old male was admitted for surgical debridement of a foot ulcer. During pre-operative evaluation and review of imaging multiple CT scans revealed a stable, 4 mm endobronchial lesion in the left lower lobe. Given history of nicotine abuse, bronchoscopy was performed. Bronchoscopy showed a pearly, polypoid lesion. Histopathological results showed strong positivity for S-100 protein and spindle cell proliferation. Repeat CT chest showed no new lesions in the bronchial tree. The rarity of this case is noted not only by the limited number of bronchial neurogenic tumors, but the combined features in this case of a traumatic neuroma and neurofibroma which has not been described.

A Rare Case of Idiopathic Plastic Bronchitis

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Mohammed Raoufi

2017-01-01

Full Text Available Plastic bronchitis is a rare disorder characterized by formation of large, branching bronchial casts, which are often expectorated. We present an interesting case of a 35-year-old woman who presented for evaluation of a chronic cough productive of voluminous secretions. Clinical and radiological examination confirmed a total left lung atelectasis without any pathological mediastinal node. Flexible bronchoscopy demonstrated tenacious, thick, and sticky whitish secretions blocking the left stem bronchus. This material was extracted, and inspection demonstrated a bronchial cast, whose pathological analysis revealed necrotic epithelial cells, some eosinophils, and Charcot-Leyden crystals. Two days after bronchoscopy, the patient rejected more bronchial casts, and dyspnea improved. Control of chest x-ray revealed complete left lung aeration and the diagnosis of idiopathic plastic bronchitis was obtained. This article shows the interest in clinical practice to evoke the diagnosis of plastic bronchitis in front of a productive chronic cough. Our case illustrates a rare clinical presentation represented by an atelectasis of an entire lung.

Medical image of the week: right middle lobe syndrome

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Cristan EA

2016-05-01

Full Text Available No abstract available. Article truncated at 150 words. A 73 year-old woman, a lifetime non-smoker, presented to the pulmonary clinic with chronic dyspnea on exertion and cough. Physical exam was unremarkable and pulmonary function testing showed normal spirometry. A chest radiograph revealed calcified mediastinal adenopathy and increased density in the right middle lobe region (Figure 1. A computed tomography scan of the chest revealed significant narrowing of the right middle lobe bronchus with partial atelectasis and prominent calcified mediastinal lymphadenopathy (Figure 2. Bronchoscopy showed no endobronchial lesions but there was evidence of extrinsic compression surrounding the right middle lobe orifice. An endobronchial biopsy revealed noncaseating granulomas. Bronchoscopy cultures and cytology were negative and this was presumed to be from a previous infection with histoplasmosis given the patient’s long-term residence in an endemic area. Given chronic narrowing of right middle lobe bronchus with persistent atelectasis of the right middle lobe, the patient was diagnosed with right middle lobe syndrome. ...

[Microbiology of bronchoalveolar lavage in infants with bacterial community-acquired pneumonia with poor outcome].

Science.gov (United States)

García-Elorriaga, Guadalupe; Palma-Alaniz, Laura; García-Bolaños, Carlos; Ruelas-Vargas, Consuelo; Méndez-Tovar, Socorro; Del Rey-Pineda, Guillermo

Community-acquired pneumonia (CAP) is one of the most common infectious causes of morbidity and mortality in children <5 years of age. The aim of the study was to clarify the bacterial etiologic diagnosis in infants with CAP. A prospective, cross-sectional and descriptive study in patients 6 months to 2 years 11 months of age with CAP with poor outcome was conducted. Patients were admitted to the Pediatric Pneumology Service and underwent bronchoscopy with bronchoalveolar lavage (BAL), taking appropriate measures during the procedure to limit the risk of contamination. Aerobic bacteria isolated were Moraxella sp. 23%, Streptococcus mitis 23%, Streptococcus pneumoniae 18%, Haemophilus influenzae 12%, Streptococcus oralis 12%, and Streptococcus salivarius 12%. In contrast to other reports, we found Moraxella sp. to be a major bacterial pathogen, possibly because of improved detection with bronchoscopy plus BAL. Copyright © 2015 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Respiratory effects of particulate matter air pollution: studies on diesel exhaust, road tunnel, subway and wood smoke exposure in human subjects

Energy Technology Data Exchange (ETDEWEB)

Sehlstedt, Maria

2011-07-01

Background: Ambient air pollution is associated with adverse health effects, but the sources and components, which cause these effects is still incompletely understood. The aim of this thesis was to investigate the pulmonary effects of a variety of common air pollutants, including diesel exhaust, biomass smoke, and road tunnel and subway station environments. Healthy non-smoking volunteers were exposed in random order to the specific air pollutants and air/control, during intermittent exercise, followed by bronchoscopy. Methods and results: In study I, exposures were performed with diesel exhaust (DE) generated at transient engine load and air for 1 hour with bronchoscopy at 6 hours post-exposure. Immunohistochemical analyses of bronchial mucosal biopsies showed that DE exposure significantly increased the endothelial adhesion molecule expression of p-selectin and VCAM-1, together with increased bronchoalveolar lavage (BAL) eosinophils. In study II, the subjects were exposed for 1 hour to DE generated during idling with bronchoscopy at 6 hours. The bronchial mucosal biopsies showed significant increases in neutrophils, mast cells and lymphocytes together with bronchial wash neutrophils. Additionally, DE exposure significantly increased the nuclear translocation of the aryl hydrocarbon receptor (AhR) and phosphorylated c-jun in the bronchial epithelium. In contrast, the phase II enzyme NAD(P)H-quinone oxidoreductase 1 (NQO1) decreased after DE. In study III, the 2-hour exposures took place in a road tunnel with bronchoscopy 14 hours later. The road tunnel exposure significantly increased the total numbers of lymphocytes and alveolar macrophages in BAL, whereas NK cell and CD56+/T cell numbers significantly decreased. Additionally, the nuclear expression of phosphorylated c-jun in the bronchial epithelium was significantly increased after road tunnel exposure. In study IV, the subjects were exposed to metal-rich particulate aerosol for 2 hours at a subway station

Author Details

African Journals Online (AJOL)

Onyekwulu, FA. Vol 13, No 1 (2008) - Articles Intensive Care Management of Myasthenia Gravis After Thymectomy Abstract · Vol 15, No 2 (2010) - Articles Bronchoscopy for foreign body removal in children: anaesthetic challenges in a tertiary health Centre. Abstract. ISSN: 1118-2601. AJOL African Journals Online. HOW TO ...

End-tidal carbon dioxide monitoring during flexible fiberoptic ...

African Journals Online (AJOL)

In recent years, flexible fiberoptic bronchoscopy (FFB) has been applied for diagnostic and some therapeutic purposes. During FFB and even in the presence of supplemental oxygen, hypoventilation leading to hypoxia and desaturation may occur; this is aggravated by the use of suction. Arterial oxygen saturation is usually ...

Inspection of the nasopharynx prior to fiberoptic-guided nasotracheal intubation reduces the risk epistaxis.

Science.gov (United States)

Kwon, Min A; Song, Jaegyok; Kim, Seokkon; Ji, Seong-Mi; Bae, Jeongho

2016-08-01

Various complications may occur during nasotracheal intubation. This may include epistaxis and damage to the nasopharyngeal airway. We tested the hypothesis that the use of fiberoptic bronchoscopy (FOB)-guided intubation is superior to endotracheal tube (ETT) obturated with an inflated esophageal stethoscope. Patients were randomly assigned to 1 of 2 groups (n=22 each): either an FOB-guided intubation group or ETT obturated with an inflated esophageal stethoscope group. After the induction of general anesthesia, patients in the FOB group received an FOB inspection through the nostril without advancement of ETT. Then, after confirming the placement of the bronchoscope tip in the trachea, the lubricated ETT was advanced via the nostril to the trachea along the bronchoscope. In the obturated ETT insertion group, the proximal opening of the ETT was blunted with an inflated esophageal stethoscope. The ETT was inserted into the selected nostril and advanced blindly into the posterior oropharynx. Then, the esophageal stethoscope was removed and tracheal intubation was performed with the bronchoscope. The number of attempts for successful tracheal intubation, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. Another anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5minutes after the intubation and postoperative complications. The FOB group had significantly less epistaxis during bronchoscopy, better navigability, and fewer intubation attempts and redirections. Fiberoptic-guided nasotracheal intubation was associated with less epistaxis. It also showed better navigability and less redirection rate. Therefore, FOB as an intubation guide is superior to ETT with an inflated esophageal stethoscope when intubating a patient via the nasotracheal route. Copyright © 2016 Elsevier Inc. All rights reserved.

The clinical features of foreign body aspiration into the lower airway in geriatric patients

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Lin LJ

2014-09-01

Full Text Available Lianjun Lin,1 Liping Lv,2,* Yuchuan Wang,1 Xiankui Zha,2 Fei Tang,2 Xinmin Liu1,* 1Geriatric Department, Peking University First Hospital, Beijing, People’s Republic of China; 2Pulmonary Intervention Department, Anhui Chest Hospital, Hefei, People’s Republic of China *These authors contributed equally to this work Purpose: To analyze the clinical features of foreign-body aspiration into the lower airway in geriatric patients. Patients and methods: The clinical data of 17 geriatric patients with foreign-body aspiration were retrospectively analyzed and compared with 26 nongeriatric adult patients. The data were collected from Peking University First Hospital and Anhui Chest Hospital between January 2000 and June 2014.Results: (1 In the geriatric group, the most common symptoms were cough and sputum (15 cases, 88%, dyspnea (six cases, 35%, and hemoptysis (four cases, 24%. Five patients (29% in the geriatric group could supply the history of aspiration on their first visit to doctor, a smaller percentage than in the nongeriatric group (13 cases, 50%. Only three cases in the geriatric group were diagnosed definitely without delay. Another 14 cases were misdiagnosed as pneumonia or lung cancer, and the time of delayed diagnosis ranged from 1 month to 3 years. Complications due to delay in diagnosis included obstructive pneumonitis, atelectasis, lung abscess, and pleural effusion. (2 Chest computed tomography demonstrated the foreign body in three cases (21% in the geriatric group, which was lower than the positive proportion of detection in the nongeriatric group (nine cases, 35%. The most common type of foreign body in the geriatric group was food, such as bone fragments (seven cases, 41% and plants (seven cases, 41%, and the foreign body was most often lodged in the right bronchus tree (eleven cases, 65%, especially the right lower bronchus (seven cases, 41%. Flexible bronchoscopy removed the foreign body successfully in all patients

[Joint application of 7 interventional pulmonology methods in early diagnosis of lung cancer].

Science.gov (United States)

Jin, Fa-Guang; Li, Wang-Ping; Mu, De-Guang; Chu, Dong-Ling; Fu, En-Qing; Xie, Yong-Hong; Lu, Jing-Li; Sun, Ya-Ni

2009-06-23

To evaluate the combination of 7 interventional pulmonology methods in early diagnosis of lung cancer. A total of 467 patients with thoracic and pulmonary lesions (include hilum pulmonis lymphadenectasis, mediastinal lymphadenectasis, pulmonary scobination, lump, lamellar infiltration, small amount of pleural fluid and pleural scobination) had negative results via exfoliative cytology, bacteriology and routine bronchoscopy. All these patients had ultrathin bronchoscopy with biopsy and brushing. For those 155 cases whose foci were located at porta pulmonis, inner zone or median zone, the authors applied ultrathin bronchoscopy with biopsy and brushing guided by X-ray. For those 95 cases whose foci were located at median zone or outer zone and unconnected with chest wall, per cutem lung puncture needle aspiration was employed under the guidance of X-ray. For those 102 cases whose foci were tightly connected with pleural membrane, per cutem lung puncture biopsy was employed under the guidance of type-B ultrasonic. For those 59 cases with suspected central airway foci, auto-fluorescence bronchoscopic biopsy and brushing were employed. For those 67 cases with hilum pulmonis or mediastinal lymphadenectasis, endobronchial ultrasonic transbronchial needle aspiration (EBUS-TBNA) was employed. For those 23 cases with small amount of pleural fluid or pleural scobination, electronic thoracoscopic biopsy and brushing were employed. It was found that 118 cases were diagnosed by ultrathin bronchoscopic biopsy and brushing with a positive rate of 25.3% (118/467), 105 cases by ultrathin bronchoscopy with biopsy and brushing guided by X-ray with a positive rate of 67.7% (105/155), 63 cases by per cutem lung puncture needle aspiration under the guidance of X-ray with a positive rate of 66.3% (63/95), 69 cases by per cutem lung puncture biopsy under the guidance of type-B ultrasound with a positive rate of 67.6% (69/102), 18 cases by auto-fluorescence bronchoscopic biopsy and brushing

IgM response to a human Pneumocystis carinii surface antigen in HIV-infected patients with pulmonary symptoms

DEFF Research Database (Denmark)

Lundgren, Bettina; Kovacs, J A; Mathiesen, Lars Reinhardt

1993-01-01

We have developed an ELISA to detect IgM antibodies to a major human Pneumocystis carinii surface antigen (gp95), and investigated the IgM response in 128 HIV-infected patients who underwent bronchoscopy for evaluation of pulmonary symptoms. Only 5 (4%) patients had IgM antibodies to P. carinii g...

Tracheobronchial foreign body aspiration in children: A continuing ...

African Journals Online (AJOL)

Ten children in early diagnosis group and 29 children in late diagnosis group presented with complications. The diagnosis delay was mainly attributed to physician misdiagnosis (41.6%). Rigid bronchoscopy was performed in all patients. Foreign body was found in all of the cases except six. Watermelon seeds and peanuts ...

Everything that wheezes… Late presentation of an aspirated foreign body as a cause of near fatal respiratory distress

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L. Hindle*

2013-12-01

Discussion: This case illustrates the difficulty doctors may have when there is delayed presentation or unwitnessed aspiration of a foreign body. History, clinical symptoms and the X-ray findings may provide clues but are not diagnostic. In cases where a FB aspiration is suspected, bronchoscopy is both diagnostic and potentially curative.

Flexible bronchoscopy contribution in the approach of diagnosis and ...

African Journals Online (AJOL)

is considered as a key exam in various conditions such as chronic interstitial lung .... consisting in bronchial stenosis (n = 5), lung hypoplasia or agenesis (n = 5), ... led to Mycobacterium tuberculosis isolation in five cas- es of suspected ...

Flexible bronchoscopy contribution in the approach of diagnosis and ...

African Journals Online (AJOL)

children's respiratory diseases: the experience of a unique pediatric unit in Tunisia. ... cases. FB was of great diagnostic value in 74.8% of the cases. ..... pneumonia ... of the child, an essential parameter to detect tracheal .... Radiology. 2007 ...

Author Details

African Journals Online (AJOL)

Kamash, FA. Vol 5, No 2 (2005) - Articles End-tidal carbon dioxide monitoring during flexible fiberoptic bronchoscopy. Abstract · Vol 5, No 2 (2005) - Articles Prediction and assessment of depression rates in patients with advanced lung cancer. Abstract · Vol 5, No 2 (2005) - Articles Re-expasion pulmonary edema and its ...

Diseases of the bronchi

International Nuclear Information System (INIS)

Lindenbraten, L.D.; Vinner, M.G.

1983-01-01

Roentgenologic semiotics of acute and chronic bronchites has been presented. It is shown, that in the combined daignosis of bronchi diseases roentgenograp hy and roentgenoscopy of lungs, roentgenofunctional tests and bronchography shou ld be used. For the diagnosis of broncholithiases, retention cysts and foreign bodies in bronchi the tomography, bronchography and bronchoscopy are used

Tuberculosis mimicking lung cancer

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I. Hammen

2015-01-01

Our case report presents two patients, who were referred to the Thorax diagnostic centre at the Department of Respiratory Medicine, Odense University Hospital, with presumptive diagnosis of neoplasm and had proved lung TB with no evidence of malignancy instead. In the first case diagnosis was confirmed after thoracotomy, in the second case after bronchoscopy.

Nasotracheal Intubation in Children for Outpatient Dental Surgery: Is ...

African Journals Online (AJOL)

2018-02-23

Feb 23, 2018 ... in Children for Outpatient Dental Surgery: Is Fiberoptic Bronchoscopy. Useful?. Niger J Clin Pract 2018;21:183-8. This is an open access article distributed under the terms of the Creative Commons. Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the ...

FOREIGN BODY ASPIRATION: A CASE REPORT

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Nafia Ozlem Kazanci

2013-03-01

Full Text Available Foreign body aspiration (FBA is common under 3 years of age. FBA can cause sudden respiratory failure. Furthermore, it leads to many respiratory system complications. Therefore, FBA is an important cause of mortality and morbidity for this age group. FBA cases are usually followed by diagnoses like pneumonia, bronchitis or bronchial asthma in the late period that history, clinical and laboratory findings suggesting foreign body aspiration can not be detected. We reported a 2-year-old male patient with pneumonia, who were administered various treatments. In thorax CT of this case, an image compatible with foreign body was seen in the right middle lobe-upper lobe separation area. Granulation tissue was detected in the entrance of the right main bronchus by rigid bronchoscopy and marked improvement occured in lung aeration after bronchoscopy. This case was reported to emphasize the importance of early diagnosis of foreign body aspiration because of high mortality and morbidity and the necessity of considering the foreign body aspiration in children with recurrent pulmonary infections. [J Contemp Med 2013; 3(1.000: 58-61

Bronchoscopic examinations for evaluating chest abnormal shadows associated with hematological disease

International Nuclear Information System (INIS)

Nakayama, Masayuki; Bando, Masashi; Kobayashi, Akira; Yamasawa, Hideaki; Ohno, Shoji; Sugiyama, Yukihiko

2006-01-01

Hematological diseases cause various respiratory complications, but their differentiation only by blood tests and chest radiology is often difficult. To clarify the characteristics of respiratory complications associated with hematological diseases and the diagnostic usefulness of bronchoscopic examinations for these complications, we clinically evaluated mainly underlying diseases, chest radiological findings, and bronchoscopic findings in 31 patients in whom we performed bronchoscopy for chest abnormal shadows associated with hematological disease during the past 13-year period. Among hematological disease, leukemia was most frequently observed, followed by malignant lymphoma and myelodysplastic syndrome. The most frequently observed chest CT findings were localized consolidation and diffuse Ground-glass opacity. Bronchoscopic examinations provided a definitive diagnosis in 20 patients (64.5%), and the most frequent diagnosis was pulmonary invasion by neoplastic cells (7 patients). Pulmonary invasion by neoplastic cells showed various images, and transbronchial lung biopsy : TBLB was useful for definitive diagnosis. After consideration of the general condition of patients and the risk of complications, bronchoscopy including TBLB should be performed when possible. (author)

An Adult Patient with Pneumonia Due to Aspiration of Dental Prosthesis

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Samil Gunay

2014-03-01

Full Text Available In patients with a new and suddenly beginning of bronchial asthma and repetitive respiratory infection, one should consider the possibility of obstruction by a foreign body. In this case we present a male patient with pneumonia due to aspiration of dental prosthesis. A 32-year-old man presented with a 4-month history of dyspnea, chest pain and new    compliants of diaphoresis and fever persistend despite of antibiotic treatment. Then the patient consultated to our chest surgery department. After the physical examination of patient we made the fiberoptic  flexible bronchoscopy according to the uncertain opasity seen in the chest radiography. Later in the operating room, with the patient under general anesthesia, we extracted the aspirated foreign body, dental prosthesis, by rigid bronchoscopy. We should think about the possibility of foreign body aspiration for the patients with suddenly beginning of the complaints such as, bronchial asthma, repetitive respiratory infection, diaphoresis, chest pain and fever. Sometimes people hides the true anamnesis because of be ashamed or amnesia.

High resolution CT for localization of early hilar lung carcinoma

International Nuclear Information System (INIS)

Minami, Yuko; Ishikawa, Shigemi; Saida, Yukihisa; Kajitani, Motomasa; Yamamoto, Tatsuo; Sato, Yukio; Onizuka, Masataka; Sakakibara, Yuzuru; Noguchi, Masayuki

2002-01-01

The purpose of this study was to analyse the usefulness of high resolution CT (HRCT) for the diagnosis and localization of roentgenographically occult lung cancer. HRCT was performed prospectively on chest X-ray negative patients with bloody sputum or suspicious or positive cells on sputum cytology between 1998 and 2000. After the HRCT scan, white light bronchoscopy and autofluorescence bronchoscopy were performed. HRCT depicted 19 hilar bronchial lesions in 13 cases out of 19 patients, of which 9 lesions were confirmed by white light broncoscope. Of 8 hilar squamous cell carcinomas diagnosed in this study, 7 lesions (87.5%) were depicted by HRCT. One CT-negative case (12.5%) was an in situ carcinoma in left B 1+2 . Four out of 20 lesions which showed bronchoscopic abnormality, could not be depicted by HRCT. HRCT could prospectively detect 80% of the bronchoscopic abnormalities and 87.5% of the hilar squamous cell carcinomas of the tracheobronchial lesions of the lung. Therefore, HRCT can be an effective supplemental means for screening for hilar squamous cell carcinoma. (author)

Clinical value of whole-blood interferon-gamma assay in patients with suspected pulmonary tuberculosis and AFB smear- and polymerase chain reaction-negative bronchial aspirates.

Science.gov (United States)

Lee, Jaehee; Lee, Shin Yup; Yoo, Seung Soo; Cha, Seung Ick; Won, Dong Il; Park, Jae Yong; Lee, Won-Kil; Kim, Chang Ho

2012-07-01

Combining a polymerase chain reaction (PCR) test with bronchoscopy is frequently performed to allow a rapid diagnosis of smear-negative pulmonary tuberculosis (PTB). However, limited data are available concerning clinical judgment in patients with suspected PTB and AFB smear- and PCR-negative bronchial aspirates (BA). The present study evaluated the usefulness of whole-blood QuantiFERON-TB Gold In-Tube (QFT) testing in these patients. Of 166 patients with suspected PTB who had undergone bronchoscopy because of smear-negative sputum or inadequate sputum production, 93 (56%) were diagnosed with culture-positive PTB. Seventy-four patients were either AFB smear- or PCR-positive. In the 75 patients whose BA AFB smear and PCR results were both negative, 19 were finally diagnosed with PTB by culture. The QFT test had a negative predictive value of 91% for PTB. The QFT test may be useful for excluding PTB in patients with suspected PTB whose BA AFB smear and PCR results are both negative. Copyright © 2012 Elsevier Inc. All rights reserved.

CYTOMORPHOLOGICAL EVALUATION AND PROGNOSIS OF BRONCHOPULMONARY COMPLICATIONS IN ACUTE AND EARLY PERIODS OF SPINAL CORD TRAUMA

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I.A. Norkin

2009-09-01

Full Text Available There were investigated 50 cytological preparations after fibro-optic bronchoscopy of 10 patients with cervical spinal cord injuries. The dynamics of broncho-pulmonary complications of spinal cord injuries was estimated on the basis of cytological broncho-alveolar lavage fluid investigations. In the work there were used clinico-neurologic methods, radiological (computer tomography and magnetic resonance imaging, endoscopic (fibro-optic bronchoscopy and cytomorphological investigations. Cytomorphological investigations of broncho-alveolar lavage fluid were carried out on the 3-4, 7, 14, 30th days. Cellular composition of the broncho-alveolar wash-out (endopulmonary cytogramme was estimated by calculation of more than 100 cells in 3 fields of the immersion microscope coverage. Quantitative changes of cellular elements were taken into account with respect to normal cell amount. The results were analyzed according to the average out method. Quantitative changes of inflammatory elements in endopulmonary cytogramme were determined by the degree of endobronchitic manifestations and were corresponding to clinico-radiological picture of development of broncho-pulmonary complications in different periods of spinal cord injury

Fiberoptic bronchoscopic treatment of blood aspiration and use of sugammadex in a patient with epistaxis

Science.gov (United States)

Ryu, Taeha; Kim, Dong Hyuck; Byun, Sung Hye

2018-01-01

Abstract Rationale: In patients with oropharyngeal and nasopharyngeal bleeding, blood aspiration can make airway management difficult and lead to severe pulmonary complications. Patient concerns: A 44-year-old male patient with recurrent epistaxis underwent surgery for hemostasis. The patient aspirated blood through the endotracheal tube when he hiccupped during the surgery. Diagnosis: The patient was diagnosed with blood aspiration after intraoperative fiberoptic bronchoscopy revealed a blood clot and viscous mucus in the airways, but no sign of active bleeding. Interventions: Tracheobronchial suctioning and irrigation with normal saline was performed through the bronchoscope to remove the aspirated blood clot. Prior to emergence from anesthesia, sugammadex was administered to induce complete neuromuscular recovery and enable the patient to cough up any blood remaining in the airways. Outcomes: The patient was successfully extubated and fully recovered with no complications. Lessons: Blood aspiration due to oropharyngeal or nasopharyngeal bleeding can be diagnosed and treated by tracheobronchial suctioning via fiberoptic bronchoscopy. In addition, sugammadex can enable patients to recover spontaneous breathing, facilitate extubation, and enable patients to cough up any blood remaining in the airways. PMID:29642212

Bronchoscopic hemostatic tamponade with oxidized regenerated cellulose for major hemoptysis control: two case reports

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C.C. Nogueira

2010-11-01

Full Text Available Hemoptysis is a common and alarming clinical problem. Acute massive hemoptysis is a life threatening condition. Different therapeutic strategies such as surgery, endovascular treatment and/or bronchoscopy have been applied. We report two cases of patients with severe hemoptysis who were treated by bronchoscopy guided topical hemostatic tamponade therapy with oxidized regenerated cellulose. Resumo: Hemoptises são um problema clinico comum e grave. Nalguns casos, como nas hemoptises maciças, podem causar mortalidade elevada. Para o seu controlo e/ou tratamento têm sido aplicadas diferentes estratégias como a cirurgia, embolização das artérias brônquicas e tratamentos broncoscópicos. Os autores descrevem dois casos clinicos de pacientes com hemoptises graves, cujo controlo foi efectuado por broncoscopia com aplicação de tamponamento hemostático com celulose oxidade regenerada (Surgicell®, Johnson and Johnson's, London. Keywords: Hemoptysis, Bronchoscopic hemostatic therapy, Oxidized regenerated cellulose, Palavras-chave: Hemoptises, Terapêutica broncoscópica hemostática, Celulose oxidada regenerada

Airway Autoimmune Inflammatory Response (AAIR) Syndrome: An Asthma-Autoimmune Overlap Disorder?

Science.gov (United States)

Spencer, Chantal Y; Millman, Jennifer; Veiga, Keila; Vicencio, Alfin G

2018-02-15

Asthma encompasses numerous phenotypes that may require alternate approaches to diagnosis and therapy, particularly for patients whose symptoms remain poorly controlled despite escalating treatment. We describe 3 patients with apparent asthma who demonstrated unusual findings on cryobiopsy by flexible bronchoscopy and responded to therapy directed against autoimmune disease. Copyright © 2018 by the American Academy of Pediatrics.

An approach to tracheostomy in a patient with an expandable metallic tracheal stent.

Science.gov (United States)

Madden, Brendan P; Sheth, Abhijat

2005-09-01

With increasing use of expandable metallic stents to manage patients with a variety of endobronchial pathologies, some will have a subsequent need for tracheostomy insertion. We describe a successful technique to insert a tracheostomy using rigid and fibre-optic bronchoscopy in a patient who had an 8 cm expandable metallic tracheal stent deployed previously on account of tracheomalacia.

Congenital bronchobiliary fistula: MRI appearance

International Nuclear Information System (INIS)

Hourigan, Jon S.; Carr, Michael G.; Burton, Edward M.; Ledbetter, Joel C.

2004-01-01

Congenital bronchobiliary fistula (CBBF) is a rare anomaly. Twenty-three cases have been reported since the anomaly was first described in 1952. Most of these cases were diagnosed by bronchoscopy, cholangiography, or hepatobiliary nuclear imaging. Our case of a newborn with bilious emesis with CBBF was depicted by T1-weighted gradient-echo MRI sequences. (orig.)

Barium aspiration and alveolarisation of barium in an infant: A case report and review of management

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Alan F. Isles

2014-05-01

Full Text Available We describe a case of bilateral inhalation and alveolarisation of barium in an infant following a barium swallow for investigation of dusky spells associated with feeds. A bronchoscopy subsequently revealed the presence of a mid-tracheal tracheo-oesophageal cleft. We review the literature on barium aspiration, its consequences and make recommendations for management.

STUDY OF TIME LAPSE IN FOREIGN BODY ASPIRATION IN RELATION TO CHEST X - RAY AND TYPE OF FOREIGN BODY

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Salma

2015-10-01

Full Text Available INTRODUCTI ON: Foreign body aspiration in pediatrics is a potentially fatal accident which will continue until children explore their surroundings with their hand and mouth. Pediatric aspirations will persist until mankind exists. Not all foreign body aspirations are witnessed hence chances of delay in diagnosing an aspiration are high. Delay in diagnosis depends on site and character of foreign body aspirated. The chest x - ray findings and type of foreign body extracted vary depending on the duration the foreign body remains in airway . OBJECTIVE: To study the X - ray finding in pediatric airway aspiration and its relation to time lapse, the type and site of lodgment of foreign body extracted via bronchoscopy. The type of foreign body in relation to time lapse in aspiration. MATERIAL AND METHODS: This was a prospective study done in Bapuji child health institute and research center, JJM Medical College, Davangere . History and pre bronchoscopy x - Ray finding were noted for 65 children who were posted for suspicious bronchoscopy from August 2011 to September 2013. 11 children were excluded from study as they showed no foreign body on bronchoscopy. Time lapse in aspir ation and seeking medical care was noted. The bronchoscopic findings regarding site of foreign body lodgment and type of foreign body were recorded. The type of foreign body and variation of x - ray picture in relation to time lapse in aspiration were noted. Data collected was analyzed using descriptive statistics. RESULT: It was observed that mean age was 28 months. About 80% of the cases were between 1 to 3 years age. 82% (n=53/54 were radio lucent foreign body, only 1.5% (n=1/54 were radio o paque. Site of lodgment of foreign body was right main bronchus in 48% (n=26/54, left main bronchus 46% (n=25/54 , tracheal 1.85% (n=1/54, subglottic 1.85% (n=1/54, carinal 1.85% (n=1/54, multiple site i.e. left bronchus +right bronchus+ carinal 1.85% (n=1/54. Groundnut was most common

The interstitial pneumonitis induced by cytostatics

International Nuclear Information System (INIS)

Dubrava, M.; Markova, I.; Mistina, L.

1998-01-01

The author presents a cause of 9-year old boy with ALL-F2B in the stage of the prevention treatment where in the its course the induced interstitial pneumonitis by cytostatics was developed. The bacterial, virus, mycological and parasitic causes of the interstitial pneumonitis on the basis of the bronchoscopy, BAL, CT, scintigraphy, laboratory and by cultivation were excluded. (authors)

Bronchial Mucus Properties in Lung Cancer: Relationship with Site of Lesion

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J Gustavo Zayas

1999-01-01

Full Text Available OBJECTIVE: To compare the biophysical properties of mucus from the left and right mainstem bronchi in patients undergoing diagnostic bronchoscopy because of a unilateral radiological abnormality. It was hypothesized that abnormalities in the properties of mucus would be greater on the side with the lesion and that this would be most obvious in patients with unilateral lung cancer.

The Importance of Bronchoscopy in Early Lung Cancer (LC Diagnosis

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Tofolean Doina-Ecaterina

2016-11-01

Full Text Available Lung cancer is a leading cause of death worldwide, due to the fact that most patients are diagnosed in a fairly advanced stage. Screening tests such as sputum citology, chest x-rays or CT scans have their limitations and need further histological confirmation of the diagnosis.

CLINICAL PROFILE OF PRIMARY LUNG CANCER AND ROLE OF BRONCHOSCOPY

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Bharate

2015-08-01

Full Text Available INTRODUCTION: Cancer is a Latin word meaning "A CRAB". The Greek word for a crab is "KARKINES" and Sanskrit word is "KARKARA ” . (1 Lung cancer is one of the commonest fatal neoplastic disease s in the world . It is at the first place at central and North India and at second place at south India. It is estimated that, every year in India, about 30,000 new lung cancer cases are registered .

Stridor and respiratory failure due to tracheobronchomalacia: case report and review of the literature

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Ramon Andrade de Mello

Full Text Available CONTEXT: Tracheobronchomalacia (TBM results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of the trachea and main bronchi. In this paper, we present a rare case of a patient with TBM who first presented with stridor and respiratory failure due to exacerbation of chronic bronchitis. CASE REPORT: An 81-year-old Caucasian man was admitted presenting coughing, purulent sputum, stridor and respiratory failure. He had a medical history of chronic obstructive pulmonary disease (COPD and silicosis and was a former smoker. Axial computed tomography on the chest revealed marked collapse of the trachea in its middle third. Bronchoscopy showed characteristics compatible with TBM. He was treated with noninvasive ventilation, without any good response. Subsequently, a Dumon Y stent was placed by means of rigid bronchoscopy. After the procedure, he was discharged with a clinical improvement. CONCLUSION: TBM is fatal and often underdiagnosed. In COPD patients, stridor and respiratory failure may be helpful signs that should alert physicians to consider TBM as an early diagnosis. Thus, these signs may be important for optimizing the treatment and evolution of such patients.

[The cause and efficacy of benign tracheal stenosis].

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Su, Zhu-quan; Wei, Xiao-qun; Zhong, Chang-hao; Chen, Xiao-bo; Luo, Wei-zhan; Guo, Wen-liang; Wang, Ying-zhi; Li, Shi-yue

2013-09-01

To analysis the causes of benign tracheal stenosis and evaluate the curative effect of intraluminal bronchoscopic treatment. 158 patients with benign tracheal stenosis in our hospital from September 2005 to September 2012 were collected to retrospectively analysis the causes and clinic features of tracheal stenosis. Interventional treatments through bronchoscopy were used to treat the benign tracheal stenosis and the curative effects were evaluated. 158 cases of benign tracheal stenosis were recruited to our study, 69.6% of them were young and middle-aged. The main causes of benign tracheal stenosis were as follows: secondary to postintubation or tracheotomy in 61.4% (97/158), tuberculosis in 16% (26/158), benign tumor in 5.1% (8/158) and other 27 cases. 94.3% patients improved in symptoms with alleviation immediately after bronchoscopic treatment, the average tracheal diameter increased form (4.22 ± 2.06) mm to (10.16 ± 2.99) mm (t = 21.48, P benign tracheal stenosis were increasing year by year. The most common cause of benign tracheal stenosis was postintubation and tracheotomy. Interventional treatments through bronchoscopy is effective in treating benign tracheal stenosis, but repeated interventional procedures may be required to maintain the favorable long-term effects.

Tension pneumomediastnum: A rare cause of acute intraoperative circulatory collapse in the setting of unremarkable TEE findings.

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Weaver, Jonathan B; Kumar, Avinash B

2017-02-01

Case report. Operating room. 25YF, ASA IV E who underwent an emergent decompressive craniectomy for refractory intracranial hypertension secondary to acute intracranial hemorhage. A 25Y caucasian female presented with acute intracranial hemorrhage with intraventricular extension secondary to Moya Moya disease. Post admisison, she underwent an emergent decompressive craniectomy for medically refractory intracranial hypertension. Introperatively (post dural closure and bone flap removal) the patient developed acutely worsening peak and plateau pressures followed by pulseless electrical activity necessitating CPR with epinephrine and Vasopressin before return of circulation before return of circulation. Intraoperative TEE done during return of circulation, was essentially non diagnostic, the patient had normal breath sounds throughout, and non-contributory bronchoscopy findings. EKG, arterial blood pressure, heart rate, resp. rate, introperative tranesophageal echocardiogram (TEE), Pulse oximetry, serial arterial blood gases, introperative bronchoscopy, ventilatory peak pressures. A post operative chest CT revealed extensive pneumomediastinum with subcutaneous emphysema. The focussed introperative echocardiogram showed preserved left ventricular function and no evidence of tamponade physiology. Tension pneumomediastinum was the likely etiologic factor for the acute hemodynamic collapse and should be considered in the differential diagnosis of intraoperative circulatory arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

CT findings of plastic bronchitis in children after a Fontan operation

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Goo, Hyun Woo [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea); Jhang, Won Kyoung; Kim, Young Hwee; Ko, Jae Kon; Park, In Sook [University of Ulsan College of Medicine, Department of Pediatric Cardiology, Asan Medical Center, Seoul (Korea); Park, Jeong-Jun; Yun, Tae-Jin; Seo, Dong-Man [University of Ulsan College of Medicine, Department of Pediatric Cardiac Surgery, Asan Medical Center, Seoul (Korea)

2008-09-15

Plastic bronchitis is a rare cause of acute obstructive respiratory failure in children. Life-threatening events are much more frequent in patients with repaired cyanotic congenital heart disease, and most frequent following a Fontan operation. Commonly, the diagnosis is not made until bronchial casts are expectorated. Detailed CT findings in plastic bronchitis have not been described. To describe the CT findings in plastic bronchitis in children after a Fontan operation. Three children with plastic bronchitis after a Fontan operation were evaluated by chest CT. Bronchial casts were spontaneously expectorated and/or extracted by bronchoscopy. Airway and lung abnormalities seen on CT were analyzed in the three children. CT demonstrated bronchial casts in the central airways with associated atelectasis and consolidation in all children. The affected airways were completely or partially obstructed by the bronchial casts without associated bronchiectasis. The airway and lung abnormalities rapidly improved after removal of the bronchial casts. CT can identify airway and lung abnormalities in children with plastic bronchitis after a Fontan operation. In addition, CT can be used to guide bronchoscopy and to monitor treatment responses, and thereby may improve clinical outcomes. (orig.)

Intrapulmonary penetration of linezolid.

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Honeybourne, David; Tobin, Caroline; Jevons, Gail; Andrews, Jenny; Wise, Richard

2003-06-01

This study was designed to measure the concentrations of linezolid in bronchial mucosa, pulmonary macrophages and epithelial lining fluid and to compare them with simultaneous blood levels. Ten adult patients undergoing bronchoscopy for diagnostic purposes were given oral linezolid at a dosage of 600 mg twice a day for a total of six doses. Patients with active lung infection were excluded from the study. Flexible bronchoscopy was carried out between 2 and 8 h after the last dose of linezolid. Bronchial biopsies and bronchoalveolar lavage were carried out and a simultaneous blood sample obtained. Linezolid levels were measured using high-performance liquid chromatography (HPLC). Mean concentrations of linezolid were 13.4 mg/L in serum, 10.7 mg/kg in mucosa, 8.1 mg/L in alveolar macrophages and 25.1 mg/L in epithelial lining fluid. The mean site/serum concentration ratios were 0.79 for bronchial mucosa, 0.71 for macrophages and 8.35 for epithelial lining fluid. The MIC90 (< or =4 mg/L) of linezolid for Staphylococcus aureus and Streptococcus pneumoniae was exceeded in serum and bronchial mucosa in all subjects, in epithelial lining fluid in nine subjects and in macrophages in six subjects.

Airway Management in a Mental Retardation Patient with Temporo-mandibular Joint Ankylosis

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Rauf GÜL

2012-01-01

Full Text Available Temporo-mandibular joint (TMJ ankylosis makes it impossible orotracheal intubation for general anesthesia because of limited mouth opening. We applied a nasotracheal intubation via fiberoptic bronchoscopy (FOB guidance on a 36 years old mental retarded (MR patient with bilateral TMJ, having extremely limited mouth opening. As a result, nasotracheal intubation via FOB is reliable technique on even mental retarded patients with extremely limited opening.

Managment of thoracic empyema.

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Sherman, M M; Subramanian, V; Berger, R L

1977-04-01

Over a ten year period, 102 patients with thoracic empyemata were treated at Boston City Hospital. Only three patients died from the pleural infection while twenty-six succumbed to the associated diseases. Priniciples of management include: (1) thoracentesis; (2) antibiotics; (3) closed-tube thoracostomy; (4) sinogram; (5) open drainage; (6) empyemectomy and decortication in selected patients; and (7) bronchoscopy and barium swallow when the etiology is uncertain.

MRI tracheomalacia (TM) assessment in pediatric patients

DEFF Research Database (Denmark)

Ciet, P.; Wielopolski, P.; Lever, S.

Purpose: TM is an excessive narrowing of the intrathoracic part of the trachea. TM is a common congenital pediatric anomaly, but it’s often not recognized due to its unspecific clinical presentation. The aims of our study are: 1) to develop cine-MRI sequences to visualize central airways in static...... in pediatric population and allows avoiding radiation exposure and bronchoscopy for the evaluation of central airway dimensions....

MDCT assessment of tracheomalacia in symptomatic infants with mediastinal aortic vascular anomalies: preliminary technical experience

International Nuclear Information System (INIS)

Lee, Edward Y.; Mason, Keira P.; Zurakowski, David; Waltz, David A.; Ralph, Amy; Riaz, Farhana; Boiselle, Phillip M.

2008-01-01

Mediastinal aortic vascular anomalies are relatively common causes of extrinsic central airway narrowing in infants with respiratory symptoms. Surgical correction of mediastinal aortic vascular anomalies alone might not adequately treat airway symptoms if extrinsic narrowing is accompanied by intrinsic tracheomalacia (TM), a condition that escapes detection on routine end-inspiratory imaging. Paired inspiratory-expiratory multidetector CT (MDCT) has the potential to facilitate early diagnosis and timely management of TM in symptomatic infants with mediastinal aortic vascular anomalies. To assess the technical feasibility of paired inspiratory-expiratory MDCT for evaluating TM among symptomatic infants with mediastinal aortic vascular anomalies. The study group consisted of five consecutive symptomatic infants (four male, one female; mean age 4.1 months, age range 2 weeks to 6 months) with mediastinal aortic vascular anomalies who were referred for paired inspiratory-expiratory MDCT during a 22-month period. CT angiography was concurrently performed during the end-inspiration phase of the study. Two pediatric radiologists in consensus reviewed all CT images in a randomized and blinded fashion. The end-inspiration and end-expiration CT images were reviewed for the presence and severity of tracheal narrowing. TM was defined as ≥50% reduction in tracheal cross-sectional luminal area between end-inspiration and end-expiration. The presence of TM was compared to the bronchoscopy results when available (n = 4). Paired inspiratory-expiratory MDCT was technically successful in all five patients. Mediastinal aortic vascular anomalies included a right aortic arch with an aberrant left subclavian artery (n = 2), innominate artery compression (n = 2), and a left aortic arch with an aberrant right subclavian artery (n 1). Three (60%) of the five patients demonstrated focal TM at the level of mediastinal aortic vascular anomalies. The CT results were concordant with the results

A randomized phase II chemoprevention trial of 13-CIS retinoic acid with or without alpha tocopherol or observation in subjects at high risk for lung cancer.

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Kelly, Karen; Kittelson, John; Franklin, Wilbur A; Kennedy, Timothy C; Klein, Catherine E; Keith, Robert L; Dempsey, Edward C; Lewis, Marina; Jackson, Mary K; Hirsch, Fred R; Bunn, Paul A; Miller, York E

2009-05-01

No chemoprevention strategies have been proven effective for lung cancer. We evaluated the effect of 13-cis retinoic acid (13-cis RA), with or without alpha tocopherol, as a lung cancer chemoprevention agent in a phase II randomized controlled clinical trial of adult subjects at high risk for lung cancer as defined by the presence of sputum atypia, history of smoking, and airflow obstruction, or a prior surgically cured nonsmall cell lung cancer (disease free, >3 years). Subjects were randomly assigned to receive either 13-cis RA, 13-cis RA plus alpha tocopherol (13-cis RA/alpha toco) or observation for 12 months. Outcome measures are derived from histologic evaluation of bronchial biopsy specimens obtained by bronchoscopy at baseline and follow-up. The primary outcome measure is treatment "failure" defined as histologic progression (any increase in the maximum histologic score) or failure to return for follow-up bronchoscopy. Seventy-five subjects were randomized (27/22/26 to observations/13-cis RA/13-cis RA/alpha toco); 59 completed the trial; 55 had both baseline and follow-up bronchoscopy. The risk of treatment failure was 55.6% (15 of 27) and 50% (24 of 48) in the observation and combined (13 cis RA plus 13 cis RA/alpha toco) treatment arms, respectively (odds ratio adjusted for baseline histology, 0.97; 95% confidence interval, 0.36-2.66; P = 0.95). Among subjects with complete histology data, maximum histology score in the observation arm increased by 0.37 units and by 0.03 units in the treated arms (difference adjusted for baseline, -0.18; 95% confidence interval, -1.16 to 0.81; P = 0.72). Similar (nonsignificant) results were observed for treatment effects on endobronchial proliferation as assessed by Ki-67 immunolabeling. Twelve-month treatment with 13-cis RA produced nonsignificant changes in bronchial histology, consistent with results in other trials. Agents advancing to phase III randomized trials should produce greater histologic changes. The

A Randomized Phase II Chemoprevention Trial of 13-CIS Retinoic Acid with Or without α Tocopherol or Observation in Subjects at High Risk for Lung Cancer

Science.gov (United States)

Kelly, Karen; Kittelson, John; Franklin, Wilbur A.; Kennedy, Timothy C.; Klein, Catherine E.; Keith, Robert L.; Dempsey, Edward C.; Lewis, Marina; Jackson, Mary K.; Hirsch, Fred R.; Bunn, Paul A.; Miller, York E.

2011-01-01

No chemoprevention strategies have been proven effective for lung cancer. We evaluated the effect of 13-cis retinoic acid (13-cis RA), with or without α tocopherol, as a lung cancer chemoprevention agent in a phase II randomized controlled clinical trial of adult subjects at high risk for lung cancer as defined by the presence of sputum atypia, history of smoking, and airflow obstruction, or a prior surgically cured nonsmall cell lung cancer (disease free, >3 years). Subjects were randomly assigned to receive either 13-cis RA, 13-cis RA plus α tocopherol (13-cis RA/α toco) or observation for 12 months. Outcome measures are derived from histologic evaluation of bronchial biopsy specimens obtained by bronchoscopy at baseline and follow-up. The primary outcome measure is treatment “failure” defined as histologic progression (any increase in the maximum histologic score) or failure to return for follow-up bronchoscopy. Seventy-five subjects were randomized (27/22/26 to obervations/13-cis RA/13-cis RA/α toco); 59 completed the trial; 55 had both baseline and follow-up bronchoscopy. The risk of treatment failure was 55.6% (15 of 27) and 50% (24 of 48) in the observation and combined (13 cis RA plus 13 cis RA/α toco) treatment arms, respectively (odds ratio adjusted for baseline histology, 0.97; 95% confidence interval, 0.36–2.66; P = 0.95). Among subjects with complete histology data, maximum histology score in the observation arm increased by 0.37 units and by 0.03 units in the treated arms (difference adjusted for baseline, −0.18; 95% confidence interval, −1.16 to 0.81; P = 0.72). Similar (nonsignificant) results were observed for treatment effects on endobronchial proliferation as assessed by Ki-67 immunolabeling. Twelve-month treatment with 13-cis RA produced nonsignificant changes in bronchial histology, consistent with results in other trials. Agents advancing to phase III randomized trials should produce greater histologic changes. The addition of �

Diagnostic value of procalcitonin, CRP, leukocytes and BAL neutrophils for pulmonary complications in the immunocompromised host

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Daiana Stolz

2006-12-01

Full Text Available We evaluated the diagnostic accuracy of laboratory biomarkers and BAL differential cell count for the diagnosis of bacterial infection in severe immunosuppressed patients. One-hundred and seven consecutive patients undergoing bronchoscopy for suspected pulmonary infection were included in this study. Assessment included history, clinical examination, chest image studies, CRP, procalcitonin (ProCT, leukocyte counts, and BAL results. Patients were classified as having proven, possible, and non-bacterial infection.

Interstitial lung disease pattern turned out to be a predominantly lepidic lung adenocarcinoma

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Irena Hammen, Dr. Med

2017-01-01

Full Text Available We report a case of a 46-year-old woman without any medical history who presented to our Respiratory Department with exertional dyspnoea for the last 6 weeks associated with non-productive cough. Chest radiography showed bilateral diffuse interstitial opacity. Bronchoalveolar lavage and transbronchial biopsies performed during flexible bronchoscopy as a step in the diagnostic workup of idiopathic interstitial pneumonia showed cells of pulmonary adenocarcinoma.

Hyalinizing Granuloma: An Unusual Case of a Pulmonary Mass

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Viviane Brandão

2010-01-01

Full Text Available We describe the case of pulmonary hyalinizing granuloma in a 34-year-old asymptomatic man who presented with a pulmonary nodule apparent by chest radiography and computed tomography (CT. He had a history of previous treatment for tuberculosis. His laboratory data were normal. Bronchoscopy and CT-guided percutaneous transthoracic fine needle aspiration cytology were inconclusive. The diagnosis was revealed after the histopathological examination of an open lung biopsy.

Mediastinal and bronchovascular amyloidosis

International Nuclear Information System (INIS)

Biggemann, M.; Hilweg, D.; Kappes, R.

1990-01-01

The clinical and radiographic aspects of an unusual case of mediastinal and bronchovascular amyloidosis are presented. Besides hilar and mediastinal lymphadenopathy, extensive amyloid deposition in the peribronchial and perivascular connective tissue sheats can be observed. Plain film radiographs and CT demonstrate an uncommon pattern of increased bronchovascular markings, which is discussed. Because of peribronchial amyloid deposits, bronchoscopy is of no help in demonstrating this special type of tracheobronchial amyloidosis. (orig.) [de

Utility of galactomannan antigen detection in bronchoalveolar lavage fluid in immunocompromised patients.

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Brownback, Kyle R; Pitts, Lucas R; Simpson, Steven Q

2013-09-01

Diagnosis of invasive pulmonary aspergillosis (IPA) is a challenging process in immunocompromised patients. Galactomannan (GM) antigen detection in bronchoalveolar lavage (BAL) fluid is a method to detect IPA with improved sensitivity over conventional studies. We sought to determine the diagnostic yield of BAL GM assay in a diverse population of immunocompromised patients. A retrospective review of 150 fiberoptic bronchoscopy (FOB) with BAL for newly diagnosed pulmonary infiltrate in immunocompromised patients was performed. Patient information, procedural details and laboratory studies were collected. BAL and serum samples were evaluated for GM using enzyme-linked immunoassay. Of 150 separate FOB with BAL, BAL GM was obtained in 143 samples. There were 31 positive BAL GM assays. In those 31 positive tests, 13 were confirmed as IPA, giving a positive predictive value of 41.9%. There was one false negative BAL GM. Of the 18 false positive BAL GM, 4 were receiving piperacillin-tazobactam and 11 were receiving an alternative beta-lactam antibiotic. BAL GM assay shows excellent sensitivity for diagnosing IPA. There was a significant number of false positive BAL GM assays and several of those patients were receiving beta-lactam antibiotics at the time of bronchoscopy. © 2013 Blackwell Verlag GmbH.

Infections requiring surgery following transbronchial biopsy in lung cancer patients. A retrospective study

International Nuclear Information System (INIS)

Kitami, Akihiko; Kamio, Yoshito; Gen, Ryozo

2009-01-01

The purpose of this study was to assess the risk factors for severe infections developing as a complication of transbronchial biopsy in lung cancer patients. From April 2001 to March 2007, 1091 patients underwent bronchoscopy at our institution. We reviewed the records of 5 of these patients diagnosed with lung cancer and who developed lung abscess or cavitary infection after transbronchial biopsy necessitating surgical resection. The 5 patients (4 men, 1 woman; mean age at diagnosis, 62.4 years; range, 42-78 years) were all smokers and were immunocompetent. One patient suffered from diabetes mellitus. Of the 5 patients, chest CT revealed a cavitary lesion in 2 patients, central low attenuation in 2 patients, and a small nodule in 1 patient. The longest tumor diameter ranged from 20-60 mm (mean, 42 mm). Sputum cultures taken prior to bronchoscopy showed no significant bacterial growth in 4 of the patients, with 1 patient showing Streptococcus pneumoniae. Three cases showed elevated serum C-reactive protein. Histologically, the diagnosis was squamous cell carcinoma in 3 patients and adenocarcinoma in 2 patients. The risk factors for the development of a lung abscess after transbronchial biopsy include large mass lesions with central necrosis or cavitary lesions. (author)

Retrospectively ECG-gated multi-detector row CT of the chest: does ECG-gating improve three-dimensional visualization of the bronchial tree?

International Nuclear Information System (INIS)

Schertler, T.; Wildermuth, S.; Willmann, J.K.; Crook, D.W.; Marincek, B.; Boehm, T.

2004-01-01

Purpose: To determine the impact of retrospectively ECG-gated multi-detector row CT (MDCT) on three-dimensional (3D) visualization of the bronchial tree and virtual bronchoscopy (VB) as compared to non-ECG-gated data acquisition. Materials and Methods: Contrast-enhanced retrospectively ECG-gated and non-ECG-gated MDCT of the chest was performed in 25 consecutive patients referred for assessment of coronary artery bypass grafts and pathology of the ascending aorta. ECG-gated MDCT data were reconstructed in diastole using an absolute reverse delay of -400 msec in all patients. In 10 patients additional reconstructions at -200 msec, -300 msec, and -500 msec prior to the R-wave were performed. Shaded surface display (SSD) and virtual bronchoscopy (VB) for visualization of the bronchial segments was performed with ECG-gated and non-ECG-gated MDCT data. The visualization of the bronchial tree underwent blinded scoring. Effective radiation dose and signal-to-noise ratio (SNR) for both techniques were compared. Results: There was no significant difference in visualizing single bronchial segments using ECG-gated compared to non-ECG-gated MDCT data. However, the total sum of scores for all bronchial segments visualized with non-ECG-gated MDCT was significantly higher compared to ECG-gated MDCT (P [de

CD4 lymphocyte counts and serum p24 antigen of no diagnostic value in monitoring HIV-infected patients with pulmonary symptoms

DEFF Research Database (Denmark)

Orholm, M; Nielsen, T L; Nielsen, Jens Ole

1990-01-01

The diagnostic value of the CD4 cell counts and the HIV p24 antigen were evaluated in a consecutive series of 105 HIV-infected patients experiencing 128 episodes of pulmonary symptoms which required bronchoscopy. One-third of patients with opportunistic infection (OI) had CD4 counts greater than ....... In conclusion, the CD4 cell counts and the presence of p24 antigen in serum had a very limited predictive value for the presence of OI in HIV-infected patients with pulmonary symptoms.......The diagnostic value of the CD4 cell counts and the HIV p24 antigen were evaluated in a consecutive series of 105 HIV-infected patients experiencing 128 episodes of pulmonary symptoms which required bronchoscopy. One-third of patients with opportunistic infection (OI) had CD4 counts greater than 0.......200 x 10(9)/l, and 60% of patients without OI had CD4 counts less than 0.200 x 10(9)/l; 47 and 42% of patients with and without OI, respectively, had detectable p24 antigen in serum. Only 36% of the patients with OI presented the combination of CD4 cells less than 0.200 x 10(9)/l and p24 in serum...

Canine chronic bronchitis: a pathophysiologic evaluation of 18 cases

International Nuclear Information System (INIS)

Padrid, P.A.; Hornof, W.J.; Kurpershoek, C.J.; Cross, C.E.

1990-01-01

Eighteen dogs with chronic bronchitis were studied using physiologic, radiologic, microbiologic, and pathologic techniques. Twelve of these dogs were evaluated before and after two weeks of oral bronchodilator administration. Thoracic radiographs, tidal breathing flow-volume loops, radioaerosol ventilation scans, airway appearance at bronchoscopy, and airway pathology were abnormal in the majority of dogs studied. There was a significant relationship between abnormal ventilation scans and abnormal results for PaO2 and end-tidal airflow. Bronchoscopy revealed excessive mucus and inflammation of airway mucosa in all 16 dogs undergoing this procedure. Endoscopically obtained aerobic bacterial cultures grew mixed bacterial flora in only three dogs. Increased numbers of neutrophils in 14 dogs were detected by airway lavage cytology. A large number of eosinophils were seen in airway lavages obtained from two dogs; these two dogs also had evidence for eosinophilic bronchitis on endobronchial biopsy. Oral bronchodilator administration resulted in clinical and expiratory airflow improvements in most dogs, but had no effect on PaO2 or on the radioaerosol-scan abnormalities. The presence of both the physiologic and pathologic airway abnormalities of chronic bronchitis in dogs presented to a veterinary hospital with chronic unexplained cough was confirmed, suggesting that aerobic bacteria do not play an etiologic role in most cases

Effect of music in endoscopy procedures: systematic review and meta-analysis of randomized controlled trials.

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Wang, Man Cai; Zhang, Ling Yi; Zhang, Yu Long; Zhang, Ya Wu; Xu, Xiao Dong; Zhang, You Cheng

2014-10-01

Endoscopies are common clinical examinations that are somewhat painful and even cause fear and anxiety for patients. We performed this systematic review and meta-analysis of randomized controlled trials to determine the effect of music on patients undergoing various endoscopic procedures. We searched the Cochrane Library, Issue 6, 2013, PubMed, and EMBASE databases up to July 2013. Randomized controlled trials comparing endoscopies, with and without the use of music, were included. Two authors independently abstracted data and assessed risk of bias. Subgroup analyses were performed to examine the impact of music on different types of endoscopic procedures. Twenty-one randomized controlled trials involving 2,134 patients were included. The overall effect of music on patients undergoing a variety of endoscopic procedures significantly improved pain score (weighted mean difference [WMD] = -1.53, 95% confidence interval [CI] [-2.53, -0.53]), anxiety (WMD = -6.04, 95% CI [-9.61, -2.48]), heart rate (P = 0.01), arterial pressure (P music group, compared with the control group. Furthermore, music had little effect for patients undergoing colposcopy and bronchoscopy in the subanalysis. Our meta-analysis suggested that music may offer benefits for patients undergoing endoscopy, except in colposcopy and bronchoscopy. Wiley Periodicals, Inc.

Customized Hinged Covered Metallic Stents for the Treatment of Benign Main Bronchial Stenosis.

Science.gov (United States)

Han, Xinwei; Al-Tariq, Quazi; Zhao, Yanle; Li, Lei; Cheng, Zhe; Wang, Huaqi; Liu, Chao; Jiao, Dechao; Wu, Gang

2017-08-01

To address the limitations of silicone stents, we designed a hinged self-expandable covered metallic stent. The aim of this study was to evaluate the safety and efficacy of the customized stents in clinical applications. This was a retrospective analysis. Under conscious sedation and local anesthesia, the stents were implanted or removed by interventional radiologists, with fluoroscopic guidance. Of 24 patients with benign main bronchial stenosis, stents were successfully placed in 21 (87.5%). The low-pressure balloon before dilation failed in 1 case (4.17%) of left main bronchial cicatricial stenosis. In 2 other cases (8.33%), stent placement was abandoned. Stents were successfully removed between 29 and 103 days after the procedure. After stent removal, the follow-up lasted for at least 12 months. Restenosis occurred only in 1 case (4.55%) owing to bronchial collapse 3 days after stent removal. Dyspnea occurred in another case (4.55%) at 2 months after retrieval; recurrence was confirmed using bronchoscopy, leading to a left pneumonectomy. The described procedure is safe and easy to be performed and avoids the use of intubation, bronchoscopy, and general anesthesia. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Mounier-Kuhn syndrome: a rare cause of bronchial dilation.

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Celik, Burcin; Bilgin, Salih; Yuksel, Canan

2011-01-01

Mounier-Kuhn syndrome, or tracheobronchomegaly, is a rare clinical and radiologic condition characterized by marked tracheobronchial dilation and recurrent lower respiratory tract infections. Diagnosis is typically accomplished with the use of computed tomography and bronchoscopy, as well as pulmonary function testing. Patients may be asymptomatic; however, symptoms can range from minimal with preserved lung function to severe respiratory failure. Therapy, if any, is supportive but minimal. Surgery rarely has a place in the treatment of Mounier-Kuhn syndrome.Herein, we report the case of a 58-year-old man with chronic obstructive pulmonary disease who had a chronic cough, increased sputum production, and chest pain. Thoracic computed tomography showed tracheal dilation (diameter, 34 mm) and multiple diverticula in the posterior region of the trachea. Fiberoptic bronchoscopy revealed enlarged main bronchi, the dilated trachea, and prominent tracheal diverticula. Pulmonary function testing disclosed impaired respiratory function. Histopathologic examination of biopsy specimens from the bronchi and the tracheal wall supported the diagnosis of Mounier-Kuhn syndrome. The patient was released from the hospital and his condition was monitored for 2 years, during which time he developed no lower respiratory tract infections.Regardless of radiologic findings that suggest recurrent lower respiratory tract infection, we recommend that Mounier-Kuhn syndrome be considered in the differential diagnosis.

Exhaled breath condensate cysteinyl leukotrienes and airway remodeling in childhood asthma: a pilot study

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Kharitonov Sergei A

2006-04-01

Full Text Available Abstract Background It has been suggested that cysteinyl leukotrienes (cysLTs play an important role in airway remodeling. Previous reports have indicated that cysLTs augment human airway smooth muscle cell proliferation. Recently, cysLTs have been measured in exhaled breath condensate (EBC. The aim of this study was to evaluate the relationship between cysLTs in EBC and another marker of airway remodeling, reticular basement membrane (RBM thickening, in endobronchial biopsies in children. Methods 29 children, aged 4–15 years, with moderate to severe persistent asthma, who underwent bronchoscopy as part of their clinical assessment, were included. Subjects underwent spirometry and EBC collection for cysLTs analysis, followed by bronchoscopy and endobronchial biopsy within 24 hours. Results EBC cysLTs were significantly lower in asthmatic children who were treated with montelukast than in those who were not (median (interquartile range 36.62 (22.60–101.05 versus 249.1 (74.21–526.36 pg/ml, p = 0.004. There was a significant relationship between EBC cysLTs and RBM thickness in the subgroup of children who were not treated with montelukast (n = 13, r = 0.75, p = 0.003. Conclusion EBC cysLTs appear to be associated with RBM thickening in asthma.

Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome

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Ravi Bhat

2014-01-01

Full Text Available The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel′s deformity (wherein the scapulae ride high on the back, synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA. After intubation, we used second smaller endotracheal tube (ETT to stabilize and elongate the first ETT while removing the LMA.

Treatment of tracheal mucoepidermoid carcinoma by argon plasma coagulation during pregnancy.

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Kesrouani, Assaad; Dabar, Georges; Rahal, Samir; Ghorra, Claude

2015-05-01

Mucoepidermoid carcinoma of the tracheobronchial tree is a rare airway tumor (cesarean section. We report the first case to be treated by Argon-Plasma Coagulation (APC) in pregnancy. A 35-year-old Caucasian woman G1P0, at 27 weeks of gestation was admitted to the emergency department because of hemoptysis and severe dyspnea. Bronchoscopy and biopsies diagnosed primary tracheal mucoepidermoid carcinoma. Following an episode of tracheal bleeding, she was intubated. After thorough explanations to the family and obtaining informed consent, therapeutic bronchoscopy, under general anesthesia using a rigid bronchoscope, was performed. The tumor was cored out with the tip of the bronchoscope and removed with an alligator forceps. The tumor bed was coagulated with APC. The obstetrical team was ready to intervene in case of maternal emergency. Immediate follow-up was good, and she left the hospital 4 days later. She delivered at 39 weeks of gestation by cesarean section because of dystocia. Five years later, the patient is doing well without any signs or symptoms of recurrence. Pediatric follow-up is normal. Argon Plasma Coagulation for treatment of mucoepidermoid tracheal carcinoma is feasible during pregnancy. Reporting this case could lead to less aggressive management of mucoepidermoid carcinoma in pregnant patients.

Transection of the innominate artery for tracheomalacia caused by persistent opisthotonus.

Science.gov (United States)

Tsugawa, Chikara; Ono, Yasuyuki; Nishijima, Eiji; Takamizawa, Shigeru; Satoh, Shiiki; Muraji, Toshihiro

2004-01-01

Patients with cerebral palsy often develop opisthotonus. The trachea may be pinched between the innominate artery and the cervical spine. This compartmentalized thoracic inlet results in severe tracheomalacia. We successfully released tracheal compression by transection of the innominate artery. In case 1, a 4-year-old girl with cerebral palsy and opisthotonus was admitted due to respiratory distress. Bronchoscopy revealed severe tracheomalacia 2 cm above the carina. An endotracheal stent was placed through a tracheostomy. Two months later, she developed tracheal bleeding and bronchoscopy demonstrated a trachea-innominate artery fistula. Magnetic resonance brain angiography showed the presence of Willis' circle, and transection of the innominate artery was justified. This was done through a low cervical skin incision. In case 2, a 6-year-old boy with cerebral palsy and opisthotonus had long-standing respiratory distress. Ventilatory support did not resolve the symptoms. The innominate artery was transected in the same fashion as in the first case. Case 1 has been free from respiratory distress for 4 months and case 2 for 3 years. Our experience suggests that the combination of tracheomalacia, opisthotonus causes severe respiratory distress. Transection of the innominate artery is a useful therapeutic strategy to release airway obstruction in this condition.

Lung cancer mimicking lung abscess formation on CT images

OpenAIRE

Taira, Naohiro; Kawabata, Tsutomu; Gabe, Atsushi; Ichi, Takaharu; Kushi, Kazuaki; Yohena, Tomofumi; Kawasaki, Hidenori; Yamashiro, Toshimitsu; Ishikawa, Kiyoshi

2014-01-01

Patient: Male, 64 Final Diagnosis: Lung pleomorphic carcinoma Symptoms: Cough • fever Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: The diagnosis of lung cancer is often made based on computed tomography (CT) image findings if it cannot be confirmed on pathological examinations, such as bronchoscopy. However, the CT image findings of cancerous lesions are similar to those of abscesses.We herein report a case of lung cancer that resemble...

Cine MRI of Tracheal Dynamics in Healthy Volunteers and Patients With Tracheobronchomalacia.

Science.gov (United States)

Ciet, Pierluigi; Boiselle, Phillip M; Heidinger, Benedikt; Andrinopoulou, Eleni-Rosalina; O'Donnel, Carl; Alsop, David C; Litmanovich, Diana E

2017-10-01

Bronchoscopy and MDCT are routinely used to assess tracheobronchomalacia (TBM). Recently, dynamic MRI (cine MRI) has been proposed as a radiation-free alternative to MDCT. In this study, we tested cine MRI assessment of airway dynamics during various breathing conditions and compared cine MRI and MDCT measurements in healthy volunteers and patients with suspected TBM. Cine MRI was found to be a technically feasible alternative to MDCT for assessing central airway dynamics.

Ventilación jet para la extracción de un cuerpo extraño endobronquial en un paciente con neumotórax drenado: Informe de caso

OpenAIRE

Latorre, Julieta; Brogly, Nicolas; Maggi, Genaro; Quinteros, Fabiola; Peña del Ser, Natalia; Gilsanz, Fernando

2017-01-01

Introduction Even though foreign body aspiration (FBA) is rare in adult patients, they sometimes require the performance of rigid bronchoscopy for its extraction. Ventilation for this procedure is challenging, especially in patients with pulmonary disease. Clinical, diagnostic evaluation and interventions We described the case of a 71-year old man who presented with a FBA in the left upper lobe associated with a controlateral pneumothorax. After the placement of a pleural drainage, the foreig...

Use of narrow-band imaging bronchoscopy in detection of lung cancer.

Science.gov (United States)

Zaric, Bojan; Perin, Branislav

2010-05-01

Narrow-band imaging (NBI) is a new endoscopic technique designed for detection of pathologically altered submucosal and mucosal microvascular patterns. The combination of magnification videobronchoscopy and NBI showed great potential in the detection of precancerous and cancerous lesions of the bronchial mucosa. The preliminary studies confirmed supremacy of NBI over white-light videobronchoscopy in the detection of premalignant and malignant lesions. Pathological patterns of capillaries in bronchial mucosa are known as Shibuya's descriptors (dotted, tortuous and abrupt-ending blood vessels). Where respiratory endoscopy is concerned, the NBI is still a 'technology in search of proper indication'. More randomized trials are necessary to confirm the place of NBI in the diagnostic algorithm, and more trials are needed to evaluate the relation of NBI to autofluorescence videobronchoscopy and to white-light magnification videobronchoscopy. Considering the fact that NBI examination of the tracheo-bronchial tree is easy, reproducible and clear to interpret, it is certain that NBI videobronchoscopy will play a significant role in the future of lung cancer detection and staging.

Composite cervical skin and cartilage flap provides a novel large airway substitute after long-segment tracheal resection.

Science.gov (United States)

Fabre, Dominique; Singhal, Sunil; De Montpreville, Vincent; Decante, Benoit; Mussot, Sacha; Chataigner, Olivier; Mercier, Olaf; Kolb, Frederic; Dartevelle, Philippe G; Fadel, Elie

2009-07-01

Airway replacement after long-segment tracheal resection for benign and malignant disease remains a challenging problem because of the lack of a substitute conduit. Ideally, an airway substitute should be well vascularized, rigid, and autologous to avoid infections, airway stenosis, and the need for immunosuppression. We report the development of an autologous tracheal substitute for long-segment tracheal resection that satisfies these criteria and demonstrates excellent short-term functional results in a large-animal study. Twelve adult pigs underwent long-segment (6 cm, 60% of total length) tracheal resection. Autologous costal cartilage strips measuring 6 cm x 2 mm were harvested from the chest wall and inserted at regular 0.5-cm intervals between dermal layers of a cervical skin flap. The neotrachea was then scaffolded by rotating the composite cartilage skin flap around a silicone stent measuring 6 cm in length and 1.4 cm in diameter. The neotrachea replaced the long segment of tracheal resection, and the donor flap site was closed with a double-Z plasty. Animals were killed at 1 week (group I, n = 4), 2 weeks (group II, n = 4), and 5 weeks (group III, n = 4). In group III the stent was removed 1 week before death. Viability of the neotrachea was monitored by means of daily flexible bronchoscopy and histologic examination at autopsy. Long-term morbidity and mortality were determined by monitoring weight gain, respiratory distress, and survival. There was no mortality during the study period. Weight gain was appropriate in all animals. Daily bronchoscopy and postmortem histologic evaluation confirmed excellent viability of the neotrachea. There was no evidence of suture-line dehiscence. Five animals had distal granulomas that were removed by using rigid bronchoscopy. In group III 1 animal had tracheomalacia, which was successfully managed by means of insertion of a silicon stent. Airway reconstruction with autologous cervical skin flaps scaffolded with costal

A morphological study of bronchi and lung tissues in long-term survived dogs

OpenAIRE

松本, 伸

1984-01-01

Morphological changes of the bronchus and lung tissue of ten adult dogs were examined at various intervals after sleeve resection of the left upper lobe was performed in combination with bronchoplasty and pulmonary artery angioplasty. Postoperative changes in the bronchus and pulmonary artery were investigated by bronchoscopy and pulmonary angiography 8 months to 14 months after the operation. The dogs were sacrificed 9 months to 32 months after the operation, and the bronchus and lung tissue...

Surgery of the Trachea

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Mark S. Allen

2015-08-01

Full Text Available Surgical procedures on the trachea have only been undertaken within the past 50 years. Knowing the unique blood supply of the trachea and how to reduce tension on any anastomosis are key to a successful outcome. Tracheal conditions requiring surgery usually present with shortness of breath on exertion, and preoperative evaluation involves computed tomography and rigid bronchoscopy. Tracheal resection and reconstruction can be safely performed with excellent outcomes by following a well-described technique.

Acute respiratory tract obstruction in children

OpenAIRE

Ahmad, Zahoor

1999-01-01

35 cases of acute respiratory tract obstruction in paediatric age group who needed surgical intervention in the form of bronchoscopy, tracheostomy or both are reviewed here. All these patients were seen and managed at National Iranian Oil company Hospital Ummeidiya Khouzestan Iran, from April 1985 to April 1988. The results obtained with a review of use of instruments is described. Most of the patients presented with foreign body inhalations, some due to allergic oedema and one case had laryn...

The study of risk factors affecting the prognosis of lung abscess

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Aghajan Zadeh M

2000-09-01

Full Text Available In spite the emergence of potent and broad spectrum antibiotics and recent advances in bronchoscopy and pulmonary physiotherapy, still there is a high rate of morbidity and mortality because of lung abscess. The objective of this study is the indication of risk factors, which have undesirable effects on the prognosis of lung abscess. In a retrospective study, all cases of lung abscess who was confined to bed during 1994 to 1999 in Rasht were collected and analyzed. From 52 cases, 40 (77% were male and 12 (23% were female. The mean duration of stay was 20 day (15 to 35. The secondary cause for lung abscess was as follows: 10 cases (19% COPD, 10 cases (19% preumonia, 15 cases (29% bronchiectasia 2 cases lung cancer, 2 cases lung hydatid cyst and 3 cases atelectasia. Extrapulmonary causes of lung abscess were consist of: 10 case (10% aspiration, 10 case (19% esophageal diseases tending to reflux, 5 case (9% periodontal disease. The factors, which had underiable effects on prognosis of disease were lung cancer, anemia, hypoalbuminemia, age over 60, abscess with pseudomonas, abscess cavity greater thus 8 cm, lower lobe in right lung and TB. Because of high mortality and morbidity of lung abscess, due attention for internal drainage, bronchoscopy, physiotherapy and timed surgery are seriously indicated.

Mechanical complication of endobronchial tuberculosis

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Quratulain Fatima Kizilbash

2015-01-01

Full Text Available A 19-year-old Vietnamese lady was diagnosed with culture positive, left upper lobe pulmonary tuberculosis for which medical treatment was initiated. Four months into treatment, she developed a 'rubber-band-like' stretching sensation in her left chest with wheezing and shortness of breath. Decreased respiratory excursion over the left lung was present on physical-examination. Chest-Xray revealed left-upper-lobe collapse with leftward deviation of the trachea and mediastinum. CT thorax revealed a long segment of stenosis in the left mainstem bronchus. FEV1 was 1.26 L (45% predicted, FVC 1.53 L (49% predicted, FEV1/FVC 82% (95% predicted indicating airway limitation. Ventilation-perfusion scan noted 9.8% ventilation to the left lung and 92.8% to the right lung and 7.6% perfusion to the left lung and 92.4% to the right lung. Bronchoscopy was notable for pin point stenosis of the left mainstem bronchus beyond which was inflamed mucosa and abnormal cartilage rings in the left upper and middle lobe bronchi. Nine months of medical therapy for tuberculosis along with oral steroid taper was completed successfully; however the patient has required six serial bronchscopies with dilatations without stent placement at four to six week intervals due to partial restenosis, with the last bronchoscopy at four months after completion of tuberculosis therapy.

Early lung cancer: detection, treatment outcome

International Nuclear Information System (INIS)

Balchum, O.J.; Huth, G.C.; Saccomanno, G.

1984-01-01

The performance of a room temperature mercuric iodide x-ray detector was investigated as a function of detector bias, amplifier time constant, and detector temperature. A Mn K/sub α/ line of 200 eV FWHM was obtained by using low noise electronics developed for Si(Li) detectors, including a cooled input FET. Measurements of the detector's resolution at various x-ray energies result in a Fano factor of 0.20. Fluorescence bronchoscopy with a violet laser and image intensifier has been developed for imaging the red fluorescence of a tumor-specific agent, hematoporphyrin derivative, that has been injected before the examination. The instrument was developed to localize carcinoma in situ and early, small bronchogenic tumors diagnosed by sputum cytology but invisible on chest x-ray and conventional bronchoscopy, in underground uranium miners and others at risk for lung cancer. In addition to the imaging devices, a video system including a processor and electronics for digital background image subtraction has been developed to enhance contrast. A ratio fluorometer and a rapid-scan spectrum analyzer have been designed for quantitative measurements of fluorescence intensity and dependence on dosage and time after injection of the fluorescent agent. Clinical trials demonstrate detection of carcinoma in situ, and the true positive rate should be improved by the new instrumentation and optimization of time delay and dosage

Value of the polymerase chain reaction method for detecting tuberculosis in the bronchial tissue involved by anthracosis.

Science.gov (United States)

Mirsadraee, Majid; Shafahie, Ahmad; Reza Khakzad, Mohammad; Sankian, Mojtaba

2014-04-01

Anthracofibrosis is the black discoloration of the bronchial mucosa with deformity and obstruction. Association of this disease with tuberculosis (TB) was approved. The objective of this study was to find the additional benefit of assessment of TB by the polymerase chain reaction (PCR) method. Bronchoscopy was performed on 103 subjects (54 anthracofibrosis and 49 control subjects) who required bronchoscopy for their pulmonary problems. According to bronchoscopic findings, participants were classified to anthracofibrosis and nonanthracotic groups. They were examined for TB with traditional methods such as direct smear (Ziehl-Neelsen staining), Löwenstein-Jensen culture, and histopathology and the new method "PCR" for Mycobacterium tuberculosis genome (IS6110). Age, sex, smoking, and clinical findings were not significantly different in the TB and the non-TB groups. Acid-fast bacilli could be detected by a direct smear in 12 (25%) of the anthracofibrosis subjects, and adding the results of culture and histopathology traditional tests indicated TB in 27 (31%) of the cases. Mycobacterium tuberculosis was diagnosed by PCR in 18 (33%) patients, but the difference was not significant. Detection of acid-fast bacilli in control nonanthracosis subjects was significantly lower (3, 6%), but PCR (20, 40%) and accumulation of results from all traditional methods (22, 44%) showed a nonsignificant difference. The PCR method showed a result equal to traditional methods including accumulation of smear, culture, and histopathology.

Recurrent posttransplant lymphoproliferative disorder involving the larynx and trachea: case report and review of the literature.

Science.gov (United States)

Banks, Caroline A; Meier, Jeremy D; Stallworth, Christina R; White, David R

2012-05-01

Posttransplant lymphoproliferative disorder (PTLD) is a well-recognized complication of solid organ transplantation and commonly affects upper airway lymphoid tissue. Tracheal and laryngeal involvement in patients with PTLD, however, is rare. We present one such case. We report the case of a patient with recurrent PTLD involving the larynx and trachea and describe the presentation, evaluation, management, and outcome. An 11-year-old boy who underwent bilateral nephrectomy and renal transplantation as an infant was admitted to the hospital with chronic cough, fever, stridor, and dyspnea. His post-transplantation course was complicated by PTLD in cervical lymph nodes at 9 years of age that was successfully treated with chemotherapy. A computed tomographic scan during his present admission revealed supraglottic swelling, a distal tracheal mass, and paratracheal lymph node enlargement. The patient underwent laryngoscopy and bronchoscopy with biopsy specimens taken from the right laryngeal ventricle and distal trachea. Pathologic examination yielded a diagnosis of Epstein-Barr virus-positive PTLD. The patient was treated with chemotherapy, which resulted in resolution of the airway lesions, as seen on repeat bronchoscopy. This is the first report, to our knowledge, of recurrent PTLD involving simultaneous lesions in the larynx and the trachea. PTLD in the head and neck can present as lymphoid hypertrophy, airway obstruction, stridor, or cough. A high degree of clinical suspicion is essential for prompt diagnosis of this life-threatening complication.

The study of risk factors affecting the prognosis of lung abscess

OpenAIRE

Aghajan Zadeh M

2000-01-01

In spite the emergence of potent and broad spectrum antibiotics and recent advances in bronchoscopy and pulmonary physiotherapy, still there is a high rate of morbidity and mortality because of lung abscess. The objective of this study is the indication of risk factors, which have undesirable effects on the prognosis of lung abscess. In a retrospective study, all cases of lung abscess who was confined to bed during 1994 to 1999 in Rasht were collected and analyzed. From 52 cases, 40 (77%) wer...

Two cases of airway obstruction after radiation therapies

International Nuclear Information System (INIS)

Matsumoto, Yuki; Hashimoto, Kazuyoshi; Yoshida, Ryu; Shimazu, Yuzou; Hattori, Hisashi; Kan, Keiichi

2016-01-01

We report two cases of airway obstruction due to several radiotherapies. In the first case, although a “cannot ventilate, cannot intubate” (CVCI) situation arose, we performed cricothyrotomy, thus saving the patient. In the second case, we were able to perform bronchoscopy early to assess her laryngeal edema before nasal intubation and tracheotomy were performed. As a result, a potentially distressing situation for the patient was prevented. We must be careful of airway obstructions that can occur in patients after several radiotherapies. (author)

A Presentation of Massive Hemoptysis in a Patient with Churg-Strauss Syndrome

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Fadi Hikmat

2014-01-01

Full Text Available Given that Churg-Strauss syndrome is a systemic small-vessel vasculitis, it is not usually considered in patients who present with massive hemoptysis, which is typically caused by bronchiectasis, cancer or, in some cases, aberrant bronchial arteries. This article, however, describes a novel case involving a 50-year-old Churg-Strauss patient who presented with sudden-onset massive hemoptysis. Details of the physical examination, laboratory investigations and several imaging studies, including computed tomography, bronchoscopy and three-dimensional imaging, are presented.

[Profitability of the bronchoscopy in the diagnosis of focal pulmonary malignant lesions].

Science.gov (United States)

García Quero, C; García Luján, R; González Torralba, F; de Miguel Poch, E; Alfaro Abreu, J; Villena Garrido, V; López Ríos, F; López Encuentra, A

2008-12-01

We define focal pulmonary lesion (FPL) as an intra-parenchymatous pulmonary lesion that is well circumscribed and completely surrounded by healthy lung. It is considered that the profitability of the fine needle aspiration puncture (FNAP) in FPL profitability of the FNAP in the malignant FPL and study if it varies according to site, size and histology. We analyzed all the FBCs of our Unit between 01/2000 and 12/2001 in patients with solitary FLP profitability by size, site and histology was analyzed with Pearson's chi(2) statistics. 124 patients. Mean FBC per patient was 1.3. A total of 101 cases (82%) were diagnosed with FBC, 15 by thoracotomy and 8 by FNAP. Global diagnostic profitability of the FBC was 0.82 and the transbronchial biopsy 0.76. There are no diagnostic profitability differences by size ( 2 cm) (0.81 vs 0.82 p = 0.96), site (peripheral vs central) (0.79 vs 0.85 p = 0.41) and histology (epidermoid vs adenocarcinoma) (0.89 vs 0.75 p = 0.21). Profitability of the FBC in malignant FPL in our hospital is elevated without differences by size, site or histology. In our site, the initial diagnostic approach of the FLP is done with FBC.

The Business of Bronchoscopy: How to Set up an Interventional Pulmonology Program.

Science.gov (United States)

Kessler, Edward; Wahidi, Momen M

2018-03-01

Interventional pulmonology has advanced rapidly over the last decade and continues to evolve with new medical advances and changes in the health care landscape. Establishing and developing a new interventional pulmonology program entails careful planning, including a needs assessment, a business plan with financial and marketing considerations, and outcomes monitoring. Addressing these aspects will provide a framework to ensure the success of a new interventional pulmonology program that can provide valuable services to the local practice and community. Copyright © 2017 Elsevier Inc. All rights reserved.

Successful treatment of azole-resistant invasive aspergillosis in a bottlenose dolphin with high-dose posaconazole

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Paulien E. Bunskoek

2017-06-01

Full Text Available Invasive aspergillosis due to azole-resistant Aspergillus fumigatus is difficult to manage. We describe a case of azole-resistant invasive aspergillosis in a female bottlenose dolphin, who failed to respond to voriconazole and posaconazole therapy. As intravenous therapy was precluded, high dose posaconazole was initiated aimed at achieving trough levels exceeding 3 mg/l. Posaconazole serum levels of 3–9.5 mg/l were achieved without significant side-effects. Follow-up bronchoscopy and computed tomography showed complete resolution of the lesions.

"Luck's always to blame": silent wounds of a penetrating gunshot trauma sustained 20 years ago.

Science.gov (United States)

Tomos, Ioannis; Manali, Effrosyni D; Argentos, Stylianos; Raptakis, Thomas; Papiris, Spyros A

2015-01-01

Gunshot tracheal injuries represent life-threatening events and usually necessitate emergent surgical intervention. We report a case of an exceptional finding of a patient with retained ballistic fragments in the soft tissues of the thorax, proximal to the right subclavian artery and the trachea, carrying silently his wounds for two decades without any medical or surgical intervention. The bullet pellet on the upper part of the trachea seen accidentally in the chest computed tomography, was also found during bronchoscopy. In short "luck's always to blame".

CD4 lymphocyte counts and serum p24 antigen of no diagnostic value in monitoring HIV-infected patients with pulmonary symptoms

DEFF Research Database (Denmark)

Orholm, M; Nielsen, T L; Nielsen, Jens Ole

1990-01-01

The diagnostic value of the CD4 cell counts and the HIV p24 antigen were evaluated in a consecutive series of 105 HIV-infected patients experiencing 128 episodes of pulmonary symptoms which required bronchoscopy. One-third of patients with opportunistic infection (OI) had CD4 counts greater than 0....... In conclusion, the CD4 cell counts and the presence of p24 antigen in serum had a very limited predictive value for the presence of OI in HIV-infected patients with pulmonary symptoms....

Scintigraphic Demonstration of Endobronchial Foreign Body Aspiration

International Nuclear Information System (INIS)

Lee, Sun Wha

1986-01-01

A 2 year-old boy was presented with wheezing, cough and stridor for 1 1/2 months. The analysis of arterial blood sample disclosed PO 2 , 44 mmHg and PCO 2 , 58 mmHg. The diagnostic procedures, chest radiography including inspiratory, expiratory and lateral decubitus views and 99m Tc-MAA lung perfusion scintigraphy, were performed, on the presumptive diagnosis of foreign body aspiration. At bronchoscopy, a foreign body (fish vertebra), partially occluding the left main bronchus from 1 cm below carima, was removed.

Gallium uptake in tryptophan-related pulmonary disease

International Nuclear Information System (INIS)

Kim, S.M.; Park, C.H.; Intenzo, C.M.; Patel, R.

1991-01-01

We describe a patient who developed fever, fatigue, muscle weakness, dyspnea, skin rash, and eosinophilia after taking high doses of tryptophan for insomnia for two years. A gallium-67 scan revealed diffuse increased uptake in the lung and no abnormal uptake in the muscular distribution. Bronchoscopy and biopsy confirmed inflammatory reactions with infiltration by eosinophils, mast cells, and lymphocytes. CT scan showed an interstitial alveolar pattern without fibrosis. EMG demonstrated diffuse myopathy. Muscle biopsy from the right thigh showed an inflammatory myositis with eosinophilic and lymphocytic infiltrations

A diagnostic dilemma of right lower lobe collapse caused by pulmonary bilharsiasis.

Science.gov (United States)

Sersar, Sameh Ibrahim; Abulmaaty, Reda Ahmed; Elnahas, Hala Ahmed; Moussa, Sherif Abdou; Shiha, Usama A; Ghafar, Wael A Abdel; Elmotawaly, Raed A

2006-02-01

A 32-year-old male was presented with massive haemoptysis. An urgent chest X-ray (Fig. 1a) and CT chest (Fig. 1b-e) was done revealing a right lower lobe consolidation collapse. An urgent rigid bronchoscopy was performed to localize the source of bleeding and try to control it. A right lower lobectomy was done using a double-lumen endotracheal tube. Preoperative and intraoperative impressions of non-specific inflammation were accused to be the aetiology. Histopathology revealed pulmonary venous congestion with bilharsial ova.

Traqueobroncopatia osteocondroplástica

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João Moura e Sá

2002-07-01

ão.REV PORT PNEUMOL 2002; VIII(4: 329-339 ABSTRACT: Tracheobronchopathia osteochondroplastica (TO is a rare disease of unknown pathogenesis and etiology. It is characterized by the presence of multiple submucosal osteocartilaginous nodules that involve luminal surfaces of anterior and lateral walls of the laryngotracheobronchial tree. In most cases the dis ease is benign and silent and its incidence in vivo (1:125 - 1:6000 is probably underestimated.Typical bronchoscopic examination of submucosal hard nodules and histologic confirmation in biopsy specimens are essential in establishing the diagnosis. In the absence of specific treatment, management is aimed at symptoms relieve. A minority of patients develop serious complications — infection, hemoptysis and obstruction — and surgical or endoscopic excision may be necessary.Incidence, clinical and bronchoscopic presentation of TO cases diagnosed in the Bronchology Unit of Centro Hospitalar de Vila Nova de Gaia during 14 years (since 1987 to 2001 were reviewed.In this period, 16 888 bronchoscopies were performed. TO was incidentally diagnosed in 13 patients (11 men, 2 women; mean age - 59,5±12,4 years. Bronchoscopy showed the characteristic endoscopic findings and all cases were histopathologically proven. None of the patients received treatment. Four patients presented with concomitant malignant lung cancer.The incidence of TO in our series (1: 1299 bronchoscopies is similar to that reported in the literature and several cases of malignant neoplasms associated with TO were identified as has been observed by other authors.REV PORT PNEUMOL 2002; VIII(4: 329-339 Palavras-chave: traqueobroncopatia osteocondroplástica, broncoscopia rígida, broncofibroscopia, traqueia, brônquios, Key-words: tracheobronchopathia osteochondroplastica, rigid bronchoscopy, flexible bronchoscopy, trachea, bronchi

[Analysis on diagnosis and treatment of 15 cases with severe influenza A].

Science.gov (United States)

Zuo, Yunlong; Yang, Yiyu; Hong, Jie; Wu, Zhiyuan; Yu, Li; Tao, Jianping; Gong, Sitang

2014-02-01

To analyze the diagnosis and treatment characteristics of patients with severe Influenza A. A retrospective investigation on the clinical manifestation, chest radiography, electronic fiber bronchoscopy and the histology of the cast, rescue course and outcome was conducted in 15 children with severe influenza A during January to May of 2013. Eleven cases were male, the range of age was 2 to 6 years; 5 cases were female, the range of age was 1 month to 6 years, accouting for 4.2% of hospitalized children with influenza. Three patients had an underlying chronic disease, two had nephrotic syndrome, and one had congenital heart disease. All the 15 cases were diagnosed as severe influenza A virus infection complicated with pneumonia and respiratory failure, of whom 10 cases were infected with H1N1 virus , the other 5 cases could not be identified as H1N1 virus by using H1N1 kit, but none of the 15 cases were infected with H7N9 virus. Of 15 cases, 8 had atelectasis, 4 had pneumothorax, 3 had pneumomediastinum, 4 had pleural effusion, 1 had pneumorrhagia; 12 patients required mechanical ventilation. 1 only required noninvasive mask CPAP, 2 did not require assisted ventilation, they were just given mask oxygen. Seven cases' sputum culture showed combined infection with bacteria and fungi, sputum smear examination detected: G(+) cocci in 2 cases, and G(-) bacilli in the other 2. By using electronic fiber bronchoscopy, bronchial cast was detected in 5 patiens. Histological examination of the bronchial cast revealed a fibrinous exudation containing large quantity of eosinophils, neutrophils in 1 patients, fibrinous exudation and necrotic material containing large quantity of neutrophils in 4 patients. After the bronchial casts were removed, 4 patients were improved greatly. All patients were treated with postural drainage of left and right side position, massage of electric oscillation, strengthening the sputum suction aiming to improve pulmonary ventilation function. Three

Impact of multidetector CT-angiography on the emergency management of severe hemoptysis

Energy Technology Data Exchange (ETDEWEB)

Chalumeau-Lemoine, Ludivine [Service de Pneumologie et Réanimation, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris (France); Khalil, Antoine, E-mail: antoine_khalil@yahoo.fr [Service de Radiologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris (France); Pathological Angiogenesis and Vessel Normalization, Center for Interdisciplinary Research in Biology, CNRS UMR 7241/INSERM U1050, Collège de France, Paris (France); Prigent, Hélène [Service de Pneumologie et Réanimation, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris (France); Carette, Marie-France [Service de Radiologie, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris (France); Université Pierre et Marie Curie, Paris VI (France); Fartoukh, Muriel [Service de Pneumologie et Réanimation, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris (France); Université Pierre et Marie Curie, Paris VI (France); Parrot, Antoine [Service de Pneumologie et Réanimation, Hôpital Tenon, HUEP, APHP, 4 rue de la Chine, 75020 Paris (France)

2013-11-01

Background: Multidetector CT-angiography (MDCTA) is commonly used in patients with severe haemoptysis requiring admission to intensive care unit. However, the impact of MDCTA on the management of severe haemoptysis in emergency setting is poorly evaluated. Methods: We prospectively compared data provided by clinical bedside evaluation (clinical examination, chest-X-ray and fiberoptic bronchoscopy) to MDCTA data in terms of lateralization, location of the bleeding site, etiology as well as impact on the treatment choice. Results: Over a 13-month period, 87 patients (men n = 58, median age = 61 years, median haemoptysis expectorated volume = 180 mL) were included. Etiology was mainly (67%) bronchiectasis, tuberculosis sequelae and tumor. MDCTA and clinical bedside evaluation were equally effective in determining lateralization (87.4% and 93.1%, respectively, p = 0.23) and location (85% and 82.7%, respectively, p = 0.82) of the bleeding site. MDCTA was significantly more accurate than the clinical bedside strategy in determining the haemoptysis cause (86% and 70%, respectively, p = 0.007). Moreover, MDCTA suggested the involvement of systemic arteries as bleeding mechanism in 92% of cases, leading to the modification of the treatment initially considered after bedside evaluation in 21.8% of patients. Conclusion: MDCTA provides useful information for the management of patients with severe haemoptysis, especially in the treatment choice. Thus, in the absence of emergency fiberoptic bronchoscopy (FOB) requirement for airways management, MDCTA should be the first-line procedure performed in emergency clinical setting.

Winter sports athletes: long-term effects of cold air exposure.

Science.gov (United States)

Sue-Chu, Malcolm

2012-05-01

Athletes such as skaters and skiers inhale large volumes of cold air during exercise and shift from nasal to mouth breathing. Endurance athletes, like cross-country skiers, perform at 80% or more of their maximal oxygen consumption and have minute ventilations in excess of 100 l/min. Cold air is always dry, and endurance exercise results in loss of water and heat from the lower respiratory tract. In addition, athletes can be exposed to indoor and outdoor pollutants during the competitive season and during all-year training. Hyperpnoea with cold dry air represents a significant environmental stress to the airways. Winter athletes have a high prevalence of respiratory symptoms and airway hyper-responsiveness to methacholine and hyperpnoea. The acute effects of exercise in cold air are neutrophil influx as demonstrated in lavage fluid and airway epithelial damage as demonstrated by bronchoscopy. Upregulation of pro-inflammatory cytokines has been observed in horses. Chronic endurance training damages the epithelium of the small airways in mice. Airway inflammation has been observed on bronchoscopy of cross-country skiers and in dogs after a 1100-mile endurance race in Alaska. Neutrophilic and lymphocytic inflammation with remodelling is present in bronchial biopsies from skiers. Repeated peripheral airway hyperpnoea with dry air causes inflammation and remodelling in dogs. As it is currently unknown if these airway changes are reversible upon cessation of exposure, preventive measures to diminish exposure of the lower airways to cold air should be instituted by all winter sports athletes.

Contribution of interventional radiology to diagnosis and staging of bronchogenic carcinoma

International Nuclear Information System (INIS)

Wittich, G.R.; Jantsch, H.; Sonnenberg, E. van; Karnel, F.; Kumpan, W.; Greene, R.

1986-01-01

The value of percutaneous radiological fine needle biopsy of the thorax will be discussed in relation to sputum cytology, bronchoscopy, mediastinoscopy and open biopsy. Commun indications for fine needle biopsies are the solitary pulmonary nodule, unless it shows definite radiological criteria of a benign lesion, chest wall lesions including Pancoast tumors as well as pulmonary lesions, which were negative on bronchoscopy. Contraindications - in part relative - are coagulopathy, pulmonary arterial and venous hypertension, bullous emphysema, chronic obstructive pulmonary disease, diseases of the lung with an oxygen tension of less than 60 mm Hg and positive pressure mechanical ventilation. Fluoroscopy is the preferred method for localization. CT guidance is used for mediastinal and hilar lesions as well as for pulmonary lesions close to large vessels and for small lesions which are not clearly identified by fluoroscopy in two planes. The sensitivity of fine needle biopsy in the diagnosis of primary lung cancer was 87% in a total of 963 patients. The most common complication was pneumothorax which occurred in 27% of the biopsies guided by fluoroscopy and in 36% of those guided by CT. Catheter drainage of pneumothorax was performed in one third of these patients. Hemoptysis and local parenchymal hemorrhage were found in less than 5% and were without clinical consequence. In addition to technique, results and complications of percutaneous thoracic biopsies, methods of adrenal and liver biopsy in patients with carcinoma of the lung will be discussed. (Author)

Bronchoscopic diagnosis of peripheral pulmonary lung cancer employing sedation with fentanyl and midazolam.

Science.gov (United States)

Minami, Daisuke; Nakasuka, Takamasa; Ando, Chihiro; Iwamoto Md, Yoshitaka; Sato, Ken; Fujiwara, Keiichi; Shibayama, Takuo; Yonei Md PhD, Toshirou; Sato, Toshio

2017-09-01

Sedation with fentanyl and midazolam during bronchoscopic examination is commonly employed by pulmonary physicians in the USA and Europe. We assessed the efficacy of such sedation in the bronchoscopic diagnosis of peripheral lung cancer. We retrospectively evaluated data from 102 patients who underwent transbronchial biopsies (TBB) for diagnosis of peripheral lung cancer. Bronchoscopies with and without fentanyl were performed in 61 (group A) and 41 (group B) patients, respectively. Midazolam was administered to all patients. Medical records were retrieved, and between-group comparisons were made using unpaired Student's t-tests. The mean fentanyl dose was 49.5 μg (range: 10-100 μg), and midazolam doses in groups A and B were 4.29mg (range: 1-14mg) and 5.54mg (range: 1-12mg), respectively. Diagnostic histological specimens were obtained from 75.4% and 65.8% of group A and B patients, respectively (P = 0.30). The diagnostic sensitivities for lung cancer, via at least one of TBB, cytological brushing, or bronchial washing, in groups A and B were 88.5% and 70.4%, respectively (P = 0.035). Moreover, lesion diagnostic sensitivities, via at least one of TBB, cytological brushing, and bronchial washing, in groups A and B were 98.1% and 68.0%, respectively (P = 0.01). Fentanyl and midazolam sedation during bronchoscopy facilitated the diagnosis of peripheral pulmonary lung cancers. Copyright © 2017 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Sensitivity and specificity of Ga-67 pulmonary scans for the detection of p. carinii pneumonitis in patients with the acquired immunodefficiency syndrome and pulmonary symptoms

International Nuclear Information System (INIS)

Hattner, R.S.; Sollitto, R.A.; Golden, J.A.; Coleman, D.L.; Okerlund, M.D.

1984-01-01

Acquired immunodeficiency syndrome (AIDS) is a severe disorder of cellular immunity of obscure etiology. Since its original recognition in 1981 the incidence of AIDS has doubled in each of the succeeding six months. The most common causes of death in AIDS are Kaposi's sarcoma and p. carinii pneumonia (PCP). The latter is treatable if diagnosed early, and AIDS patients (pts) may suffer recurrent episodes of PCP. Since the invasive technique of fiberoptic bronchoscopy with transbronchial biopsy, brushing, and bronchialveolar lavage are necessary for diagnosis and follow-up a noninvasive method of categorizing which AIDS pts require this procedure would be most welcome. Twenty-one pts with the syndrome of AIDS and pulmonary symptoms underwent Ga-67 scans of the thoracic region, and fibroptic bronchoscopy with washings, and brush and transbronchial biopsy. Pulmonary activity was graded in a blinded fashion by three experienced observers as follows: 1, less than, or equal to adjacent soft tissues; 2, greater than adjacent soft tissues, but less than liver; 3, equal to liver; 4, greater than liver. Eleven pts had documented PCP, and the remaining ten had non-specific pulmonary inflammation, or other, in some cases, putative, infections. The sensitivity and specificity of Ga-67 scans ≥ grade 3 was 100% and 90% respectively. These results suggests a useful role for graded Ga-67 scans in AIDS pts with pulmonary symptoms, permitting selection of pts with a high risk of PCP for further mandatory invasive investigation of this otherwise usually fatal disease

Impact of multidetector CT-angiography on the emergency management of severe hemoptysis

International Nuclear Information System (INIS)

Chalumeau-Lemoine, Ludivine; Khalil, Antoine; Prigent, Hélène; Carette, Marie-France; Fartoukh, Muriel; Parrot, Antoine

2013-01-01

Background: Multidetector CT-angiography (MDCTA) is commonly used in patients with severe haemoptysis requiring admission to intensive care unit. However, the impact of MDCTA on the management of severe haemoptysis in emergency setting is poorly evaluated. Methods: We prospectively compared data provided by clinical bedside evaluation (clinical examination, chest-X-ray and fiberoptic bronchoscopy) to MDCTA data in terms of lateralization, location of the bleeding site, etiology as well as impact on the treatment choice. Results: Over a 13-month period, 87 patients (men n = 58, median age = 61 years, median haemoptysis expectorated volume = 180 mL) were included. Etiology was mainly (67%) bronchiectasis, tuberculosis sequelae and tumor. MDCTA and clinical bedside evaluation were equally effective in determining lateralization (87.4% and 93.1%, respectively, p = 0.23) and location (85% and 82.7%, respectively, p = 0.82) of the bleeding site. MDCTA was significantly more accurate than the clinical bedside strategy in determining the haemoptysis cause (86% and 70%, respectively, p = 0.007). Moreover, MDCTA suggested the involvement of systemic arteries as bleeding mechanism in 92% of cases, leading to the modification of the treatment initially considered after bedside evaluation in 21.8% of patients. Conclusion: MDCTA provides useful information for the management of patients with severe haemoptysis, especially in the treatment choice. Thus, in the absence of emergency fiberoptic bronchoscopy (FOB) requirement for airways management, MDCTA should be the first-line procedure performed in emergency clinical setting

Tracheomalacia associated with Mounier-Kuhn syndrome in the Intensive Care Unit: treatment with Freitag stent. A case report.

Science.gov (United States)

Giannoni, S; Benassai, C; Allori, O; Valeri, E; Ferri, L; Dragotto, A

2004-09-01

Tracheomalacia is a process characterized by softness of the supporting tracheal cartilages, by the extension of the posterior membranous wall and by reduction of the tracheal antero-posterior diameter. Exceptionally, tracheomalacia can be associated with tracheobronchomegaly or Mounier-Kuhn syndrome. Fibro-bronchoscopy represents the ''gold standard'' for diagnosis. The case of a 79-year-old male observed after hospitalization in a medical ward for chronic pulmonary obstructive disease (COPD) decompensation, and with basal left bronchopulmonary focus, is described. During this period, a progressive worsening of clinical conditions occurred, despite cortisone and antibiotic therapy, and the patient was transferred to the ICU for dyspnea, hypoxia, hypocapnia and with a diagnosis of pulmonary fibrosis. Bronchoscopy, performed during spontaneous breathing, revealed tracheomalacia which was responsible for tracheal dynamic complete stenosis during expiration and dynamic subtotal stenosis of the left primary bronchus in the first tract, together with sputum retention. Moreover, this investigation confirmed the diagnosis of tracheobronchomegaly already seen on CT. It was suggested to place a Freitag stent, since the insertion of another model would not have had enough chance of stability, due to the enormous extension of the tracheal lumen and could not have guaranteed good clearance of the secretions. Seven days after this intervention, performed in an outpatients' setting, the patient was dismissed from the ICU, without the help of O2, with good ventilation, saturation in line with his age and good expectoration.

Salivary Pepsin Lacks Sensitivity as a Diagnostic Tool to Evaluate Extraesophageal Reflux Disease.

Science.gov (United States)

Dy, Fei; Amirault, Janine; Mitchell, Paul D; Rosen, Rachel

2016-10-01

To determine the sensitivity of salivary pepsin compared with multichannel intraluminal impedance with pH testing (pH-MII), endoscopy, and gastroesophageal reflux disease (GERD) questionnaires. We prospectively recruited 50 children from Boston Children's Hospital who were undergoing pH-MII to evaluate for GERD. The patients completed 24-hour pH-MII testing, completed symptom and quality of life questionnaires, and provided a saliva specimen that was analyzed using the PepTest lateral flow test. A subset of patients also underwent bronchoscopy and esophagogastroduodenoscopy. Receiver operating characteristic curve analyses were performed to determine the sensitivity of salivary pepsin compared with each reference standard. Twenty-one of the 50 patients (42%) were salivary pepsin-positive, with a median salivary pepsin concentration of 10 ng/mL (IQR, 10-55 ng/mL). There was no significant difference in the distributions of acid, nonacid, total reflux episodes, full column reflux, or any other reflux variable in patients who were pepsin-positive compared with those who were pepsin-negative (P > .50). There was no significant correlation between the number of reflux episodes and pepsin concentration (P > .10). There was no positive relationship between salivary pepsin positivity, any extraesophageal symptoms or quality of life scores, or inflammation on bronchoscopy or esophagogastroduodenoscopy (P > .30). Salivary pepsin measurement has a low sensitivity for predicting pathological gastroesophageal reflux in children. Copyright © 2016 Elsevier Inc. All rights reserved.

Endobronchial aspergilloma: report of 10 cases and literature review.

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Ma, Jeong Eun; Yun, Eun Young; Kim, You Eun; Lee, Gi Dong; Cho, Yu Ji; Jeong, Yi Yeong; Jeon, Kyoung-Nyeo; Jang, In Seok; Kim, Ho Cheol; Lee, Jong Deok; Hwang, Young Sil

2011-09-01

A retrospective investigation of the clinical and radiologic features as well as the bronchoscopic appearance was carried out in patients with endobronchial aspergilloma. Ten patients with endobronchial aspergilloma diagnosed by bronchoscopy and histological examination were identified at the Gyeongsang University Hospital of Korea, from May 2003 to May 2009. The patients included 9 men and 1 woman, and the age of the patients ranged from 36 to 76 (median, 58 years). The associated diseases or conditions were: previous pulmonary tuberculosis in 7 patients, lung cancer in 2 patients, pulmonary resection in 1 patient, and foreign body of the bronchus in 1 patient. The chest radiologic finding showed fibrotic changes as a consequence of previous tuberculosis infection in 6 patients and a mass-like lesion in 2 patients. Two patients had a co-existing fungus ball, and an endobronchial lesion was suspected in only 2 patients on the CT scan. The bronchoscopic appearance was a whitish to yellow necrotic mass causing bronchial obstruction in 7 patients, foreign body with adjacent granulation tissue and whitish necrotic tissue in 1 patient, whitish necrotic tissue at an anastomosis site in 1 patient, and a protruding mass with whitish necrotic tissue in 1 patient. An endobronchial aspergilloma is a rare presentation of pulmonary aspergilosis and is usually incidentally found in immunocompetent patients with underlying lung disease. It usually appears as a necrotic mass causing bronchial obstruction on bronchoscopy and can be confirmed by biopsy.

Endobronchial ultrasound-guided transbronchial needle aspiration of lesions in mediastinum

DEFF Research Database (Denmark)

Eckardt, Jens

2010-01-01

investigations METHODS: During a period of 36 months 601 patients underwent EBUS at our institution. Two hundred ninety three patients had an established diagnosis of lung cancer and were referred to us for mediastinal staging. The remaining patients had a radiologically suspicious intrathoracic lesion of which...... 107 had an undiagnosed lesion in mediastinum. All patients had been investigated by previous chest CT and bronchoscopy including brush cytology but remained undiagnosed. RESULTS: Of the 107 patients with undiagnosed lesions in the mediastinum 89 enlarged lymph nodes and 18 mediastinal tumours. Forty...

Tracheal Penetration and Tracheoesophageal Fistula Caused by an Esophageal Self-Expanding Metallic Stent

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Karan Madan

2014-01-01

Full Text Available Tracheal penetration of esophageal self-expanding metallic stents (SEMS with/without tracheoesophageal fistula (TEF formation is a rare occurrence. We report the case of a 66-year-old female patient with advanced esophageal squamous cell carcinoma who had undergone palliative esophageal stenting on three occasions for recurrent esophageal stent obstruction. On evaluation of symptoms of breathing difficulty and aspiration following third esophageal stent placement, tracheal erosion and TEF formation due to the tracheal penetration by esophageal stent were diagnosed. The patient was successfully managed by covered tracheal SEMS placement under flexible bronchoscopy.

Gastric cancer metastasis mimicking primary lung cancer - case report and review of the literature

International Nuclear Information System (INIS)

Escuissato, Dante Luiz; Ledesma, Jorge Alberto; Urban, Linei Augusta Brolini Delle; Liu, Cristhian Bau; Reis Filho, Jorge Sergio; Oliveira Filho, Adilson Gil; Ferri, Mauricio Beller; Hossaka, Marco Aurelio

2002-01-01

Gastric cancer frequently presents intraperitoneal spread. Distant metastasis are rare. The authors describe a case of a 47-year-old white man, long-term cigarette smoker, who had a right upper lobe mass seen on plain films and computed tomography of the chest. A gastric adenocarcinoma was concomitantly diagnosed by endoscopic examination. A bronchoscopy guided biopsy showed that the lung mass was in fact a metastasis from gastric adenocarcinoma. In this article, the imaging findings of gastric cancer and the patterns of dissemination to other organs are reviewed. (author)

Normal lymph node size at Endobronchial ultrasound guided Transbronchial needle aspiration correlates to benign cytopathological diagnosis but does not rule out malignancy

DEFF Research Database (Denmark)

Ida Skovgaard, Christiansen; Bødtger, Uffe

2016-01-01

.Methods Retrospective, observational study including all patients referred 01.01.2013 to 31.12.2014 to the Dep. of Pulmonology, Odense University Hospital, Denmark, and having a thoracentesis performed. Data were collected from electronic medical file.Results In total, 138 patients were identified, and 78 (57 were......, bronchoscopy and thoracoscopy did not differ between groups.Conclusion Malignancy is the most likely diagnosis in patients with PE referred to pulmonologists. Half of cases were diagnosed by thoracentesis but without a reduction in number of investigations used. Additional tissue for advanced...

Pulmonary manifestations in HIV patients: The role of chest films, CT and HRCT

International Nuclear Information System (INIS)

Kauczor, H.U.; Schnuetgen, M.; Fischer, B.; Schwickert, H.C.; Haertel, S.; Schadmand-Fischer, S.; Gerken, G.; Schweden, F.

1995-01-01

64 HIV patients were examined prospectively. 15 had no respiratory symptoms (group I), 30 had non-specific respiratory symptoms (group II), 19 complained of dyspnoea (group III). Chest radiographs and CT were performed within a week. In patients with positive findings, bronchoscopy was carried out with bacteriological and histological examinations. In group I, 13% of chest radiographs and 40% of CT's showed infiltrative changes. In group II, the figures were 27% and 57% respectively. In group III, abnormalities were found in all cases by both examinations. (orig./MG) [de

Scintigraphic examinations after stent implantation in central airways

International Nuclear Information System (INIS)

Richter, W.S.; Kettner, B.I.; Munz, D.L.

1998-01-01

Endotracheal and endobronchial stent implantation has been developed as an effective treatment of benign and malignant airway stenosis and of tracheo- or bronchoesophageal fistulas. The selection of the stent type depends on the kind and site of disease. Chest X-ray and bronchoscopy are the procedures of choice for monitoring of stent position, structure, and function. However, with scintigraphic methods the effects of stent implantation on pulmonary ventilation and perfusion can be assessed non-invasively. The validation of the effect of a stent implantation on mucociliary and tussive clearance remains to be elucidated. (orig.) [de

Gastric cancer metastasis mimicking primary lung cancer - case report and review of the literature; Metastase de cancer gastrico simulando neoplasia primaria de pulmao - relato de caso e revisao da literatura

Energy Technology Data Exchange (ETDEWEB)

Escuissato, Dante Luiz; Ledesma, Jorge Alberto; Urban, Linei Augusta Brolini Delle; Liu, Cristhian Bau [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Radiologia]. E-mail: info@dapi.com.br; Reis Filho, Jorge Sergio [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas. Servico de Patologia; Oliveira Filho, Adilson Gil; Ferri, Mauricio Beller; Hossaka, Marco Aurelio [Parana Univ., Curitiba, PR (Brazil). Hospital de Clinicas

2002-04-01

Gastric cancer frequently presents intraperitoneal spread. Distant metastasis are rare. The authors describe a case of a 47-year-old white man, long-term cigarette smoker, who had a right upper lobe mass seen on plain films and computed tomography of the chest. A gastric adenocarcinoma was concomitantly diagnosed by endoscopic examination. A bronchoscopy guided biopsy showed that the lung mass was in fact a metastasis from gastric adenocarcinoma. In this article, the imaging findings of gastric cancer and the patterns of dissemination to other organs are reviewed. (author)

Fractured tracheostomy tube presenting as a foreign body in a paediatric patient

Science.gov (United States)

Gupta, Suman Lata; Swaminathan, Srinivasan; Ramya, Ravivalar; Parida, Satyen

2016-01-01

Tracheostomy tube fracture and aspiration into the tracheobronchial tree leading to airway obstruction is a dangerous complication after tracheostomy. We report a case of a fractured tracheostomy tube in a 6-year-old child who had been maintained on a tracheostomy tube for the past 5 years. The tracheostomy tube got fractured at the junction of the tube and neck plate, and impacted in the trachea and right main bronchus. Rigid bronchoscopy performed through the tracheostomy stoma to retrieve the fractured tracheostomy tube and the anaesthetic management during the period are discussed. PMID:26957033

Tracheo-esophageal fistula in children: a diagnosis to keep in mind. Two case reports and review of the literature = Fístula traqueoesofágica en niños: un diagnóstico para tener en cuenta. Reporte de dos casos y revisión de la literatura

Directory of Open Access Journals (Sweden)

Olga Lucía Morales Múnera

2013-07-01

Full Text Available The tracheo-esophageal fistula without esophageal atresia is a rare type esophageal malformation. It has a multifactorial etiology including environmental and genetic factors. Common clinical manifestations are coughing and choking after meals, cyanosis and/or recurrent pneumonia. Diagnosis requires a high clinical suspicion index. Fistula confirmation is done with imaging studies including upper digestive series, video-fluoroscopy or with the use of bronchoscopy wich allows direct visualization of the fistula or methylene blue passage through the abnormal communication. Fistula closure can be done endoscopically or surgically, in both cases with good results.

The value of conventional tomography and CT in the diagnosis of bronchial tumors

International Nuclear Information System (INIS)

Mayr, B.; Ingrisch, H.; Haeussinger, K.; Sunder-Plassmann, L.; Huber, R.

1988-01-01

66 patients with suspected bronchial tumors were examined by conventional tomography and by CT. The results were evaluated separately by two radiologists (A and B). All diagnoses were confirmed by bronchoscopy or surgery. In evaluating individual bronchi, conventional tomography had a sensitivity of 88% (A) or 87% (B) and a specificity of 97% (A) or 95% (B); CT had a sensitivity of 95% (A and B) and a specificity of 99% (A and B). If CT is available, our experience indicates that conventional tomography is no longer indicated. (orig.) [de

Clinical potential for imaging in patients with asthma and other lung disorders.

Science.gov (United States)

DeBoer, Emily M; Spielberg, David R; Brody, Alan S

2017-01-01

The ability of lung imaging to phenotype patients, determine prognosis, and predict response to treatment is expanding in clinical and translational research. The purpose of this perspective is to describe current imaging modalities that might be useful clinical tools in patients with asthma and other lung disorders and to explore some of the new developments in imaging modalities of the lung. These imaging modalities include chest radiography, computed tomography, lung magnetic resonance imaging, electrical impedance tomography, bronchoscopy, and others. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the ''fallen lung'' sign

International Nuclear Information System (INIS)

Wintermark, M.; Schnyder, P.; Wicky, S.

2001-01-01

Tracheo-bronchial injuries occur in less than 1 % of blunt chest trauma patients. Indirect signs, such as pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, are revealed on admission plain films and chest CT survey. In most instances, however, tracheo-bronchoscopy is mandatory in assessing the definite diagnosis of tracheo-bronchial lesion. Occasionally, an abnormal course of a mainstem bronchus or a ''fallen lung'' sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury. (orig.)

Novel use of laryngeal mask airway classic excel™ for bronchoscopy and tracheal intubation

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Anusha Kannan

2013-01-01

Full Text Available The usage frequency and scope of supraglottic airway devices in anesthesia has expanded since the original laryngeal mask airway (LMA prototype was invented by Dr Archie Brain in the early 1980s. Today, anesthesiologists are spoilt-for-choice with more than thirty options. The LMA Classic Excel™ was introduced to anesthesia practice in 2009; designed with an epiglottic elevating bar and a removable airway connector to facilitate tracheal intubation using the LMA as a conduit. We present a case report of a women diagnosed with papillary carcinoma of thyroid, who underwent bronchoscopic assessment of the trachea and subsequent intubation for an en-bloc dissection and removal of thyroid gland through the LMA Classic Excel™.

Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance.

Science.gov (United States)

Almuneef, Maha; Memish, Ziad A; Balkhy, Hanan H; Alalem, Hala; Abutaleb, Abdulrahman

2004-09-01

To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients. This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions. Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP. The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.

Bronchoscopic techniques in the management of patients with tuberculosis

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Michele Mondoni

2017-11-01

Full Text Available Tuberculosis (TB is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis.We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB.We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting and ablative procedures (both heat and cold therapies. Keywords: Bronchoscopy, Tuberculosis, Endoscopic ultrasound-guided fine needle aspiration, Tracheobronchial stenosis

Percutaneous dilatational tracheostomy using the ETView Tracheoscopic Ventilation Tube®: a teaching course in a pig model.

Science.gov (United States)

Fiorelli, Alfonso; Ferraro, Fausto; Frongillo, Elisabetta; Fusco, Pierluigi; Pierdiluca, Matteo; Nagar, Francesca; Iuorio, Angela; Santini, Mario

2017-10-01

We planned a training course for trainees of different specialties with the aim of teaching the skills of a new procedure for performing percutaneous dilatational tracheostomy (PDT) with an ETView tracheoscopic ventilation tube instead of standard bronchoscopy in an ex vivo pig model. The endotracheal tube, with a camera-embedded tip, was used as an alternative to standard bronchoscopy for visualization of patient airways. The procedure was performed on a home-made animal model. The participants were asked to perform PDT in three different sessions to improve their dexterity. The primary endpoint was the reduction of complications seen during the different sessions of the training course. The secondary endpoint was the satisfaction of the participants as assessed by an anonymous survey. Thirty-seven residents in anesthesiology and 7 in thoracic surgery in the first 2 years of their training and without any confidence with percutaneous tracheostomy participated in the study. Tracheal cuff lesions and impalement of the tracheal tube were the most observed complications, and were concentrated in the early sessions. A significant reduction in complications and operative time was seen during the ongoing sessions of the course. No lesions of the posterior tracheal wall and only a ring fracture occurred during the last session of the course. All participants were satisfied with the course. Our course seems to confer the technical skills to perform percutaneous tracheostomy to trainees and instill confidence with the procedure. However, the experience acquired on a training course should be evaluated in clinical practice.

Effect of serial-day exposure to nitrogen dioxide on airway and blood leukocytes and lymphocyte subsets

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Solomon, C.; Chen, L.L.; Erle, D.J.; Balmes, J.R. [Univ. of California, Lung Biology Center and Center for Occupational and Environmental Health, San Francisco, CA (United States); Christian, D.L.; Welch, B.S.; Dunham, E. [Univ. of California, Lung Biology Center, San Francisco, CA (United States); Kleinman, M.T. [Univ. of California, Dept. of Community and Environmental Medicine, Irvine, CA (United States)

2000-07-01

Nitrogen dioxide (NO{sub 2}) is a free radical-producing oxidant gas. Inhalation of NO2 could cause airway inflammation, and decrease immune function. This experiment tested the hypothesis that exposure to NO{sub 2} would: (1) increase leukocytes in bronchoalveolar lavage (BAL); and (2) change the distribution of lymphocyte subsets and activation in BAL and peripheral blood (PB). Using a counter-balanced, repeated-measures design, 15 healthy volunteers were exposed to filtered air (FA) or 2.0 parts per million NO{sub 2} for 4 h.day{sup -1} (4 x 30 min of exercise), for three consecutive days. Bronchoscopy was performed 18 h following each exposure set, and PB was drawn pre-exposure and pre-bronchoscopy. Flow cytometry was used to enumerate lymphocyte subsets and activation makers in BAL and PB. In the bronchial fraction, there was an increase in the percentage of neutrophils following NO2 exposure compared to FA (median (interquartile range): 10.6 (4.8. 17.2)% versus 5.3 (2.5-8.3)%; p=0.005). In the BAL, there was a decrease in the percentage of T-helper cells following NO{sub 2} exposure compared to FA (55.9 (40.8-62.7)% versus 61.6 (52.6-65.2)%; p=0.022). For PB, there were no between-condition differences in any leukocyte or lymphocyte subsets, or activation. In conclusion exposure to nitrogen dioxide results in bronchial inflammation and a minimal change in bronchoalveolar lavage T-helper cells, and no changes in peripheral blood cells. (au)

Bronchial artery embolization in the treatment of massive hemoptysis

International Nuclear Information System (INIS)

Zubairi, Ali Bin Sarwar; Zubairi, M.A.; Irfan, M.; Tanveer-ul-Haq; Fatima, K.; Azeemuddin, M.

2007-01-01

Objective was to evaluate the efficacy of bronchial arteriography and bronchial artery embolization (BAE) in the management of massive hemoptysis in a developing Asian country. A retrospective review was carried out from March 2000 to March 2005 to evaluate the demographics, clinical presentation, radiographic studies, bronchoscopy results, and complications of bronchial arteriography and BAE at a tertiary care hospital in Pakistan. Fourteen patients (9males, 5 females) with a mean age of 49 years underwent bronchial arteriography and BAE for massive hemoptysis. Hemoptysis was caused by bronchiectasis (10 patients), active pulmonary tuberculosis (3 patients), and lung malignancy (one patient). A CT scan of the chest was carried out in 11 patients, which revealed bronchiectasis (8 patients), cavity with infiltrates (3 patients), and mass lesion (one patient). Bronchoscopy was performed in all patients. Bleeding lobe or segment was identified in 12 patients. Bronchial arteriography revealed hypervascularity (13 patients), bronchial artery hypertrophy (5 patients), hypervascularity with shunting (one patient), dense soft tissue staining (7 patients), extravasation of contrast (one patient) pseudoaneurysm (one patient). Bronchial artery embolization was carried out in all patients. Rebleeding occurred within 24 hours in 2 patients who underwent surgery and within one week another 2 patients who were managed with repeat BAE. The complication of embolization occurred in one patient (transverse myelitis). Thirteen patients improved and were discharged home. One patient with terminal lung carcinoma died due to cardiogenic shock secondary to acute myocardial infarction. Bronchial artery embolization is an effective method for management of massive hemoptysis in developing countries and has a low complication rate. (author)

Aerosolized pentamidine: Effect on diagnosis and presentation of Pneumocystis carinii pneumonia

International Nuclear Information System (INIS)

Jules-Elysee, K.M.; Stover, D.E.; Zaman, M.B.; Bernard, E.M.; White, D.A.

1990-01-01

The objective of this study was to determine the effect of previous aerosolized pentamidine therapy on diagnosis and presentation of Pneumocystis carinii pneumonia. This was a retrospective study of fifty-two consecutive patients with P. carinii pneumonia and underlying infection with the human immunodeficiency virus (HIV) who had bronchoscopy. Twenty-one patients who were on aerosolized pentamidine therapy served as the study group. Thirty-one patients who had not received the drug served as the control group. The yield of bronchoalveolar lavage for P. carinii pneumonia was 62% for the study group and 100% for the control group (P less than 0.05). This lower yield was significant for the subset of patients having their first episode of P. carinii pneumonia. The yield of transbronchial biopsy was similar for both groups of patients (81% compared with 84%). The yield of bronchoscopy was not influenced by use of zidovudine. Review of lavage specimen slides suggested that there may be fewer organisms present in patients receiving aerosolized pentamidine. An atypical roentgenographic presentation of upper lobe predominant infiltrates was seen in 38% of the study patients and 7% of the control patients. In addition, pneumothoraces and cystic changes were also frequently seen in the study patients. Gallium scans, when done, were also atypical in the study group. Markers of the severity of disease, however, were similar in both groups. The yield of bronchoalveolar lavage for P. carinii pneumonia in HIV-infected patients is lower in patients receiving aerosolized pentamidine. Unusual roentgenographic presentations and atypical gallium scans are also found in this setting

Pulmonary hydatidosis: An unusual cause of haemoptysis

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Pandey A

2007-01-01

Full Text Available A 28-year-old female patient was referred to us with complaints of massive haemoptysis and cough with expectoration, of two years′ duration. Her chest radiograph, computed tomography scan and video-bronchoscopy revealed a cystic lesion in the right upper and lower zones of the lungs. Aspiration from the cyst fluid was grossly hemorrhagic and full of inflammatory cells. On digestion of the fluid with potassium hydroxide, it showed plenty of hooklets and scolices of Echinococcus granulosus . An intact brood capsule was also seen. Diagnosis of hydatidosis was further confirmed by a positive serological and therapeutic response to albendazole.

A case of endobronchial lipoma mimicking bronchial asthma

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Sevket Ozkaya

2009-05-01

Full Text Available Sevket Ozkaya1, Hasan Demir1, Serhat Findik21Samsun Chest Diseases and Thoracic Surgery Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, TurkeyAbstract: Endobronchial lipoma is a rare neoplasm of the tracheobronchial tree and it may cause irreversible pulmonary damage due to recurrent pneumonia. Rarely, it may mimic bronchial asthma. We present a 53-year-old woman with an endobronchial lipoma, which had been treated as a bronchial asthma for four years. She also had developed recurrent pneumonia three times.Keywords: endobronchial lipoma, asthma, radiology, bronchoscopy

Alveolar damage in AIDS-related Pneumocystis carinii pneumonia

DEFF Research Database (Denmark)

Benfield, T L; Prentø, P; Junge, Jette

1997-01-01

OBJECTIVE: Pneumocystis carinii pneumonia is the most common and serious of the pulmonary complications of AIDS. Despite this, many basic aspects in the pathogenesis of HIV-associated P carinii pneumonia are unknown. We therefore undertook a light and electron microscopic study of transbronchial...... biopsy specimens to compare pathologic features of P carinii pneumonia and other HIV-related lung diseases. DESIGN AND PATIENTS: Thirty-seven consecutive HIV-infected patients undergoing a diagnostic bronchoscopy. RESULTS: P carinii pneumonia was characterized by an increase in inflammation, edema...... with P carinii pneumonia, whereas none without P carinii pneumonia had this finding (p pneumonia. The changes may form...

Treatment of malignant or benign tracheobronchial stenosis by home made Nitrol stents

International Nuclear Information System (INIS)

Zhang Fanchang; Luo Zhehuang; Hu Xunying; Liu Jiubao; Jin Aifang

2002-01-01

Objective: To evaluate the therapeutic effects of home made Nitrol stents in the treatment of malignant or benign tracheobronchial stenosis. Methods: Thirteen patients with malignant or benign tracheobronchial stenosis were treated by Nitrol stents. The stenosed sites located in trachea in 5, tracheo-bronchi in 6, main bronchus in 2. All cases were malignant except one was benign. Results: 15 stents were successfully placed the expected position with dyspnea rapidly improved. The average survival time was 11.4 months. Conclusions: It is an effective way to place Nitrol stent in treatment of tracheobronchial stenosis under x-ray guidance with fiber tracheo-bronchoscopy

Diffuse alveolar hemorrhage in a patient with acute poststreptococcal glomerulonephritis caused by impetigo.

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Yoshida, Masahiro; Yamakawa, Hideaki; Yabe, Masami; Ishikawa, Takeo; Takagi, Masamichi; Matsumoto, Kei; Hamaguchi, Akihiko; Ogura, Makoto; Kuwano, Kazuyoshi

2015-01-01

We herein report a case of pulmonary renal syndrome with nephritis in a 17-year-old boy with diffuse alveolar hemorrhage (DAH) associated with acute poststreptococcal glomerulonephritis (APSGN). The patient exhibited hemoptysis two weeks after developing impetigo, and DAH was diagnosed on bronchoscopy. Respiratory failure progressed, and high-dose methylprednisolone therapy was administered; the respiratory failure regressed immediately after the onset of therapy. Streptococcus pyogenes was detected in an impetigo culture, and, together with the results of the renal biopsy, a diagnosis of APSGN was made. This case demonstrates the effects of high-dose methylprednisolone therapy in improving respiratory failure.

Lung Metastases from Bile Duct Adenocarcinoma Mimicking Chronic Airway Infection and Causing Diagnostic Difficulty.

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Sato, Mitsuo; Okachi, Shotaro; Fukihara, Jun; Shimoyama, Yoshie; Wakahara, Keiko; Sakakibara, Toshihiro; Hase, Tetsunari; Onishi, Yasuharu; Ogura, Yasuhiro; Maeda, Osamu; Hasegawa, Yoshinori

2018-05-15

We herein report a case of lung metastases with unusual radiological appearances that mimicked those of chronic airway infection, causing diagnostic difficulty. A 60-year-old woman who underwent liver transplantation from a living donor was incidentally diagnosed with bile duct adenocarcinoma after a histopathological analysis of her explanted liver. Six months later, chest computed tomography (CT) revealed bilateral bronchogenic dissemination that had gradually worsened, suggesting chronic airway infection. A biopsy with bronchoscopy from a mass lesion beyond a segmental bronchus revealed adenocarcinoma identical to that of her bile duct adenocarcinoma, leading to the diagnosis of multiple lung metastases from bile duct adenocarcinoma.

Aspiration of tracheoesophageal prosthesis in a laryngectomized patient

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Conte Sergio C

2012-08-01

Full Text Available Abstract Background The voice prosthesis inserted into a tracheoesophageal fistula has become the most widely used device for voice rehabilitation in patients with total laryngectomy. Case presentation We describe a case of tracheoesophageal prosthesis’ (TEP aspiration in a laryngectomized patient, with permanent tracheal stoma, that appeared during standard cleaning procedure, despite a programme of training for the safe management of patients with voice prosthesis. Conclusions The definitive diagnosis and treatment were performed by flexible bronchoscopy, that may be considered the procedure of choice in these cases, also on the basis of the literature.

Pulmonary zygomycosis in a diabetic patient

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Anuradha K

2006-01-01

Full Text Available We report a case of pulmonary zygomycosis in an adult male diabetic patient who presented with fever and altered sensorium initially and later developed streaky haemoptysis. Bronchoscopy showed picture of necrotizing pneumonia. Sputum was negative for fungal elements on admission but later bronchial wash and repeat sputum samples were positive by microscopy and culture showed growth of Rhizopus species. Immediately the patient was put on amphotericin B but had a bout of massive haemoptysis and succumbed. A high index of suspicion is needed for an early diagnosis and aggressive treatment of this infection in view of the high mortality rate.

Gigi tiruan sebagian lepasan sebagai benda asing dalam trakea (Removable partial denture as foreign body in trachea

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Sri Herawati JPB

2005-09-01

Full Text Available Foreign bodies in the trachea are not uncommon. Usually the patients come with dyspnea and a history of having aspirate something. This is an emergency case and needs extraction of the foreign body via bronchoscopy with general anesthesia as soon as possible. The optimal preparation is a controlled, well-equipped and well prepared operative setting. A case of removable partial denture as foreign body in trachea was reported and the extraction of the denture was done with difficulty due to the size of the denture compared with the width of the rima glottis and the trachea.

Viral Pneumonia in Patients with Hematologic Malignancy or Hematopoietic Stem Cell Transplantation.

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Vakil, Erik; Evans, Scott E

2017-03-01

Viral pneumonias in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation cause significant morbidity and mortality. Advances in diagnostic techniques have enabled rapid identification of respiratory viral pathogens from upper and lower respiratory tract samples. Lymphopenia, myeloablative and T-cell depleting chemotherapy, graft-versus-host disease, and other factors increase the risk of developing life-threatening viral pneumonia. Chest imaging is often nonspecific but may aid in diagnoses. Bronchoscopy with bronchoalveolar lavage is recommended in those at high risk for viral pneumonia who have new infiltrates on chest imaging. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical value of radiological methods in evaluation and therapy of severe thoracic trauma

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Glinz, W.

1987-09-01

Plain chest radiographs allow the diagnosis of most intrathoracic injuries. However, they are only momentary pictures and give no information on the respiratory function. A tension pneumothorax, rib fractures and subcutaneous emphysema should be diagnosed clinically before radiographs are taken. Computed tomography is helpful in evaluation of intrapulmonary lesions, hemothorax, rupture of the diaphragm and dislocation of the heart. Further diagnostic tools include aortography in suspected aortic rupture, sonography in cardiac injuries and hemopericardium, bronchoscopy in suspected bronchial or tracheal rupture, ECG and enzyme determinations in cardiac contusion, and eventually pneumoperitoneum in suspected rupture of the diaphragm.

Blunt traumatic rupture of a mainstem bronchus: spiral CT demonstration of the ''fallen lung'' sign

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Wintermark, M.; Schnyder, P.; Wicky, S. [Dept. of Diagnostic and Interventional Radiology, University Hospital, Lausanne (Switzerland)

2001-03-01

Tracheo-bronchial injuries occur in less than 1 % of blunt chest trauma patients. Indirect signs, such as pneumomediastinum, pneumothorax, and/or subcutaneous emphysema, are revealed on admission plain films and chest CT survey. In most instances, however, tracheo-bronchoscopy is mandatory in assessing the definite diagnosis of tracheo-bronchial lesion. Occasionally, an abnormal course of a mainstem bronchus or a ''fallen lung'' sign, featuring a collapsed lung in a dependent position, hanging on the hilum only by its vascular attachments, may allow for CT diagnosis of a blunt traumatic bronchial injury. (orig.)

Clinical value of radiological methods in evaluation and therapy of severe thoracic trauma

International Nuclear Information System (INIS)

Glinz, W.

1987-01-01

Plain chest radiographs allow the diagnosis of most intrathoracic injuries. However, they are only momentary pictures and give no information on the respiratory function. A tension pneumothorax, rib fractures and subcutaneous emphysema should be diagnosed clinically before radiographs are taken. Computed tomography is helpful in evaluation of intrapulmonary lesions, hemothorax, rupture of the diaphragm and dislocation of the heart. Further diagnostic tools include aortography in suspected aortic rupture, sonography in cardiac injuries and hemopericardium, bronchoscopy in suspected bronchial or tracheal rupture, ECG and enzyme determinations in cardiac contusion, and eventually pneumoperitoneum in suspected rupture of the diaphragm. (orig.)

The comparative development of elevated resistance to macrolides in community-acquired pneumonia caused by Streptococcus pneumoniae

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Yayan J

2014-10-01

Full Text Available Josef Yayan Department of Internal Medicine, Division of Pulmonary, Allergy and Sleep Medicine, Saarland University Medical Center, Homburg/Saar, Germany Background: Community-acquired pneumonia (CAP is an acute inflammation of the lungs, which is often caused by Streptococcus pneumoniae. CAP is the leading cause of death by infectious disease in industrialized countries. Therefore, an immediate and effective antibiotic therapy is of great importance for the nonfatal outcome of the disease. The literature contains increasing data about the development of resistance to antibiotics that are used for the treatment of CAP caused by S. pneumoniae; this article also examines the possible development of resistance to antibiotics in S. pneumoniae in recent years.Methods: Within the study period of 2004–2014, all hospital charts from patients with CAP caused by S. pneumoniae were collected from the Department of Internal Medicine, Saarland University Medical Center, Homburg/Saar, Germany. The tracheal secretions of S. pneumoniae in CAP patients were obtained by bronchoalveolar lavage; bronchial aspirates were obtained through flexible bronchoscopy and directly from sputum, and blood cultures were examined microbiologically for microorganisms.Results: From a total of 100 patients with CAP caused by S. pneumoniae, 23 (53.49% [34.78% female], 95% confidence interval, 38.58–68.4 patients with a mean age of 59.78±15.77 years met the inclusion criteria of this investigation. These patients were compared to a total of 20 (46.51% [35% female], 95% confidence interval, 31.6–61.42 patients with a mean age of 58.9±13.36 years with CAP who were infested with S. pneumoniae. In the latter group, the streptococcal antigen was detected in pulmonary aspirations by bronchoscopy or in urine using polymerase chain reaction and a rapid pneumococcal test. Penicillin G and vancomycin had a high rate of sensitivity on the antibiogram for S. pneumoniae, which was

Identification of risk groups in patients with completely resected N1 non-small cell lung carcinoma

International Nuclear Information System (INIS)

Sawyer, T.E.; Bonner, J.A.; Gould, P.J.; Foote, R.L.; Deschamps, C.; Trastek, V.F.; Pairolero, P.C.; Allen, M.S.; Lange, C. M.; Li, H.

1997-01-01

Purpose: Although the potential benefits of radiation therapy and chemotherapy in the management of completely resected AJCC N1 non-small cell lung cancer are unknown, the majority of studies have failed to demonstrate a survival benefit with any neoadjuvant or adjuvant therapy. While it is possible that radiation therapy and chemotherapy are ineffective adjunctive therapies in this disease, it is also possible that previous studies have been diluted by the inclusion of patients at low risk for local recurrence and/or distant metastasis and therefore, this study was undertaken to assess these risks. Methods: From 1987 through 1990, 107 patients underwent complete resection of AJCC N1 non-small cell lung carcinoma and received no other treatment. These patients were the subject of a retrospective review to separate patients into high-, medium-, and low-risk groups with respect to freedom from local recurrence (FFLR), freedom from distant metastasis (FFDM), and overall survival (OS) utilizing a regression analysis of Cox and a regression tree analysis (Breiman LI et al, Wadsworth International Group, Belmont, CA 1984). Results: The 5-year rates of FFLR, FFDM, and OS were 62%, 53%, and 32% respectively. The following factors were assessed for potential relationships with FFLR, FFDM, and OS: status of the pre-operative bronchoscopy, type of surgery performed (segmentectomy/wedge resection vs. lobectomy vs. bilobectomy/pneumonectomy), number of involved N1 nodes, number of involved N1 stations, number of N1 nodes removed, number of N2 nodes removed, number of lung lobes involved, tumor grade, tumor histology (squamous vs non-squamous), AJCC T-stage, pathologic tumor size, and pathologic margin status. Regression analyses revealed that the factors independently associated with an improved outcome included a positive bronchoscopy (FFLR, p=.005), a greater number of N1 nodes dissected (FFDM, p=.02), and a lesser T-stage (OS, p=.01). Regression tree analyses were then

Descriptive data on cancerous lung lesions detected by auto-fluorescence bronchoscope: A five-year study

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Asmitananda Thakur

2012-01-01

Full Text Available Background: Auto-fluorescence bronchoscopy (AFB has been used for the identification and localization of intra-epithelial pre-neoplastic and neoplastic lesions within the bronchus. Objectives: To determine the applicability of AFB for the detection and localization of precancerous and cancerous lesions, in addition to analyzing the morphologic presentation, their association to histological type and the variation between genders. Methods: A five-year study involving 4983 patients, who underwent routine bronchoscopy [B] examination in a local tertiary teaching hospital, was done. The B examination was performed under intratracheal lidocaine, and samples were obtained using suitable approach. One thousand four hundred and eighty-five pathologically confirmed lung cancer patients were included in the study. The following parameters were studied: Morphological presentation, biopsy sites, histology. Differences between the groups were analyzed using Chi square test. Result: One thousand four hundred and eighty-five patients who had hyperplasia or neoplastic lesions were further confirmed as lung cancer pathologically. Lung cancer was more commonly found in the right lung (51.58% vs. 42.82%. The lesion occurred more frequently in the upper lobe than the lower lobe (44.17% vs. 22.42%. Male patients with squamous cell carcinoma showed upper lobe involvement more commonly, while the left main bronchus was more commonly involved in female patients. Adenocarcinoma mostly involved lesion of the upper lobe. Squamous cell carcinoma and small cell carcinoma were the major proliferative types (80.15% and 76.16% respectively. Conclusion: AFB is efficient in the detection of pre-invasive and invasive lung lesions. The morphological presentation is associated to the histological type. There is variation in the presentation and histology of cancerous lung lesions between genders.

Bronchoscopic assessment of airway retention time of aerosolized xylitol

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Durairaj, Lakshmi; Neelakantan, Srividya; Launspach, Janice; Watt, Janet L; Allaman, Margaret M; Kearney, William R; Veng-Pedersen, Peter; Zabner, Joseph

2006-01-01

Background Human airway surface liquid (ASL) has abundant antimicrobial peptides whose potency increases as the salt concentration decreases. Xylitol is a 5-carbon sugar that has the ability to lower ASL salt concentration, potentially enhancing innate immunity. Xylitol was detected for 8 hours in the ASL after application in airway epithelium in vitro. We tested the airway retention time of aerosolized iso-osmotic xylitol in healthy volunteers. Methods After a screening spirometry, volunteers received 10 ml of nebulized 5% xylitol. Bronchoscopy was done at 20 minutes (n = 6), 90 minutes (n = 6), and 3 hours (n = 5) after nebulization and ASL was collected using microsampling probes, followed by bronchoalveolar lavage (BAL). Xylitol concentration was measured by nuclear magnetic resonance spectroscopy and corrected for dilution using urea concentration. Results All subjects tolerated nebulization and bronchoscopy well. Mean ASL volume recovered from the probes was 49 ± 23 μl. The mean ASL xylitol concentration at 20, 90, and 180 minutes was 1.6 ± 1.9 μg/μl, 0.6 ± 0.6 μg/μl, and 0.1 ± 0.1 μg/μl, respectively. Corresponding BAL concentration corrected for dilution was consistently lower at all time points. The terminal half-life of aerosolized xylitol obtained by the probes was 45 minutes with a mean residence time of 65 minutes in ASL. Corresponding BAL values were 36 and 50 minutes, respectively. Conclusion After a single dose nebulization, xylitol was detected in ASL for 3 hours, which was shorter than our in vitro measurement. The microsampling probe performed superior to BAL when sampling bronchial ASL. PMID:16483382

Durability of Silicone Airway Stents in the Management of Benign Central Airway Obstruction.

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Karush, Justin M; Seder, Christopher W; Raman, Anish; Chmielewski, Gary W; Liptay, Michael J; Warren, William H; Arndt, Andrew T

2017-10-01

The literature is devoid of a comprehensive analysis of silicone airway stenting for benign central airway obstruction (BCAO). With the largest series in the literature to date, we aim to demonstrate the safety profile, pattern of re-intervention, and duration of silicone airway stents. An institutional database was used to identify patients with BCAO who underwent rigid bronchoscopy with dilation and silicone stent placement between 2002 and 2015 at Rush University Medical Center. During the study period, 243 stents were utilized in 63 patients with BCAO. Pure tracheal stenosis was encountered in 71% (45/63), pure tracheomalacia in 11% (7/63), and a hybrid of both in 17% (11/63). Median freedom from re-intervention was 104 (IQR 167) days. Most common indications for re-intervention include mucus accumulation (60%; 131/220), migration (28%; 62/220), and intubation (8%; 18/220). The most common diameters of stent placed were 12 mm (94/220) and 14 mm (96/220). The most common lengths utilized were 30 mm (60/220) and 40 mm (77/220). Duration was not effected by stent size when placed for discrete stenosis. However, 14 mm stents outperformed 12 mm when tracheomalacia was present (157 vs. 37 days; p = 0.005). Patients with a hybrid stenosis fared better when longer stents were used (60 mm stents outlasted 40 mm stents 173 vs. 56 days; p = 0.05). Rigid bronchoscopy with silicone airway stenting is a safe and effective option for the management of benign central airway obstruction. Our results highlight several strategies to improve stent duration.

Management of tracheal chondrosarcoma almost completely obstructing the airway: a case report.

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Andolfi, Marco; Vaccarili, Maurizio; Crisci, Roberto; Puma, Francesco

2016-07-11

Primary malignant tracheal tumors account for only 0.2 % of all malignancies of the respiratory tract. Tracheal chondrosarcoma is a rare condition and only 17 cases have been described in the literature from 1965 to date. Herein we report the very unusual case of a patient with a tracheal chondrosarcoma, electively treated by curative surgery despite the virtually complete obstruction of the airway. We present the case of a 79-year old Caucasian man with long-lasting wheezing misdiagnosed as asthma and affected by a tracheal chondrosarcoma almost completely obstructing the airway. Videobronchoscopy and imaging investigations revealed a well-circumscribed mass arising from the cartilaginous rings of the cervical trachea with a posterior residual respiratory space of about 1 mm. Because of the mobility and flaccidity of the uninvolved pars membranacea, the tiny respiratory space slightly expanded during inspiration and expiration allowing the patient to be treated without an essential emergency procedure. Standard tracheal intubation was impossible. Rigid bronchoscopy enabled placement of a small tracheal tube distally to the tumor. Successful cervical tracheal resection and reconstruction was then performed, achieving complete tumor excision. Histologically, the mass was characterized as a low-grade tracheal chondrosarcoma. Videobronchoscopy performed 9 months after surgery showed a wide, well healed tracheal anastomosis. Ten months after surgery, the patient is alive and disease free. Complete surgical resection is the treatment of choice for tracheal chondrosarcoma. Rigid bronchoscopy is an essential tool for diagnostic and therapeutic purposes. It allows the palliative maneuvers for obstruction relief but also, in resectable patients, the intraoperative safe and straightforward management of the obstructed airway.

Clinico-radiological profile and risk factors in patients with anthracosis

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Virendra Singh

2015-01-01

Full Text Available Background: Anthracosis is the black pigmentation of the mucosal lining of the tracheo-bronchial tree. The significance of this finding is not known and often ignored. The aim of the present study is to find the association of anthracosis with demographic variables, biomass fuel and occupational exposure, respiratory diseases, radiological pattern and functional morbidity. Materials and Methods: Enrolment of the subjects for the study was done at SMS hospital, Jaipur. Patients with anthracosis evident on bronchoscopy were included as the cases. Patients without anthracosis on bronchoscopy, matched according to age, gender and smoking habits, were included in the control group. Subjects in both the arms completed a questionnaire and also underwent computed tomography (CT of the chest and six minute walk test (6MWT. Results: Thirty cases and 53 controls were included in the study. The patients with anthracosis presented with symptoms ranging from cough (76.65%, hemoptysis (46.6%, fever (26.6%, dyspnea (90% and malaise (73.3%. Biomass fuel exposure for the cases was 35.13 ± 55.86 hours in a year and for the controls was 28.15 ± 40.09 hours in a year (P > 0.05. Stone mining was significantly associated with anthracosis (P < 0.05. CT chest revealed fibrosis (43.3%, consolidation (33.3%, cavitation (16.6% and mass (46.6% in the cases. Sixty percent of cases and 15% of controls were diagnosed to have either old or active pulmonary tuberculosis (P < 0.05. Conclusions: Anthracosis is associated with pulmonary tuberculosis. Biomass exposure is not significantly associated with anthracosis. Post tubercular fibrosis is more common on CT chest of patients with anthracosis.

A Prospective Randomized Study Comparing Manual and Wall Suction in the Performance of Bronchoalveolar Lavage.

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Seijo, Luis M; Flandes, Javier; Somiedo, Maria V; Naya, Alba; Manjón, Josefina; Álvarez, Susana; Fernández-Navamuel, Iker

2016-01-01

Bronchoalveolar lavage (BAL) may be performed using a hand-held syringe or wall suction. The aim was to study BAL volume and diagnostic yields based on BAL technique. A total of 220 consecutive patients undergoing BAL at our center were included. Manual aspiration was performed in 115 patients (group 1), and wall suction (<50 mm Hg of negative pressure) was used in 105 patients (group 2). All bronchoscopies were performed under conscious sedation applying topical anesthesia with lidocaine. Three 50-ml sterile saline aliquots were instilled in all patients. The mean total amount of fluid recovered was 67 ± 20 ml in group 1 and 55 ± 22 ml in group 2 (p < 0.001). More patients in the manual aspiration group met American Thoracic Society criteria (recovery of ≥30% of instilled fluid) for an optimal BAL (81 vs. 59%; p < 0.001). The quantity of recovered fluid was also related to BAL location (p < 0.001) and radiologic findings (p = 0.002). Forty-eight (22%) BALs were diagnostic (23 in group 1 and 25 in group 2), including 37 positive bacterial cultures, 6 positive stains for Pneumocystis, and 5 cases of malignancy. No statistically significant difference in diagnostic yield was observed between the two groups. A BAL diagnosis was more likely in patients with certain radiologic (p = 0.033) and endoscopic findings (p = 0.001). When taking into account all bronchoscopic techniques performed during the procedure (e.g. biopsies, brushing, etc.), bronchoscopy was diagnostic in 37% of patients. Manual aspiration is superior to wall suction during BAL yielding a larger quantity of aspirate. Diagnostic yields are similar for both techniques. © 2016 S. Karger AG, Basel.

Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

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Marcia Jacomelli

Full Text Available ABSTRACT Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy, we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm and 19 masses (mean diameter, 4.1 ± 0.9 cm. The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS. Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7% and bronchial bleeding, which was controlled bronchoscopically (in 9.3%. Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

[Aortopexy for tracheomalacia in infants and children].

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Vinograd, I; Klin, B; Silbiger, A; Eshel, G

2000-06-15

During the past 12 years (1985-1998), 28 infants and children were operated on here for tracheomalacia. The diagnosis was made in all using rigid bronchoscopy. During the examination the infants breathed spontaneously, but the trachea collapsed on forced expiration. Indications for surgery were repeated cyanotic spells ("dying spells") in 22, recurrent pneumonia, and inability to extubate (in 8). In 11 there were more than 1 indications. Age at surgery was from 7 days to 3 years (average 11.7 months). All 28 children underwent bronchoscopy and guided aortopexy via a left-third intercostal approach. The ascending aorta and aortic arch (and in 6 the proximal innominate artery as well) were lifted anteriorly, using 3-5 non-absorbable sutures (5.0). The sutures were placed through the adventitia of the great vessels and then passed through the sternum. Respiratory distress was significantly improved in 21. Another 2 required external tracheal stenting with autologous rib grafts, and in 1 other an internal Palmaz stent was introduced for tracheal stability. In 4 aortopexy failed, 1 of whom had tracheobronchomalacia throughout, and another 3 had laryngomalacia which required tracheostomy to relieve the respiratory symptoms. Postoperative complications were minor: pericardial effusion in 1 and relaxation of the left diaphragm in another. 1 infant subsequently died, of unknown cause 10 days after operation, after having been extubated on the 1st postoperative day. On long-term follow-up (6 months to 12 years) 25 were found free of residual respiratory symptoms and 3 remained with a tracheostomy. Thus, infants and children with severe tracheomalacia associated with severe respiratory symptoms, can be relieved by bronchoscopic guided suspension of the aortic arch to the sternum.

Unguided bronchoscopic biopsy: Does yield increase with operator experience

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Tyagi Rahul

2017-08-01

Full Text Available Background Bronchoscopic Forceps biopsy (Endobronchial Biopsy (EBB and Trans Bronchial Lung Biopsy (TBLB are commonly performed for diagnosis in patients with endobronchial abnormalities or diffuse parenchymal involvement. As the operator gains experience his yield of various diagnostic bronchoscopic biopsies is expected to increase, however, no studies on the subject are available in literature. Aims To determine the effect of on- job experience on the yield of unguided bronchoscopic biopsies. Methods A total of 244 bronchoscopies were performed between Oct 2013 and Oct 2016. A retrospective analysis of all these bronchoscopies was undertaken. All patients who underwent biopsy were included in the study. Patients were divided into two groups with first group (Group A comprising of biopsies done between Oct 2013 to Apr 2015 and second group comprising biopsies done between May 2015 to Oct 2016 (Group B. The diagnostic yield in two groups was compared. Results Total 71 bronchoscopic biopsies were performed during Oct 2013 to Oct 2016. 36 patients were included in group A and 35 patients were included in group B. The groups were matched in demographic profile, clinical diagnosis, bronchoscopic findings and type of biopsy undertaken. The biopsy was diagnostic in 31 patient (43.6 per cent and nondiagnostic in 33 patients (46.4 per cent. There were 15 diagnostic biopsies in group A and 16 diagnostic biopsies in group B. The difference in the diagnostic biopsies between the two groups was not significant. Conclusion There was no significant impact of on job experience on diagnostic yield of biopsies. This may be due to adequate exposure during training leading to a diagnostic plateau being reached.

Percutaneous dilatational tracheostomy without fiber optic bronchoscopy-Evaluation of 80 intensive care units cases

NARCIS (Netherlands)

J.A. Calvache (Jose Andrés); R.A. Molina García (Rodrigo); A.L. Trochez (Adolfo); J. Benitez (Javier); L.A. Flga (Lucía Arroyo)

2013-01-01

textabstractBackground: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy

EBUS: Uma nova dimensão na broncoscopia EBUS: A new dimension in bronchoscopy

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H D Becker

2007-01-01

Full Text Available O autor revê neste artigo, sob a forma de editorial, a implementação da ecografia endobrônquica na broncologia, as suas indicações e futuras aplicações. No começo dos anos 90, com o início do desenvolvimento da ecografia endobrônquica, o seu primeiro objectivo era avaliar a infiltração das vias aéreas centrais por tumores externos. A TAC torácica permanece o exame standard de avaliação e estadiamento pré-operatório do cancro do pulmão. Contudo, sabe-se actualmente que este exame imagiológico não é totalmente fidedigno na análise do envolvimento ganglionar e totalmente insuficiente na detecção de infiltração da parede das vias aéreas. O desenvolvimento da EBUS (endobronchial ultrasound, foi inicialmente complicado por motivos técnicos e anatómicos relacionados com as diferentes interfaces da estrutura pulmonar, e, posteriormente, dificilmente aceite pelos pneumologistas, dado o seu reduzido contacto prévio com a ecografia. O primeiro reconhecimento da utilidade desta técnica partiu dos cirurgiões cardiotorácicos ao tentarem saber de antemão a eventual invasão da parede das vias aéreas, nomeadamente da traqueia, antes de cada cirurgia. Actualmente, a ecografia endobrônquica é executada em mais de cem centros de broncoscopia a nível mundial. A ecografia endobrônquica pode ser realizada com uma sonda de 20- MHz, o que permite analisar as diferentes camadas teciduais das vias aéreas centrais, estruturas peritraqueais ou peribrônquicas, avaliação da permeabilidade pós-estenótica da árvore brônquica, ou através de um broncofibroscopio com transducer incorporado de 7,5- MHz que apenas analisa as estruturas adjacentes das vias aéreas centrais, com a possibilidade de puncionar em tempo real essas mesmas estruturas. Estas duas técnicas são complementares, sendo a utilização de uma ou outra dependente das necessidades de cada centro. Apesar de apresentar uma curva de aprendizagem lenta, a EBUS será uma técnica com futuro e que permitiu, nos centros onde é efectuada, a redução drástica do número de mediastinoscopias e aumento da rentabilidade da TBNA (transbronchial needle aspiration.

Bronchial Leech Infestation in a 15-Year-Old Female.

Science.gov (United States)

Moslehi, Mohammad Ashkan; Imanieh, Mohammad Hadi; Adib, Ali

2016-01-01

Foreign body aspiration (FBA) is a common incidence in young children. Leeches are rarely reported as FBA at any age. This study describes a 15-year-old female who presented with hemoptysis, hematemesis, coughs, melena, and anemia seven months prior to admission. Chest X-ray showed a round hyperdensity in the right lower lobe. A chest computed tomography (CT) demonstrated an area of consolidation and surrounding ground glass opacities in the right lower lobe. Hematological investigations revealed anemia. Finally, bronchoscopy was performed and a 5 cm leech was found within the right B 7-8 bronchus and removed by forceps and a Dormia basket.

A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration.

Science.gov (United States)

Huang, Chun-Ta; Chen, Chung-Yu; Ho, Chao-Chi; Yu, Chong-Jen

2011-07-01

The introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) brought about significant advancement in the field of bronchoscopy. The major indications for EBUS-TBNA are lung cancer staging and diagnosis of mediastinal lymphadenopathy. This procedure is minimally invasive and cost saving, and no complications have been described in large-scale studies. In this report, we present a case of empyema, lung abscess, and mediastinal abscess that developed in a patient undergoing EBUS-TBNA; the patient subsequently recovered uneventfully after aggressive surgical debridement and antimicrobial therapy. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Blunt traumatic bronchial transection in a 28-month-old child

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Sung Mi Hwang

2014-01-01

Full Text Available Tracheobronchial injury is uncommon in children, but may result in life-threatening conditions. We present a case of transection of the right intermediate bronchus, right middle lobe bronchus and right lower lobe bronchus in a 28-month-old child with blunt chest injury. The gold standard for diagnosis is tracheobronchoscopy, however, the bronchoscopy may not always be available for little children. For diagnosis in similar cases, a high index of suspicion should be needed based on symptoms, chest X-ray and computed tomography findings. In addition, anesthesiologists should be aware of this dangerous condition and must be fully prepared for rapid and appropriate management during operation.

Wegener's granulomatosis: chest computed tomography findings; Granulomatose de Wegener: aspectos na tomografia computadorizada de torax

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Monteiro, Evelise de Azevedo; Marchiori, Edson; Martins, Erick Malheiro Leoncio [Universidade Federal Fluminense, Niteroi, RJ (Brazil). Dept. de Radiologia]. E-mail: edmarchiori@zipmail.com.br; Souza Junior, Arthur Soares [Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP), SP (Brazil). Hospital de Base; Cerqueira, Elza Maria F.P. de [Universidade Estadual de Campinas, SP (Brazil). Faculdade de Ciencias Medicas. Dept. de Radiologia; Irion, Klaus L. [Pavilhao Pereira Filho, Porto Alegre, RS (Brazil); Araujo Neto, Cesar de [Bahia Univ., Salvador, BA (Brazil). Dept. de Radiologia; Souza, Rodrigo Azeredo de [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia

2003-03-01

Wegeners granulomatosis is an inflammatory systemic necrotizing idiopathic vasculitis affecting mainly small vessels. In this paper we analyzed the computed tomography findings of seven patients with Wegeners granulomatosis. The most common findings were masses and nodules (71.4%), areas of ground glass attenuation (57.1%), consolidation (42.8%), halo sign (42.8%), cavitation (42.8%), interlobular septa thickening (14.2%), bronchial wall thickening (14.2%) and pleural effusion (14.2%). Although radiological findings are mostly nonspecific, computed tomography and particularly high-resolution computed tomography are important tools in the evaluation of disease activity when evaluated in association with bronchoscopy findings and clinical data. (author)

Unmasking of tracheomalacia following short-term mechanical ventilation in a patient of adult respiratory distress syndrome

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Harihar V Hegde

2012-01-01

Full Text Available Patients with chronic obstructive pulmonary disease (COPD are susceptible to airway malacia, which may be unmasked following mechanical ventilation or tracheostomy decannulation. Dynamic imaging of central airways, a non-invasive test as effective as bronchoscopy to diagnose airway malacia, has increased the recognition of this disorder. We describe a 70-year-old woman admitted with adult respiratory distress syndrome. She had cardiorespiratory arrest on admission, from which she was successfully resuscitated. She had obesity, hypertension, diabetes mellitus, recurrent ventricular tachycardia, sarcoidosis with interstitial lung disease and COPD. She received short-term (18 days mechanical ventilation with tracheostomy and developed respiratory distress following tracheostomy decannulation.

Late Onset Isolated Traumatic Pneumomediastinum in a Child: A Case Report

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Ali Kemal Erenler

2013-04-01

Full Text Available Pneumomediastinum (PM is defined as the presence of gas or free air in mediastinum. Pneumomediastinum may ocur either by trauma or spontaneously. Traumatic PM is frequently seen after blunt thoracic trauma, head trauma, after endoscopy-bronchoscopy (osephagus perforation, tracheobronchial injury and due to mechanical ventilation. Pneumomediastinum after blunt trauma is a lethal injury that generally occurs in adults with concomittant injuries such as rib fractures, hemo-pneumothorax and thoracic vascular injuries after high-energy traumas. We represent case report of a late onset isolated traumatic PM in a child and aim to underline the difficulty and importance of diagnosis of this lethal injury in the emergency department.

Esophageal Foreign Body: A Case Report of a Refractory Croup in a 20-Month-Old Boy

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sevil Nasirmohtaram

2016-11-01

Full Text Available Introduction: Foreign body ingestion is common among children and more common in boys and in children under the age of 3. It can present with a wide variety of symptoms like dysphagia and drooling or symptoms related to the upper aerodigestive tract.   Case Report: A 20-month-old male presented with refractory croup and poor feeding since 2 weeks. Bronchoscopy and esophagoscopy was performed due to suspicious history of eating loquat. The core of the fruit was found in the esophagus.   Conclusion:  Physicians should be aware of the variability of esophageal foreign body presentations to prevent serious complications due to delay in diagnosis.

Esophageal Metastasis From Occult Lung Cancer

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Po-Kuei Hsu

2010-06-01

Full Text Available A 66-year-old man with dysphagia was found to have a poorly differentiated esophageal carcinoma by incision biopsy. Following esophagectomy, reconstruction with a gastric tube was performed. Pathological examination and immunohisto-chemistry showed infiltration of adenocarcinoma cells with positive thyroid transcription factor 1-staining in the submucosal layer, which indicated metastatic esophageal carcinoma. Although no pulmonary lesion could be visualized by imaging or bronchoscopy, pulmonary origin was highly suspected as a result of positive thyroid transcription factor 1-staining. To the best of our knowledge, this is the first reported case of metastatic esophageal carcinoma from occult lung cancer (AJCC TNM stage TX.

IgM response to a human Pneumocystis carinii surface antigen in HIV-infected patients with pulmonary symptoms

DEFF Research Database (Denmark)

Lundgren, Bettina; Kovacs, J A; Mathiesen, Lars Reinhardt

1993-01-01

We have developed an ELISA to detect IgM antibodies to a major human Pneumocystis carinii surface antigen (gp95), and investigated the IgM response in 128 HIV-infected patients who underwent bronchoscopy for evaluation of pulmonary symptoms. Only 5 (4%) patients had IgM antibodies to P. carinii gp...... response to gp95. These patients also showed an increase in IgG antibodies to gp95 and had microbiologically proven PCP. Prior to the development of the IgM response, IgG antibodies to gp95 were detectable in all 3 patients. Thus, HIV-infected patients with PCP seldom produce IgM antibodies to the major...

Diffuse abnormalities of the trachea: computed tomography findings

International Nuclear Information System (INIS)

Marchiori, Edson; Araujo Neto, Cesar de

2008-01-01

The aim of this pictorial essay was to present the main computed tomography findings seen in diffuse diseases of the trachea. The diseases studied included amyloidosis, tracheobronchopathia osteochondroplastica, tracheobronchomegaly, laryngotracheobronchial papillomatosis, lymphoma, neurofibromatosis, relapsing polychondritis, Wegener's granulomatosis, tuberculosis, paracoccidioidomycosis, and tracheobronchomalacia. The most common computed tomography finding was thickening of the walls of the trachea, with or without nodules, parietal calcifications, or involvement of the posterior wall. Although computed tomography allows the detection and characterization of diseases of the central airways, and the correlation with clinical data reduces the diagnostic possibilities, bronchoscopy with biopsy remains the most useful procedure for the diagnosis of diffuse lesions of the trachea. (author)

The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation.

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Mahmood, Kamran; Wahidi, Momen M

2016-12-01

Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully. A multidisciplinary approach to tracheostomy care leads to improved outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia.

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Kopanakis, Antonios; Golias, Christos; Pantentalakis, George; Patentalakis, Michalis; Mermigkis, Charalampos; Mermigkis, Christos; Charalabopoulos, Alexandros; Peschos, Dimitrios; Batistatou, Anna; Charalabopoulos, Konstantinos

2009-01-01

A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis.

Production of Technegas and comparison of it with the other agents in ventilation studies

International Nuclear Information System (INIS)

Li Beilei; Chen Shaoliang

2002-01-01

Technegas is a suspension of ultrafine 99 Tc m labelled carbon particles produced in an atmosphere of high-quality argon. It is cheap, always available and easy to use, delivers a low radiation dose, and for the most parts, provides good quality lung images. In normal lungs, there was no difference radios in the lungs between Technegas and inhaled 81 Kr m , 133 Xe. Compared with ordinary radioaerosols, it causes fewer and less intense foci of parasitic bronchial activity, and assures good peripheral penetration and alveolar deposition. And Technegas ventilation imaging also has many advantages over other methods, such as X-ray examinations and bronchoscopy

The sweet lung: Chewing gummi bear aspiration.

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Tavladaki, Theonimfi; Fitrolaki, Michaela-Diana; Spanaki, Anna-Maria; Ilia, Staurula; Geromarkaki, Elissabet; Briassoulis, George

2012-07-01

Inhalation of foreign bodies, a leading cause of accidental death, is most common in preschool children. In this article we report our experience with a 5-year-old Greek girl who presented with a 24-hour history of sore throat, chest pain, and shortness of breath. Emergency bronchoscopy was performed and multiple small chewing gummi bear (HARIBO) particles impacted in the orifices of the right main bronchus and right lobar and segmentalinic bronchi were successfully removed and aspirated. Aspiration of gummi bears, which is for the first time reported, may cause a silent choking episode leading to life-threatening bronchi obstruction at multiple sites, even in children older than 4 years.

February 2018 pulmonary case of the month

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Wesselius LJ

2018-02-01

Full Text Available No abstract available. Article truncated after first page. History of Present Illness: A 75-year-old woman was diagnosed with a thymic carcinoid tumor in April, 2015 (Figure 1. This was treated with surgical resection followed by radiation therapy. She began having cough and dyspnea 1 to 2 months later and in August, 2015 had a thoracic CT scan of her chest (Figure 2. Which of the following are true? 1. Bronchoscopy should be performed; 2. She should be given an empiric course of antibiotics; 3. The most like diagnosis is radiation pneumonitis. 4.\t1 and 3; 5. All of the above. …

Indications and interventional options for non-resectable tracheal stenosis

Science.gov (United States)

Bacon, Jenny Louise; Patterson, Caroline Marie

2014-01-01

Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management. PMID:24624290

Pneumocystis carinii in bronchoalveolar lavage and induced sputum: detection with a nested polymerase chain reaction

DEFF Research Database (Denmark)

Skøt, J; Lerche, A G; Kolmos, H J

1995-01-01

To evaluate polymerase chain reaction (PCR) for detection of Pneumocystis carinii, 117 bronchoalveolar lavage (BAL) specimens, from HIV-infected patients undergoing a diagnostic bronchoscopy, were processed and a nested PCR, followed by Southern blot and hybridization with a P32-labelled probe......, but sensitivity dropped markedly with this system. A further 33 patients had both induced sputum and bronchoalveolar lavage performed and the induced sputum was analysed using PCR and routine microbiological methods. The PCR sensitivity on induced sputum was equal to that of routine methods. At present...... the evaluated PCR cannot replace routine microbiological methods for detection of Pneumocystis carinii, on either BAL fluid or induced sputum....

Avaliação do risco de contaminação por bactérias, no paciente submetido à broncoscopia, após o reprocessamento do broncoscópio Evaluation of the risk of bacterial contamination in the patient submitted to bronchoscopy, after reprocessing the bronchoscope

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NANCY SPEKLA GRANDE

2002-09-01

bronchoscopy at the Hospital São Paulo of Unifesp University, State of São Paulo. Methods: From 1997 to 1998, bronchoscope reprocessing included cleaning, rinsing with sterile or potable water, followed by rinsing with 2% glutaraldehyde for 20 minutes, rinsing again with sterile or potable water, and rinsing with 70% ethyl alcohol, and forced-air drying through the suction channel. Samples of 65 patients were collected for microbiologic tests by instilling sterile saline solution through the suction channel of the bronchoscope. Results: After reprocessing, the following were found in the samples: Staphylococcus epidermidis, Enterobacter sp, Acinetobacter baumanni, Streptococcus viridans, Staphylococcus aureus, Streptococcus beta hemoliticus A, Staphylococcus coagulase negative, and mycobacterial growth was found in the culture of five samples. Conclusions: Bronchoscope disinfection with 2% glutaraldehyde was not sufficient to assured disinfection of the scope and the presence of Staphylococcus epidermidis shows that there was bronchoscope contamination due to handling after disinfection.

Ruptura traumática de via aérea em criança: um desafio diagnóstico Traumatic airway disruption in a child: a diagnostic challenge

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Andréa Maria Cordeiro Ventura

2005-04-01

Full Text Available OBJETIVO: Relatar um caso de ruptura da via aérea em criança vítima de trauma torácico decorrente de queda do tanque de lavar roupas. DESCRIÇÃO: Relato de caso descritivo. O paciente pré-escolar de 34 meses, do sexo masculino foi atendido na unidade de terapia intensiva pediátrica de Hospital Universitário. Foram realizados os seguintes procedimentos: radiografia simples e tomografia de tórax, endoscopia respiratória, toracotomia, antibioticoterapia, ventilação mecânica. A radiografia simples de tórax, tomografia computadorizada de tórax e endoscopia respiratória foram necessárias para definir o diagnóstico de ruptura traumática da via aérea associada a contusão pulmonar, pneumotórax, pneumomediastino e enfisema subcutâneo. O paciente foi submetido a toracotomia para reparação de lesão quase completa de brônquio principal esquerdo. Antibioticoterapia de largo espectro e suporte ventilatório contribuíram para resolução do caso sem seqüelas a médio prazo. COMENTÁRIOS: Na vigência de trauma torácico em criança, a busca diagnóstica por lesões incomuns, mas potencialmente letais, como a ruptura da via aérea, deve ser incessante, particularmente naqueles pacientes com fortes evidências clínicas. A complementação diagnóstica deve ser otimizada com a radiografia simples de tórax, a tomografia de tórax e o exame endoscópico que estabelece o diagnóstico definitivo.OBJECTIVE: To report a case of airway disruption in a child victim of blunt thoracic trauma due to falling off a sink. DESCRIPTION: Descriptive case report. A 34-month old boy victim of thoracic trauma was seen at the pediatric intensive care unit of a university hospital. Plain chest radiograph, thoracic computed tomography, bronchoscopy, thoracotomy, antibiotics, hemodynamic and respiratory support were performed. Plain chest radiograph, thoracic computed tomography and bronchoscopy were performed in order to arrive at a precise diagnosis of

Argon Plasma Coagulation Combined with Covered Stent Placement for Management of Tracheobronchial Stenoses/occlusions as well as Esophagorespiratory Fistulas

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Hongwu WANG

2010-09-01

Full Text Available Background and objective It is a complex problem and difficult treatment for tracheobronchial stenoses/occlusions involving in carina. The aim of this study is to investigate the feasibility and efficiency of argon plasma coagulation (APC and bifurcated covered Z-type stents (CZTS placement for the treatment of tracheobronchus stenoses and esophagorespiratory fistula (ERF. Methods Thirty-two cases with airway disorders were retrospectively reviewed for the treatment of APC and CZTS placement. Under the bronchoscopic guidance, APC was first given in patients with airway stenoses, then CZTS was placed under the fluoroscopic and flexible bronchoscopic guidance either with airway stenoses or ERF. Results APC was first given in 19 patients with airway stenoses. Airway structures were significantly improved after APC procedure (57.4%-72.1% before APC vs 12.8%-25.8% after APC. Thirty-two CZTS were technically successfully placed in 30 out of 32 cases involving in carinal bifurcation. After APC and stent placement, short breath index was significantly reduced and karnofsky physical score (KPS increased obviously. The endobronchial defects were successfully palliated with bifurcated CZTS placed under fluoroscopy and flexible bronchoscopy in 12 out of 13 patients with ERFs. There is no bleeding introprocedure. Mucous retention was very common in all types of the stents less than 2 weeks after stenting, which required debridement by bronchoscopy and could be prevented by normal saline solution nebulizations. Granuloma developed at the ends of stents after 1 month of stenting which all of them were treated successfully with APC and CO2 cryosurgery. Conclusion Utilization of APC and retrieval bifurcated CZTS placement is a simple and safe protocol for the management of airway complex stenoses involving the tracheal carina and ERF.

Two-piece cryopreserved tracheal allotransplantation: an experimental study.

Science.gov (United States)

Iyikesici, Tuncel; Tuncozgur, Bulent; Sanli, Maruf; Isik, Ahmet Feridun; Meteroglu, Fatih; Elbeyli, Levent

2009-10-01

For successful reconstruction with tracheal allotransplants following long tracheal resections, problems related to the preservation and vascularisation of the tracheal graft have to be solved. In this study, instead of using a long-segment single-piece graft, we used a graft that has been split into two. The aim was to use this graft after cryopreservation in order to ease neo-vascularisation and to maintain tracheal integrity by transplanting it to two separate regions of the dog cervical trachea. This experimental study was conducted in animal laboratories of the medical school on 11 half-blood dogs. The trachea obtained from the first dog was 8 cm in length; it was split into two pieces of 4 cm each and stored in the preservation solution at -80 degrees C for 4 weeks. Following this, the dog was sacrificed. Two 2 cm portions of cervical trachea were excised from the second dog. These parts were then reconstructed with two tracheal grafts of the same length as the cryopreserved ones. Ten dogs that were grouped into five groups of two dogs each underwent the same procedure. The subjects had a bronchoscopic evaluation on the third postoperative week. Anastomosis regions of the test tracheas were resected to be examined histopathologically. Seven subjects were found to have third-degree obstructions during bronchoscopy; two had close to fourth-degree obstructions. In the histopathological examination, contrary to the findings of the bronchoscopies, 75% of the anastomoses had intact epithelium. The cartilage was seen to have well-preserved structural characteristics in all the anastomoses. Twelve anastomoses had moderate, seven mild and one had severe inflammation. All anastomoses had either good or very good level of vascularisation. The integrity of the tracheal epithelium can be maintained with cryopreservation and split anastomosis technique. The cartilage preserves its structural characteristics despite losing its viability, thereby offering an advantage to

Clinical and radiological features of bronchiolitis obliterans in children

International Nuclear Information System (INIS)

Peng Yun; Sun Guoqiang; Zeng Jinjin; Ma Daqing

2006-01-01

Objective: To study the value of chest radiograph and thin-section computed tomography (CT) in diagnosis bronchiolitis obliterans in children, and to determine clinical view of obliterative bronchiolitis in children. Methods: We identified 12 infants, 10 boys, and 2 girls (age range, 5 month to 11 years) with clinical confirmation of bronchiolitis obliterans. Three cases were after Steven-Johnson syndrome, 8 were post-infection (2 adenovirus, 2 measles and 1 Pseudomonas aeruginosa infection, 3 cases were unknown etiology infection); The symptoms lasted for at least 6 weeks. One case had lung ventilation nuclear scan. We evaluated individual bronchoscopy, pulmonary function test, chest radiograph and thin- section CT features and their characteristic appearance. Results: All cases had typical clinical characteristics and pulmonary function testing results that were consistent with nonreversible small airways obstruction. One case had lung ventilation nuclear scan illustrated absent and reduced ventilation of the right lower lobe. Nine cases who underwent bronchoscopy were chronic endobronchial inflammation. Three children had transbronchial biopsy and 1 patient who underwent open pulmonary biopsies were uncertain of histological diagnosis. Chest radiography showed hyperinflation in 8 cases; peribronchial thickening in 6 cases; consolidation/atelectasia in 6 cases; unilateral hyperlucency of a small/normal-sized lung in 4 cases. Thin-section CT/HRCT features included: mosaic perfusion pattern, decreased lung attenuation in 11 cases, pulmonary vascular attenuation in 10 cases; bronchial dilatation in 7 cases; bronchial wall thickening in 9 cases; unilateral hyperlucency of a small/normal-sized lung in 5 cases; consolidation in 6 cases; nodular in 3 cases; mucoid impaction in 5 cases. Conclusions: In our study, correct diagnoses of bronchiolitis obliterans in children were made more special with thin-section CT than with chest radiographs. The diagnosis of BO in

Retrospective Analysis of Factors Leading to Pediatric Tracheostomy Decannulation Failure. A Single-Institution Experience.

Science.gov (United States)

Bandyopadhyay, Anuja; Cristea, A Ioana; Davis, Stephanie D; Ackerman, Veda L; Slaven, James E; Jalou, Hasnaa E; Givan, Deborah C; Daftary, Ameet

2017-01-01

There is a lack of evidence regarding factors associated with failure of tracheostomy decannulation. We aimed to identify characteristics of pediatric patients who fail a tracheostomy decannulation challenge Methods: A retrospective review was performed on all patients who had a decannulation challenge at a tertiary care center from June 2006 to October 2013. Tracheostomy decannulation failure was defined as reinsertion of the tracheostomy tube within 6 months of the challenge. Data on demographics, indications for tracheostomy, home mechanical ventilation, and comorbidities were collected. Data were also collected on specific airway endoscopic findings during the predecannulation bronchoscopy and airway surgical procedures before decannulation. We attempted to predict the decannulation outcome by analyzing associations. 147 of 189 (77.8%) patients were successfully decannulated on the first attempt. Tracheostomy performed due to chronic respiratory failure decreased odds for decannulation failure (odds ratio = 0.34, 95% confidence interval = 0.15-0.77). Genetic abnormalities (45%) and feeding dysfunction (93%) were increased in the population of patients failing their first attempt. The presence of one comorbidity increased the odds of failure by 68% (odds ratio = 1.68, 95% confidence interval = 1.23-2.29). Decannulation pursuit based on parental expectation of success, rather than medically determined readiness, was associated with a higher chance of failure (P = 0.01). Our study highlights the role of genetic abnormalities, feeding dysfunction, and multiple comorbidities in patients who fail decannulation. Our findings also demonstrate that the outcome of decannulation may be predicted by the indication for tracheostomy. Patients who had tracheostomy placed for chronic respiratory support had a higher likelihood of success. Absence of a surgically treatable airway obstruction abnormality on the predecannulation bronchoscopy increased the

The influence of propofol, remifentanil and lidocaine on the tone of human bronchial smooth muscle.

Science.gov (United States)

Rogliani, Paola; Calzetta, Luigino; Rendina, Erino A; Massullo, Domenico; Dauri, Mario; Rinaldi, Barbara; Capuano, Annalisa; Matera, Maria Gabriella

2013-06-01

Bronchoscopy is generally a safe procedure, but the induction of anaesthesia can induce bronchospasm. Consequently we investigated the influence of propofol, remifentanil and lidocaine on the tone of the human bronchial smooth muscle. The influence of propofol, remifentanil and lidocaine on the contractile response of human bronchial smooth muscle to electrical field stimulation (EFS) has been evaluated. The role of capsaicin-sensitive sensory nerves and of inducible nitric oxide synthase has also been assessed. Furthermore, the interaction between these three dugs has been measured by Bliss Independence (BI) theory. Statistical significance (P < 0.05) was assessed by Student's t test or ANOVA. Propofol (1.3 μg ml(-1)) and lidocaine (1 mg ml(-1)) reduced the baseline tone of bronchial rings (-14.45 ± 4.53% and -33.40 ± 1.07%, respectively, P < 0.05), whereas remifentanil had not such effect. Aminoguanidine prevented the relaxant effect of propofol. Propofol did not alter the bronchial contractile response to EFS following 30 min of treatment, whereas remifentanil enhanced the bronchial tension (133.83 ± 9.38%, control 101.93 ± 6.82%, P < 0.05 P < 0.05) and lidocaine completely abolished the contractility at 1 mg ml(-1) (P < 0.05). The desensitization of capsaicin-sensitive sensory nerves normalized the hyperresponsiveness induced by remifentanil (-26.77 ± 1.68%, P < 0.05). Significant BI antagonism (P < 0.001) was detected for propofol and lidocaine on the bronchial hyperresponsiveness induced by remifentanil. Propofol and remifentanil may be used safely for bronchoscopy, although remifentanil should be associated with propofol or lidocaine to prevent the potential opioid-mediated bronchospasm. Copyright © 2013 Elsevier Ltd. All rights reserved.

Bronchoscopic findings and bleeding control predict survival in patients with solid malignancies presenting with mild hemoptysis.

Science.gov (United States)

Grosu, Horiana B; Casal, Roberto F; Morice, Rodolfo C; Nogueras-González, Graciela M; Eapen, Georgie A; Ost, David; Sarkiss, Mona G; Jimenez, Carlos A

2013-08-01

Regardless of its volume, hemoptysis is a concerning symptom. Mild hemoptysis and its significance in patients with solid malignancies has not been studied. We conducted a retrospective chart review of patients with solid malignancies who presented for evaluation of mild hemoptysis. In this population, we studied the impact of bronchoscopic findings and endobronchial therapies on overall survival and bleeding recurrence. Patients were categorized into four groups on the basis of the presence or absence of active bleeding and endobronchial disease at the time of initial bronchoscopy: active bleeding with endobronchial lesion (AB/EBL), active bleeding without endobronchial lesion (AB/no-EBL), absence of active bleeding but with endobronchial lesion (no-AB/EBL), and absence of active bleeding and endobronchial lesion (no-AB/no-EBL). Ninety-five of the 112 patients with solid malignancies and mild hemoptysis underwent bronchoscopies. There was a significantly lower median survival time for patients with bronchoscopic findings of active bleeding and endobronchial lesion compared with patients with no active bleeding and/or no endobronchial lesion (3.48 mo; 95% confidence interval [CI], 2.14-6.05). On a multivariate analysis, factors independently associated with improved survival were higher hemoglobin values (hazard ratio [HR], 0.78; 95% CI, 0.67-0.91) and cessation of hemoptysis without recurrence at 48 hours (HR, 0.43; 95% CI, 0.22-0.84). Variables independently associated with worse survival were disease stage (HR, 10.8; 95% CI, 2.53-46.08) and AB/EBL (HR, 3.20; 95% CI, 1.74-5.89). In patients with solid malignancies presenting with mild hemoptysis, bronchoscopic findings of AB/EBL are associated with decreased survival. Hemoptysis control without recurrence at 48 hours after endobronchial intervention may improve survival.

Imipenem/cilastatin-induced acute eosinophilic pneumonia.

Science.gov (United States)

Foong, Kap Sum; Lee, Ashley; Pekez, Marijeta; Bin, Wei

2016-03-04

Drugs, toxins, and infections are known to cause acute eosinophilic pneumonia. Daptomycin and minocycline are the commonly reported antibiotics associated with acute eosinophilic pneumonia. In this study, we present a case of imipenem/cilastatin-induced acute eosinophilic pneumonia. The patient presented with fever, acute hypoxic respiratory distress, and diffuse ground-glass opacities on the chest CT a day after the initiation of imipenem/cilastatin. Patient also developed peripheral eosinophilia. A reinstitution of imipenem/cilastatin resulted in recurrence of the signs and symptoms. A bronchoscopy with bronchoalveolar lavage showed 780 nucleated cells/mm(3) with 15% eosinophil. The patient's clinical condition improved significantly after the discontinuation of imipenem/cilastatin therapy and the treatment with corticosteroid. 2016 BMJ Publishing Group Ltd.

Electroversion in treatment of arrhythmia in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury

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SHEN Peng

2013-06-01

Full Text Available 【Abstract】We report electroversion in treatment of atrial fibrillation (AF and atrioventricular nodal reentry ta-chycardia (AVNRT in a patient with Wolff-Parkinson-White syndrome and cervical spinal cord injury. At first, the pa-tient sustained respiratory failure and weak cough reflex, thereafter repeated bronchoscopy was used to aspirate the sputum as well as control the pneumonia, which resulted in arrhythmia (AF and AVNRT. Two doses of intravenous amiodarone failed to correct the arrhythmia. After restora-tion of sinus rhythm by electroversion, he was successfully weaned from mechanical ventilation and discharged from the intensive care unit without recurrent arrhythmia. Key words: Arrhythmia, cardiac; Atrial fibrillation; Electric countershock; Wolff-Parkinson-White syndrome; Spinal cord injuries

Vintage meets contemporary: Use of rigid TBNA in the era of real-time imaging - first report from India.

Science.gov (United States)

Khan, Ajmal; Nath, Alok; Lal, Hira; Krishnani, Narendra; Agarwal, Aarti

2018-01-01

In the modern era, real-time imaging-guided transbronchial needle aspiration (TBNA) has completely replaced the traditional surgical approaches to sample the mediastinal lesions for diagnosis and cancer staging. However, there is a limited role of these innovations in the presence of critical airway narrowing due to a further decrease in cross-sectional area of the airway proportionate to the outer diameters of the scope. Rigid TBNA with airway control by rigid bronchoscopy is one alternative which can be used for mediastinal sampling when modern technique is impracticable. Herein, we report the use of rigid TBNA, an underutilized old method to sample the mediastinal lesion in a patient with severe orthopnea secondary to tracheal compression by mediastinal mass.

Pulmonary nocardiosis with osteomyelitis

International Nuclear Information System (INIS)

Bechet, R.; Granier, P.; Mourad, M.; Dufranc, A.; Adoue, D.

2007-01-01

We report a case of a 49-year-old female who developed a bronchopneumonia associated with atelectasis of the upper right lobe and back pain of bone origin. Bronchoscopy revealed an endobronchial mass at the origin of the right upper lobe bronchus. Scintigraphy showed three paravertebral spots of the seventh and eighth thoracic vertebrae, without any radiological modification. Culture of lung tissue obtained by trans-parietal punction under CT scan control became positive to Nocardia belonging to the pneumoniae complex. Positive diagnosis of pulmonary nocardiosis associated with two rare localizations was set, one was an endobronchial mass, the other was osteomyelitis of the posterior chest wall. The patient was treated with Trimethoprim ulfamethoxazole and recovered completely. (author)

[Fatal toxic respiratory epitheliolysis. Subacute tracheo-bronchial desquamation in Stevens-Johnson syndrome].

Science.gov (United States)

Martin, L; Hazouard, E; Michalak-Provost, S; Maurage, C; Machet, L

2001-09-01

Acute bronchial mucosal sloughing related to Toxic Epidermal Necrolysis (Lyell syndrome) is widely reported in literature. On the contrary severe respiratory involvement is rare in post-infectious or toxic Epitheliolysis (Stevens-Johnson syndrome). There is no well-known predictive sign of bronchial epithelium involvement. An 18-year-old patient was admitted for Stevens-Johnson syndrome related to sulfasalazine (salazosulfapyridine). There were no respiratory signs. An acute respiratory failure occurred 36 hours after from admission due to an obstructive and desquamative necrosis of the tracheobronchial epithelium. We purpose that a fiberoptic laryngoscopy should be performed even in non-dyspneic patients suffering from Stevens-Johnson syndrome if hypersecretion is present. Fiberoptic bronchoscopy can be helpful in these cases.

Bronchospasm and anaphylactic shock following lidocaine aerosol inhalation in a patient with butane inhalation lung injury.

Science.gov (United States)

Lee, Min-Young; Park, Kyong Ah; Yeo, So-Jeong; Kim, Shin-Hee; Goong, Hyeun-Jeong; Jang, An-Soo; Park, Choon-Sik

2011-10-01

Allergic reactions to local anesthetics are very rare and represent inhalation lung injury due to butane gas fuel. On the fifth day, he developed an asthmatic attack and anaphylactic shock immediately after lidocaine aerosol administration to prepare for bronchoscopy to confirm an acute inhalational lung injury diagnosis. Cardiopulmonary resuscitation was performed immediately after respiratory arrest, and the patient was admitted to the intensive care unit intubated and on a ventilator. He was extubated safely on the third post-cardiopulmonary resuscitation day. These observations suggest that aerosol lidocaine anesthesia may cause airway narrowing and anaphylactic shock. Practitioners should be aware of this potential complication. We report on this case with a brief review of the literature.

Tracheal collapse diagnosed by multidetector computed tomography: evaluation of different image analysis methods

DEFF Research Database (Denmark)

Nygaard, Mette; Bendstrup, Elisabeth; Dahl, Ronald

2017-01-01

diseases when using an expiratory collapse of = 50% as a threshold. The four methods were comparable with highly significant Pearsons correlation coefficients (0.764-0.856). However, the four methods identified different patients with collapse of = 50 There was no correlation between symptoms...... and the degree of collapse. Conclusion: The different methods identify tracheal collapse in different patients. Hence, the diagnosis of excessive tracheal collapse can not rely solely on MDCT images. Generally, there is a poor correlation between symptoms and the degree of collapse in the different methods....... However, when using the maximal collapse, there is some correlation with symptoms. When in doubt regarding the diagnosis, further investigations, such as bronchoscopy, should be carried out....

Chronicle pulmonary histoplasmosis

International Nuclear Information System (INIS)

Llanos, Elkin; Ojeda, Paulina

2004-01-01

Histoplasmosis is an acquired mycotic disease produced by the histoplasma capsulatum very frequent in Colombia, primarily affecting lungs. The pathogenesis of the histoplasmosis is similar to the one of tuberculosis. From the clinical point of view, this disease has several manifestations including the primary acute and chronic pulmonary forms. Histoplasmoma pulmonary disseminated histoplasmosis, mediastinal compromise due to granulomatosis and fibrosis, as well as ocular histoplasmosis. A clinical case of a 33-year old man is presented who consults for dry coughing of one year of evolution, without any other symptomatology, with a normal chest x-ray and after several studies including chest cat and fiber-bronchoscopy. A pulmonary histoplasmosis was determined by histopathology

Pneumocystis carinii in bronchoalveolar lavage and induced sputum: detection with a nested polymerase chain reaction

DEFF Research Database (Denmark)

Skøt, J; Lerche, A G; Kolmos, H J

1995-01-01

was performed. The sensitivity and specificity were 85 and 100% 934/40 and 77/77) respectively. A non-radioactive labelling system BluGENE was evaluated on all specimens, and found to be as effective as P32-labelling. To increase the speed and convenience of detection, a dot blot system was tested......To evaluate polymerase chain reaction (PCR) for detection of Pneumocystis carinii, 117 bronchoalveolar lavage (BAL) specimens, from HIV-infected patients undergoing a diagnostic bronchoscopy, were processed and a nested PCR, followed by Southern blot and hybridization with a P32-labelled probe...... the evaluated PCR cannot replace routine microbiological methods for detection of Pneumocystis carinii, on either BAL fluid or induced sputum....

Syngeneic peripheral blood stem cell transplantation with immunosuppression for hepatitis-associated severe aplastic anemia

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Aleksandar Savic

2010-12-01

Full Text Available Hepatitis-associated aplastic anemia occurs in up to 10% of all aplastic anemia cases. Syngeneic bone marrow transplantation is rare in patients with severe aplastic anemia and usually requires pre-transplant conditioning to provide engraftment. We report on a 29-year-old male patient with hepatitis-associated severe aplastic anemia who had a series of severe infectious conditions before transplantation, including tracheal inflammation. Life-threatening bleeding, which developed after bronchoscopy, was successfully treated with activated recombinant factor VII and platelet transfusions. Syngeneic peripheral blood stem cell transplantation using immunosuppressive treatment with antithymocyte globulin and cyclosporin A without high-dose pre-transplant conditioning was performed, followed by complete hematologic and hepatic recovery.

Simulation-Based Training in Flexible Bronchoscopy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA)

DEFF Research Database (Denmark)

Naur, Therese Maria Henriette; Nilsson, Philip Mørkeberg; Pietersen, Pia Iben

2017-01-01

. The studies included participants of varying experience and most commonly used a virtual reality simulator as a training modality. Assessment of the participants' skills was based on simulator metrics or on an assessment tool. Some studies included performance on patients for assessment of the operator after...... training on a simulator. CONCLUSIONS: Simulation-based training was demonstrated to be more efficient than the traditional apprenticeship model. Physical models and virtual reality simulators complement each other. Simulation-based education should be based on a mastery learning approach and structured...

Admission Chest CT Complements Fiberoptic Bronchoscopy in Prediction of Adverse Outcomes in Thermally Injured Patients

Science.gov (United States)

2012-08-01

full-thickness burn (% FT), injury severity score (ISS), presence of tracheos- tomy, arterial carboxyhemoglobin levels (COHb), and the ratio (PFR) of...RADS, radiologist score; COHb, carboxyhemoglobin . Table 3. Results* Variable Inhalation Injury, N = 25 No Inhalation Injury, N = 19 P RADS 109 (74... carboxyhemoglobin . Table 6. Logistic regression predictor of composite outcome* Variable P Odds Ratio 95% Confidence Interval Limit I nhalation injury + RADS

Eficácia e tolerabilidade de próteses na via aérea

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Carla Valente

2010-05-01

Full Text Available Resumo: As próteses na via aérea têm a função de manter as estruturas tubulares abertas e estáveis. A sua colocação está indicada essencialmente na obstrução intrínseca ou compressão extrínseca da via aérea, fístulas ou traqueobroncomalacia.Com este estudo pretendeu-se determinar a tolerabilidade a eficácia de próteses na via aérea nas situações em que a sua colocação era imprescindível.Procedeu-se ao estudo retrospectivo dos processos clínicos de 23 doentes em que se tinha procedido à colocação de próteses traqueobrônquicas através de broncoscopia rígida, durante dois anos consecutivos (2006-2007, na Unidade Funcional de Técnicas de Diagnóstico e Terapêutica, tendo sido avaliadas a indicação, a eficácia, a tolerabilidade, as complicações e a localização exacta da sua inserção, tendo em conta a informação imagiológica fornecida por TC do tórax. Em todas as situações foram utilizadas próteses flexíveis de silicone tipo Dumon (Tracheobronxane®, sendo previamente avaliada, através de broncoscopia flexível, a necessidade de técnicas complementares, nomeadamente laserterapia e dilatação mecânica.O estudo efectuado permitiu concluir que a inserção de próteses não apresentou complicações, demonstrando boa tolerabilidade, tendo em conta a maioria das situações, de natureza neoplásica em estádio avançado, apenas com indicação terapêutica paliativa.Rev Port Pneumol 2010; XVI (3: 407-418 Abstract: The function of airway stents is to keep the tubular structures open and stable. Their insertion is essentially indicated for intrinsic obstruction or extrinsic compression of the airway, fistulae or tracheobronchomalacia.The aim of this study was to determine the tolerability and efficacy of airway stents in situations in which their insertion was vital.A retrospective study of airway stent insertion with rigid bronchoscopy (23 patients was carried out over a two year period (2006-2007 at

Histopathologic Consideration of Fiducial Gold Markers Inserted for Real-Time Tumor-Tracking Radiotherapy Against Lung Cancer

International Nuclear Information System (INIS)

Imura, Mikado; Yamazaki, Koichi; Kubota, Kanako C.; Itoh, Tomoo; Onimaru, Rikiya; Cho, Yasushi; Hida, Yasuhiro; Kaga, Kichizo; Onodera, Yuya; Ogura, Shigeaki; Dosaka-Akita, Hirotoshi; Shirato, Hiroki; Nishimura, Masaharu

2008-01-01

Purpose: Internal fiducial gold markers, safely inserted with bronchoscopy, have been used in real-time tumor-tracking radiotherapy for lung cancer. We investigated the histopathologic findings at several points after the insertion of the gold markers. Methods and Materials: Sixteen gold markers were inserted for preoperative marking in 7 patients who subsequently underwent partial resection of tumors by video-assisted thoracoscopic surgery within 7 days. Results: Fibrotic changes and hyperplasia of type 2 pneumocytes around the markers were seen 5 or 7 days after insertion, and fibrin exudation without fibrosis was detected 1 or 2 days after insertion. Conclusions: Because fibroblastic changes start approximately 5 days after gold marker insertion, real-time tumor-tracking radiotherapy should be started >5 days after gold marker insertion

Severe nitrofurantoin lung disease resolving without the use of steroids

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Bhullar S

2007-01-01

Full Text Available We report a case of an elderly woman who developed a severe, chronic pulmonary reaction to nitrofurantoin therapy that she had taken continuously for three years to prevent urinary tract infections. The patient was taking no other drug known to cause lung disease but the diagnosis was delayed by failure to recognize the association between nitrofurantoin and adverse drug reactions affecting the lung. When originally seen, the patient was unable to care for herself due to dyspnea. Bronchoscopy with biopsy ruled out other causes of her pulmonary disease. Immediate withdrawal of nitrofurantoin led to substantial, sustained improvement and disappearance of symptoms over several months without administration of corticosteroids. Nitrofurantoin toxicity should always be considered in any person taking that drug who develops bilateral infiltrates.

Diffuse pulmonary ossification. A case report

International Nuclear Information System (INIS)

Torres D, Carlos A; Ojeda L, Paulina

1997-01-01

The diffuse pulmonary ossification (DPO) is a rare disease characterized by metaplastic formation of bony tissue in the lung parenchyma. Generally it is associated with other disorders as mitral stenosis and interstitial fibrosis. Sometimes the DPO is idiopathic. We report the case of a 49-year-old man who presented with cough and hemoptysis. The radiological findings suggested an interstitial lung disease. The fiber optic bronchoscopy was normal. The pulmonary function tests showed a mild airway obstruction. The bacteriological and serological studies for tuberculosis, mycosis, and collagen-vascular disease were negatives. An open lung biopsy was performed and the pathologic findings were interpreted as diffuse pulmonary ossification (DPO). Any other disease was found; so, in this case the DPO was classified as idiopathic

Osteoradionecrosis of the head and neck: a case of a clavicular-tracheal fistula secondary to osteoradionecrosis of the sternoclavicular joint

International Nuclear Information System (INIS)

Stofman, G.M.; Lowry, L.D.; Cohn, J.R.; Jabourian, Z.

1988-01-01

Radiation therapy is an integral part of treatment for head and neck cancer, but its use is not without complications. We describe the first reported sternoclavicular-tracheal fistula resulting from osteoradionecrosis (ORN) at the medial clavicle. This ORN resulted from definitive radiation therapy for a primary pyriform sinus squamous cell carcinoma. The diagnosis of ORN was made by fiberoptic bronchoscopy. The physiologic damage of ORN is based on a compromised blood supply and altered metabolism of bone formation secondary to effects of ionizing radiation. Treatment requires meticulous hygiene, antibiotics, and debridement as conservative therapy. Radical surgery and reconstruction may be indicated in refractory cases. A thorough preirradiation assessment of patients is mandatory to decrease the incidence of radiation-induced ORN

New Delhi Metallo-Β-Lactamase-Producing Carbapenem-Resistant Enterobacteriacae Isolated From Bronchial Washings.

LENUS (Irish Health Repository)

Cullivan, S

2017-11-01

The prevalence of Carbapenem resistance among Enterobacteriacae species is increasing and poses a potential major public health risk. In recent years, several new carbapenemases have been identified, including New Delhi metallo-β-lactamase (NDM). A 78-year-old non-smoking female with prior medical history of type 2 diabetes mellitus, gastroesophageal reflux disease (GERD) and prior coronary artery bypass grafting was referred to our respiratory outpatient service for evaluation of a chronic cough and dyspnoea in 2013. Clinical examination revealed bibasal pulmonary crepitations but was otherwise unremarkable. Computed tomography of the chest demonstrated atelectasis of the lingula and right middle lobe. She underwent bronchoscopy, which demonstrated laryngeal mucosa inflammation, consistent with her GERD. There was no growth on bacterial, fungal or mycobacterial bronchial washings cultures.

Oesophageal foreign body and a double aortic arch: rare dual pathology.

Science.gov (United States)

O'Connor, T E; Cooney, T

2009-12-01

We report the rare case of an oesophageal foreign body which lodged above the site of oesophageal compression by a double aortic arch. Case report and a review of the literature surrounding the classification, embryology, diagnosis and management of vascular rings and slings. An eight-month-old male infant presented with symptoms of tracheal compression following ingestion of an oesophageal foreign body. Following removal of the oesophageal foreign body, the infant's symptoms improved initially. However, subsequent recurrence of respiratory symptoms lead to a repeat bronchoscopy and the diagnosis of a coexisting double aortic arch, causing tracheal and oesophageal compression. To our knowledge, this is only the second reported case of a double aortic arch being diagnosed in a patient following removal of an oesophageal foreign body.

A rare tumor of trachea: Inflammatory myofibroblastic tumor diagnosis and endoscopic treatment

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Mehmet Akif Özgül

2014-01-01

Full Text Available Inflammatory myofibroblastic tumors (IMTs are rare childhood neoplasms, with benign clinical course. Although etiology of IMTs are not clear, recent studies have reported that IMT is a true neoplasm rather than a reactive or inflammatory lesion. IMTs are rarely seen in adults and tracheal involvement is also rare both in adults and also in children. We describe a 16-year old female patient who was misdiagnosed and treated as asthma in another center for a few months and presented with acute respiratory distress due to upper airway obstruction. Computerized tomography (CT of the chest and rigid bronchoscopy revealed a mass lesion that was nearly totally obliterating tracheal lumen. Bronchoscopic resection was performed under general anesthesia and the final pathological diagnosis was tracheal IMT.

Comparative Analysis of the Solid Phases of Bronchoalveolar Lavage and Oral Fluid in Children with Acute Necrotizing Pneumonia

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V.N. Grona

2014-05-01

Full Text Available The growing number of acute lung abscesses, and pleural empyema, high invalidization and mortality determine the necessity for search of new methods of its diagnosis and treatment. The aim of this research was to study the morphological characteristics of in bronchoalveolar lavage and oral fluid facies in children with acute destructive pneumonias and to find out correlations between them. We examined 24 patients of department of purulent surgery in age from 1 to 14 years. Collection of mixed unstimulated oral fluid was carried out by spitting into special tubes, bronchoalveolar lavage was obtained by bronchoscopy. There has been revealed a correlation between morphological pattern of bronchoalveolar lavage and oral fluid in children depending on the pathological condition of the body.

Organising pneumonia in common variable immunodeficiency.

Science.gov (United States)

Boujaoude, Ziad; Arya, Rohan; Rafferty, William; Dammert, Pedro

2013-06-07

Common variable immunodeficiency (CVID) is the most common of the primary immunodeficiency disorders. Pulmonary manifestations are characterised by recurrent rhinosinusitis, respiratory tract infections and bronchiectasis. Less commonly the lung may be affected by lymphoid disorders and sarcoid-like granulomas. Organising pneumonia (OP) is a rare pulmonary manifestation. We report the case of a 32-year-old woman with CVID who presented with fever, dyspnoea and persistent lung infiltrates despite antibiotic therapy. CT of the chest showed bilateral patchy alveolar infiltrates. Pulmonary function tests revealed moderate restriction and reduction in diffusion capacity. Initial bronchoscopy with transbronchial biopsies did not yield a diagnosis but surgical lung biopsies identified OP. Significant clinical, radiographic and physiological improvement was achieved after institution of corticosteroid therapy.

A case of bronchiolitis obliterans organising pneumonia associated with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome.

Science.gov (United States)

Hameed, Fawad; Steer, Henry

2017-08-01

A 57-year-old woman with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteitis) syndrome presented with recurrent episodes of pneumonia. She was treated with multiple courses of antibiotics with no success. The transbronchial biopsy undertaken via bronchoscopy revealed organising pneumonia (OP). She was treated with steroids and responded well with full clinical recovery and normalisation of her chest X-ray.To our knowledge, this is the first reported case of OP in association with SAPHO syndrome. This case report highlights the importance of considering OP in patients with SAPHO syndrome who present with chest infection. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Airway management of a rare huge-size supraglottic mass

International Nuclear Information System (INIS)

Abou-Zeid, Haitham A.; Al-Ghamdi, Abdel Mohsin A.; Al-Qurain, Abdel-Aziz A.; Mokhazy, Khalid M.

2006-01-01

Laser excision of a huge-sized supraglottic mass nearly obstructing the airway passage is a real challenge to anesthesiologists. Upper airway obstruction due to neoplasm in supraglottic region, is traditionally managed by preoperative tracheostomy, however, such a common procedure can potentially have an impact on long-term outcome. A 26-year-old patient presented with dysphagia caused by left cystic vallecular synovial sarcoma. The airway was successfully secured via fiberoptic bronchoscopy, followed by excision of the supraglottic tumor with CO2 laser surgery. Tracheostomy was not required. The patient was discharged from the hospital on the 4th day of surgery. This case, highlights the possibility to secure the airway passage without performing preoperative tracheostomy resulting in good outcome and short hospital stay. (author)

Airway fibroepithelial polyposis

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Gonzalo Labarca

2017-01-01

Full Text Available Fibroepithelial polyps are benign lesions, frequently found in the skin and genitourinary tract. Airway involvement is rare, and few case reports have been published. Our patient was a 79 y.o. male smoker, who was referred to us with a 3-month history of dry cough. At physical examination, the patient looked well, but a chest CT showed a 6-mm polyp lesion in his trachea. A flexible bronchoscopy confirmed this lesion, and forceps biopsies were performed. Argon plasma coagulation was used to completely resect and treat the lesion. Pathological analysis revealed a fibroepithelial polyp (FP. The aim of this manuscript is to report a case of FP with bronchoscopic management and to review the current literature about this condition.

Pneumocystis carinii pneumonia in AIDS patients

International Nuclear Information System (INIS)

Wojtycha-Kwasnica, B.; Leszczynski, S.; Mian, M.; Mydlowska, A.

1994-01-01

On the basis of observed sixteen AIDS patients the authors discuss problems connected with early diagnosis, dynamics and differential diagnosis of chest radiographic findings during pneumocystis carinii pneumonia (pcp). 13 patients with P. carinii had the classic pulmonary appearance of this organism: a symmetrical diffuse perihilar interstitial infiltration and alveolar air-space consolidation. Pleural effusions and hilar adenopathy were characteristically absent. Three patients with pcp had unusual pulmonary features. In these cases the diagnosis was proven by laboratory tests and fiberooptic bronchoscopy. Early recognition of pulmonary findings improves the course of pcp. Contemporary existence of tuberculosis and Kaposi sarcoma makes worse the prognosis in AIDS patients with pcp. CT is an important part of the early diagnosis of pulmonary findings in pcp. (author)

Antibiotic treatment and the diagnosis of Streptococcus pneumoniae in lower respiratory tract infections in adults

DEFF Research Database (Denmark)

Korsgaard, Jens; Møller, Jens Kjølseth; Kilian, Mogens

2005-01-01

OBJECTIVE: To analyze the possible influence of antibiotic treatment on the results of different diagnostic tests for the diagnosis of lower respiratory tract infections with Streptococcus pneumoniae. MATERIAL AND METHODS: A prospective cohort of 159 unselected adult immunocompetent patients...... admitted to Silkeborg County Hospital in Denmark with community-acquired lower respiratory tract infections underwent microbiological investigations with fiber-optic bronchoscopy with bronchoalveolar lavage, blood and sputum culture and urine antigen test for type-specific polysaccharide capsular antigens...... was positive in both systems, making a total of 22 patients with documented pneumococcal infection. As a positive culture test was dependent on the absence of antibiotic treatment, whereas a positive urine antigen test depended on antibiotic treatment within 48 hours, the two tests were complementary...

Disseminated Nocardia cyriacigeorgia causing pancreatitis in a haploidentical stem cell transplant recipient

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Jason Chen

2017-01-01

Full Text Available We report the first published case of acute pancreatitis secondary to disseminated nocardiosis in a hematopoietic stem cell transplant (HSCT recipient on chronic immunosuppression for graft-versus-host disease (GVHD. Nocardiosis in the HSCT population is relatively rare, and has not yet been described in haploidentical HSCT recipients. Our patient is a 28-year-old male with a history of haploidentical HSCT and GVHD of the skin and lung who was admitted to the hospital with acute pancreatitis. The workup for the etiology of his pancreatitis was initially unrevealing. He subsequently developed worsening sepsis and respiratory failure despite broad spectrum antimicrobials. After multiple bronchoscopies and pancreatic fluid sampling, he was found to have disseminated nocardiosis with Nocardia cyriacigeorgia.

A case of pulmonary carcinoid tumour in a pregnant woman successfully treated with bronchoscopic (electrocautery) therapy

Science.gov (United States)

Binesh, Fariba; Samet, Mohammad; Bovanlu, Taghi Roshan

2013-01-01

We present an uncommon case of a carcinoid tumour of the bronchus that was diagnosed during pregnancy in a 28-year-old woman. The patient was admitted at the emergency department with massive haemoptysis. Owing to the patient's critical condition, she underwent urgent flexible bronchoscopy. Bleeding was controlled by local injection of 500 mg tranexamic acid and electrocautery. After the bleeding has stopped, multiple specimens were taken. Histological examination confirmed typical carcinoid tumour. Owing to repeated haemoptysis, she was treated with bronchoscopic (electrocautery) therapy, and, after delivery, she underwent pulmonary lobectomy. Only a few similar cases were found in the literature reporting bronchopulmonary carcinoid tumour during pregnancy and we could not find any similar case which was treated by electrocautery. PMID:23608865

Medical image of the week: healthcare-associated pneumonia secondary to aspiration

Directory of Open Access Journals (Sweden)

Nissim L

2015-07-01

Full Text Available A 57 year-old bedbound paraplegic man developed a worsening productive cough after being hospitalized for several days. He was brought to the radiology suite for a CT scan of the chest, revealing a soft tissue density within his right main-stem bronchus, with volume loss of his right lung (Figure 1. Bronchoscopy was performed, yielding a 2 cm piece of broccoli, successfully removed with forceps (Figure 2. Culture from the bronchial aspirate was positive for Pseudomonas aeruginosa. The patient’s respiratory status dramatically improved after removal of the foreign body and commencement of pathogen-directed antibiotics. This study illustrates a dramatic example of healthcare-associated pneumonia (HCAP secondary to aspiration, as described by the American Thoracic Society / Infectious Diseases Society of America (1.

Emergency department management of smoke inhalation injury in adults [digest].

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Otterness, Karalynn; Ahn, Christine; Nusbaum, Jeffrey; Gupta, Nachi

2018-03-01

Smoke inhalation injury portends increased morbidity and mortality in fire-exposed patients. Upper airway thermal burns, inflammation from lower airway irritants, and systemic effects of carbon monoxide and cyanide can contribute to injury. A standardized diagnostic protocol for inhalation injury is lacking, and management remains mostly supportive. Clinicians should maintain a high index of suspicion for concomitant traumatic injuries. Diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests. Treatment includes airway and respiratory support, lung protective ventilation, 100% oxygen or hyperbaric oxygen therapy for carbon monoxide poisoning, and hydroxocobalamin for cyanide toxicity. Due to its progressive nature, many patients with smoke inhalation injury warrant close monitoring for development of airway compromise. [Points & Pearls is a digest of Emergency Medicine Practice.].

Tracheal palpation to assess endotracheal tube depth: an exploratory study.

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McKay, William P; Klonarakis, Jim; Pelivanov, Vladko; O'Brien, Jennifer M; Plewes, Chris

2014-03-01

Correct placement of the endotracheal tube (ETT) occurs when the distal tip is in mid-trachea. This study compares two techniques used to place the ETT at the correct depth during intubation: tracheal palpation vs placement at a fixed depth at the patient's teeth. With approval of the Research Ethics Board, we recruited American Society of Anesthesiologists physical status I-II patients scheduled for elective surgery with tracheal intubation. Clinicians performing the tracheal intubations were asked to "advance the tube slowly once the tip is through the cords". An investigator palpated the patient's trachea with three fingers spread over the trachea from the larynx to the sternal notch. When the ETT tip was felt in the sternal notch, the ETT was immobilized and its position was determined by fibreoptic bronchoscopy. The position of the ETT tip was compared with our hospital standard, which is a depth at the incisors or gums of 23 cm for men and 21 cm for women. The primary outcome was the incidence of correct placement. Correct placement of the ETT was defined as a tip > 2.5 cm from the carina and > 3.5 cm below the vocal cords. Movement of the ETT tip was readily palpable in 77 of 92 patients studied, and bronchoscopy was performed in 85 patients. Placement by tracheal palpation resulted in more correct placements (71 [77%]; 95% confidence interval [CI] 74 to 81) than hospital standard depth at the incisors or gums (57 [61%]; 95% CI 58 to 66) (P = 0.037). The mean (SD) placement of the ETT tip in palpable subjects was 4.1 (1.7) cm above the carina, 1.9 cm (1.5-2.3 cm) below the ideal mid-tracheal position. Tracheal palpation requires no special equipment, takes only a few seconds to perform, and may improve ETT placement at the correct depth. Further studies are warranted.

Acute tracheobronchial injuries: Impact of imaging on diagnosis and management implications

International Nuclear Information System (INIS)

Scaglione, Mariano; Romano, Stefania; Pinto, Antonio; Sparano, Amelia; Scialpi, Michele; Rotondo, Antonio

2006-01-01

Purpose: To evaluate the role of chest radiography, single-slice CT and 16-row MDCT in the direct evidence of tracheobronchial injuries. Methods: Patients with acute tracheobronchial injury were identified from the registry of our level 1 trauma center during a 5-year period ending July 2005. Findings at chest radiograph and CT were compared to those shown at bronchoscopy. Results: Eighteen patients with tracheobronchial injury - three patients with cervical trachea injury, eight with thoracic trachea injury and seven with bronchial injury - were identified. Twelve patients had a blunt trauma (67%), six patients had a penetrating (iatrogenic) injury (33%). Chest radiograph directly identified the site of tracheal injury in four cases, showing overdistension of the endotracheal cuff in three cases and displacement of the endotracheal tube in one case. At the level of the bronchi, chest radiograph demonstrated only one injury. CT directly identified the site of tracheal injury in all the cases showing the overdistension of the endotracheal cuff at the level of the thoracic trachea (three cases), posterior herniation of the endotracheal cuff at the thoracic trachea (three cases), lateral endotracheal cuff herniation at the thoracic trachea (one case), tracheal wall discontinuity at the cervical (one case) and at the thoracic trachea (one case) and displacement of endotracheal tube at the cervical trachea (two cases). At the level of the bronchi, CT correctly showed the site of injury in six case including: discontinuity of the left main bronchial wall (two cases), the 'fallen lung' sign (one case), right main bronchial wall enlargement (one case), discontinuity of the right middle bronchial wall (two cases). In one case, CT showed just direct 'air leak' at the level of the carina suggesting main bronchus injury. This finding was confirmed by bronchoscopy. Conclusion: Chest radiograph was helpful for the assessment of iatrogenic tracheal injuries. CT detected the site

Management of complex benign post-tracheostomy tracheal stenosis with bronchoscopic insertion of silicon tracheal stents, in patients with failed or contraindicated surgical reconstruction of trachea.

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Tsakiridis, Kosmas; Darwiche, Kaid; Visouli, Aikaterini N; Zarogoulidis, Paul; Machairiotis, Nikolaos; Christofis, Christos; Stylianaki, Aikaterini; Katsikogiannis, Nikolaos; Mpakas, Andreas; Courcoutsakis, Nicolaos; Zarogoulidis, Konstantinos

2012-11-01

Tracheal stenosis is a potentially life-threatening condition. Tracheostomy and endotracheal intubation remain the commonest causes of benign stenosis, despite improvements in design and management of tubes. Post-tracheostomy stenosis is more frequently encountered due to earlier performance of tracheostomy in the intensive care units, while the incidence of post-intubation stenosis has decreased with application of high-volume, low-pressure cuffs. In symptomatic benign tracheal stenosis the gold standard is surgical reconstruction (often after interventional bronchoscopy). Stenting is reserved for symptomatic tracheal narrowing deemed inoperable, due to local or general reasons: long strictures, inflammation, poor respiratory, cardiac or neurological status. When stenting is decided, silicone stent insertion is considered the treatment of choice in the presence of inflammation and/or when removal is desirable. We inserted tracheal silicone stents (Dumon) under general anaesthesia through rigid bronchoscopy in two patients with benign post-tracheostomy stenosis: a 39-year old woman with failed initial operation, and continuous relapses with proliferation after multiple bronchscopic interventions, and a 20-year old man in a poor neurological status, with a long tracheal stricture involving the subglottic larynx (lower posterior part), and inflamed tracheostomy site tissues (positive for methicillin resistant staphylococcus aureus). The airway was immediately re-establish, without complications. At 15- and 10-month follow-up (respectively) there was no stent migration, luminal patency was maintained without: adjacent structure erosion, secretion adherence inside the stents, granulation at the ends. Tracheostomy tissue inflammation was resolved (2(nd) patient), new infection was not noted. The patients maintain good respiratory function and will be evaluated for scheduled stent removal. Silicone stents are removable, resistant to microbial colonization and are

Role of Scintigraphy with Technetium-99m Depreotide in the Diagnosis and Management of Patients with Suspected Lung Cancer

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Axelsson, R.; Herlin, G.; Baaaath, M.; Aspelin, P.; Koelbeck, K.G. (Div. of Radiology, Dept. of Clinical Science, Intervention and Technology (CLINTEC), and Div. of Pulmonary Medicine and Allergology, Dept. of Medicine, Karolinska Inst., Stockholm (Sweden))

2008-04-15

Background: In Sweden, there are over 3000 new lung cancer cases every year. There are still numerous patients with undetermined lesions after routine diagnostic evaluation by clinical examination, chest radiography, computed tomography (CT) of the thorax, and bronchoscopy. An appropriate method for further diagnostic workup is therefore needed. Purpose: To evaluate the diagnostic value of the somatostatin analogue depreotide in patients with suspected lung cancer, and to determine in which clinical settings it would be beneficial to use 99mTc-depreotide scintigraphy. Material and Methods: We included 99 consecutive patients referred to our hospital with suspected lung cancer. A clinical examination, bronchoscopy, chest radiography, CT of the thorax and upper abdomen, and scintigraphy were done. Scintigraphy was performed after injection of 740 MBq 99mTc depreotide with tomographical imaging of the thorax and whole-body scanning. The diagnostic outcome of the scintigrams was compared to CT, using morphology or clinical outcome as the endpoint. Results: 99mTc-depreotide uptake was found in 62 out of 66 malignancies, including 57 of 58 primary lung cancer cases. Two cases of lung metastasis (one from a colon cancer and one from an adenoid cystic carcinoma originating in the palate) and one rib chondrosarcoma did not show depreotide uptake. There were 33 patients with benign lesions, of whom 16 displayed false-positive 99mTc-depreotide uptake, whereof 11 were pneumonias. Tc-99m-depreotide uptake was absent in 17 patients with benign lesions, including all 10 hamartomas. The sensitivity in detecting malignancy was 94%, and in detecting lung cancer 98%. The specificity was calculated based on two sets of data. When all cases were used, the specificity was 52%. If the 12 pneumonias are excluded, the specificity was 77%. Conclusion: 99mTc-depreotide scintigraphy has a high sensitivity in detecting lung cancer. The method is useful in decision-making with respect to

Bronchoplasty for Primary Broncho-Pulmonary Tumors

International Nuclear Information System (INIS)

ABDEL RAHMAN, A.M.

2010-01-01

Parenchyma-sparing procedures are widely used in patients with low-grade malignancies of the airway when anatomically suited lesions exist. This study was conducted to evaluate the short-term and the long-term results of bronchoplastic procedures for patients with centrally located primary bronchopulmonary tumors. Methods: Between 2000 and 2009, 36 patients with primary lung tumors required bronchoplasty were retrospectively analyzed. Preoperative assessment included computed tomography (CT) of the chest, bronchoscopy, and spirometry. Pre operative diagnosis was achieved by bronchoscopy for all patients, mediastinoscopy was done for patients with primary lung cancer. Neo adjuvant chemotherapy was given for 6 patients with non small cell lung cancer (NSCLC). Results: We had 15 males and 21 female, the mean age was 37 years and the mean hospital stay was 7.2 days. Operative procedures performed were:Sleeve lobectomy in 30 patients (13 right, 17 left), partial sleeve right pneumonectomy in 3 and bronchial resection with re-anastomosis in 3 (2 left, 1 right). Twelve patients (33.3%) suffered post-operative problems. There was one operative related mortality. Post operative pathology revealed: 27 patients with typical carcinoid, 2 with atypical carcinoid, 4 with squamous cell carcinoma, 2 with adenocarcifioma and one with hamartoma. Pathological TNM staging revealed: 17 patients with stage 1A, 11 with IB, 5 with IIA and 2 with stage IIIA. Follow-up data were available for all patients except two. Two patients died with disseminated disease 1.5 year and 2 years after surgery. The patient with hamartoma developed local recurrence 5 years later and re-excision was done. One patient with lung cancer developed bone metastases and was alive with disease, while the remaining 30 patient's were alive and disease free. The overall 5 years survival was 83.3%. Conclusion: Bronchoplastic resections achieve local control and long-term survival comparable to the standard resections in

Therapeutic Bronchoalveolar Lavage with Conventional Treatment in Allergic Bronchopulmonary Aspergillosis

International Nuclear Information System (INIS)

Khalil, K. F.

2015-01-01

Objective: To establish the role of therapeutic bronchoalveolar lavage in addition to conventional treatment among two groups, with allergic bronchopulmonary aspergillosis, in terms of regression in serum IgE levels and clinical recurrence at 3 and 6 months of follow-up. Study Design: Aquasi-experimental study. Place and Duration of Study: Department of Pulmonology, Fauji Foundation Hospital, Rawalpindi, from July 2010 to December 2013. Methodology: The study was carried out on 132 patients who fulfilled the Greenberger and Patterson criteria and underwent a chest X-ray, an HRCT chest and classified radiologically as with Central Bronchiectasis (CB), High Attenuation Mucus (HAM) or Other Radiological Features (ORF). Baseline serum IgE levels were noted. All patients were given treatment including prednisolone and antifungal agent itraconazole for 4 months. Patients with ORF on HRCT chest and just received the medical treatment were labeled as conventional group. Those patients who had CB or HAM radiological features also underwent bronchoscopy with therapeutic Bronchoalveolar Lavage (BAL), labeled as BAL group. Clinical recurrence and serum IgE levels were noted at 3 and 6 months. Values were compared using chi-square and Mann-Whitney tests respectively. Results: Around 78 (59.1 percentage) of patients underwent bronchoscopy with therapeutic bronchoalveolar lavage to remove the mucus plugs. The mean serum IgE levels at baseline were 3312.04 ± 2526.217 and 3486.15 ± 2528.324 IU/ml in the BAL and conventional groups respectively. There was a statistically significant reduction in the mean serum IgE levels at 3 (p < 0.00) and 6 months (p < 0.001) of follow-up in BALas compared to conventional group. There was no significant difference in the clinical recurrence rate in both the groups (p=0.078 at 3 and 0.343 at 6 months respectively). Conclusion: Therapeutic bronchoalveolar lavage may be a useful adjunct to treatment in patients with allergic bronchopulmonary

Role of Scintigraphy with Technetium-99m Depreotide in the Diagnosis and Management of Patients with Suspected Lung Cancer

International Nuclear Information System (INIS)

Axelsson, R.; Herlin, G.; Baaaath, M.; Aspelin, P.; Koelbeck, K.G.

2008-01-01

Background: In Sweden, there are over 3000 new lung cancer cases every year. There are still numerous patients with undetermined lesions after routine diagnostic evaluation by clinical examination, chest radiography, computed tomography (CT) of the thorax, and bronchoscopy. An appropriate method for further diagnostic workup is therefore needed. Purpose: To evaluate the diagnostic value of the somatostatin analogue depreotide in patients with suspected lung cancer, and to determine in which clinical settings it would be beneficial to use 99m Tc-depreotide scintigraphy. Material and Methods: We included 99 consecutive patients referred to our hospital with suspected lung cancer. A clinical examination, bronchoscopy, chest radiography, CT of the thorax and upper abdomen, and scintigraphy were done. Scintigraphy was performed after injection of 740 MBq 99m Tc depreotide with tomographical imaging of the thorax and whole-body scanning. The diagnostic outcome of the scintigrams was compared to CT, using morphology or clinical outcome as the endpoint. Results: 99m Tc-depreotide uptake was found in 62 out of 66 malignancies, including 57 of 58 primary lung cancer cases. Two cases of lung metastasis (one from a colon cancer and one from an adenoid cystic carcinoma originating in the palate) and one rib chondrosarcoma did not show depreotide uptake. There were 33 patients with benign lesions, of whom 16 displayed false-positive 99m Tc-depreotide uptake, whereof 11 were pneumonias. Tc-99m-depreotide uptake was absent in 17 patients with benign lesions, including all 10 hamartomas. The sensitivity in detecting malignancy was 94%, and in detecting lung cancer 98%. The specificity was calculated based on two sets of data. When all cases were used, the specificity was 52%. If the 12 pneumonias are excluded, the specificity was 77%. Conclusion: 99m Tc-depreotide scintigraphy has a high sensitivity in detecting lung cancer. The method is useful in decision-making with respect to

In vivo imaging of the airway wall in asthma: fibered confocal fluorescence microscopy in relation to histology and lung function

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Bel Elisabeth H

2011-06-01

Full Text Available Abstract Background Airway remodelling is a feature of asthma including fragmentation of elastic fibres observed in the superficial elastin network of the airway wall. Fibered confocal fluorescence microscopy (FCFM is a new and non-invasive imaging technique performed during bronchoscopy that may visualize elastic fibres, as shown by in vitro spectral analysis of elastin powder. We hypothesized that FCFM images capture in vivo elastic fibre patterns within the airway wall and that such patterns correspond with airway histology. We aimed to establish the concordance between the bronchial elastic fibre pattern in histology and FCFM. Second, we examined whether elastic fibre patterns in histology and FCFM were different between asthmatic subjects and healthy controls. Finally, the association between these patterns and lung function parameters was investigated. Methods In a cross-sectional study comprising 16 subjects (8 atopic asthmatic patients with controlled disease and 8 healthy controls spirometry and bronchoscopy were performed, with recording of FCFM images followed by endobronchial biopsy at the airway main carina. Elastic fibre patterns in histological sections and FCFM images were scored semi-quantitatively. Agreement between histology and FCFM was analysed using linearly weighted kappa κw. Results The patterns observed in histological sections and FCFM images could be divided into 3 distinct groups. There was good agreement between elastic fibre patterns in histology and FCFM patterns (κw 0.744. The semi-quantitative pattern scores were not different between asthmatic patients and controls. Notably, there was a significant difference in post-bronchodilator FEV1 %predicted between the different patterns by histology (p = 0.001 and FCFM (p = 0.048, regardless of asthma or atopy. Conclusion FCFM captures the elastic fibre pattern within the airway wall in humans in vivo. The association between post-bronchodilator FEV1 %predicted and

STUDY OF 200 CASES OF PLEURAL FLUID

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Ramakrishna R

2016-09-01

Full Text Available BACKGROUND We have studied 200 patients of pleural fluid presenting to our tertiary care centre. Presence of cases of pleural fluid is a common presentation both in pulmonary and extrapulmonary diseases. We analysed the patients having both exudates and transudates and studied the results. MATERIALS AND METHODS We selected patients above 20 years of age and classified the patients with pleural fluid as having transudates and exudates. We studied the causes of transudates and exudates. A total of 200 patients are studied in this prospective study. Diagnosis of pleural exudates is made on the basis of Light’s criteria, chest x-ray, pleural fluid analysis, CT scan in selected patients, sputum examination, bronchoscopy and bronchial washings. Moribund and non-cooperative patients and HIV positives were excluded from the study. RESULTS Among the 200 patients, 91% have exudates. 9% have transudates by Light’s criteria. Tuberculosis is the commonest cause of effusions (64.83% followed by malignancy (13.73% and sympneumonic or parapneumonic effusions (9.89%. Pleural effusions occurred predominantly in males. Prevalence of diabetes Mellitus among cases of tuberculous pleural effusions is 13.56%. Tuberculous effusions are predominantly right-sided. CONCLUSION Predominant cases of pleural fluid are exudates. Commonest cause of pleural effusion is Tuberculosis followed by malignancy both pulmonary and extrapulmonary and sym. and parapneumonic effusions. Prevalence of Diabetes among Tuberculous pleural effusion cases is more or less same as in general population. Cough, expectoration fever, chest pain and breathlessness are the common symptoms occurring in three fourths of the patients of tuberculous pleural effusion. Most of the cases of Tuberculous effusion are above 30 years of age. In the diagnosis of tuberculous pleural effusion, Pleural fluid ADA is very important. Pleural fluid cytology, pleural biopsy, bronchoscopy, bronchial washings and sputum

Bronchial leiomyoma, a case report and review of literature

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José Cárdenas-García, MD

2014-01-01

Full Text Available A 44 year old male former smoker from Ecuador presented with productive cough for 3 weeks, positive tuberculin skin test, 40 lbs weight loss and right lower lobe collapse. He denied wheezing or hemoptysis. He was treated with antibiotics and ruled out for tuberculosis with negative sputum smear. Bronchoscopy showed an endobronchial lesion at the distal end of bronchus intermedius as cause of the collapse. Endobronchial biopsy of the lesion revealed an endobronchial leiomyoma, a rare cause of endobronchial tumor. The patient underwent bilobectomy as definite therapy for the leiomyoma due to its large size and possible extra-luminal extension, which made it not amenable to bronchoscopic resection or bronchoplasty. Differential diagnoses of endobronchial lesions are discussed along with clinical, radiographic, pathologic characteristics and various treatment modalities for endobronchial leiomyomas.

Lung inflammatory pseudo tumor

International Nuclear Information System (INIS)

Veliz, Elizabeth; Leone, Gaetano; Cano, Fernando; Sanchez, Jaime

2005-01-01

The inflammatory pseudo tumor is a non neoplastic process characterized by an irregular growth of inflammatory cells. We described the case of a 38 year-old patient, she went to our institute for a in situ cervix cancer and left lung nodule without breathing symptoms; valued by neumology who did bronchoscopy with biopsy whose result was negative for malignancy. She went to surgery in where we find intraparenquima nodule in felt lingula of approximately 4 cms, we remove it; the result was: Inflammatory pseudotumor. This pathology is a not very frequent, it can develop in diverse regions of the organism, it is frequent in lung. The image tests are not specific for the diagnose, which it is possible only with the biopsy. The treatment is the complete resection. (The author)

Myocardial Infarction as a Complication of Bronchial Artery Embolization

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Labbé, Hugo, E-mail: hugo.labbe.1@ulaval.ca [Université Laval, Department of Medicine (Canada); Bordeleau, Simon [Université Laval, Department of Emergency Medicine (Canada); Drouin, Christine [Université Laval, Department of Anesthesiology and Critical Care Medicine (Canada); Archambault, Patrick [Université Laval, Department of Emergency Medicine (Canada)

2017-03-15

Bronchial artery embolization is now a common treatment for massive pulmonary hemoptysis if flexible bronchoscopy at the bedside failed to control the bleeding. Complications of this technique range from benign chest pain to devastating neurological impairments. We report the case of a 41-year-old man who developed an ST elevation myocardial infarction during bronchial artery embolization, presumably because of coronary embolism by injected particles. In this patient who had no previously known coronary artery disease, we retrospectively found a communication between the left bronchial artery and the circumflex coronary artery. This fistula was not visible on the initial angiographic view and likely opened because of the hemodynamic changes resulting from the embolization. This case advocates for careful search for bronchial-to-coronary arterial fistulas and the need for repeated angiographic views during embolization procedures.

Delayed Recurrence of Atypical Pulmonary Carcinoid Cluster: A Rare Occurrence

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Salim Surani

2014-01-01

Full Text Available Carcinoid is one of the most common tumors of the gastrointestinal tract followed by the tracheobronchial tree. Bronchial carcinoid compromises 20% of total carcinoid and accounts for 1–5% of pulmonary malignancies. Carcinoid can be typical or atypical, with atypical carcinoid compromises 10% of the carcinoid tumors. Carcinoid usually presents as peripheral lung lesion or solitary endobronchial abnormality. Rarely it can present as multiple endobronchial lesion. We hereby present a rare case of an elderly gentleman who had undergone resection of right middle and lower lobe of lung for atypical carcinoid. Seven years later he presented with cough. CT scan of chest revealed right hilar mass. Flexible bronchoscopy revealed numerous endobronchial polypoid lesions in the tracheobronchial tree. Recurrent atypical carcinoid was then confirmed on biopsy.

A case of squamous cell lung cancer after treating with radiation for small cell lung cancer

International Nuclear Information System (INIS)

Hayashi, Toshinari; Ide, Hiroshi; Siomi, Katsuhiko; Nakamura, Yukinobu; Tada, Shinya; Kageyama, Hiroshi; Kido, Masamitsu

1999-01-01

A 77-year-old man was admitted due to an abnormal shadow on a chest X-ray film in September 1993. Small cell lung cancer was diagnosed by transbronchial lung biopsy of left S 3 . Because of his pulmonary and renal dysfunction, he received only 40 Gy irradiation alone, and the tumor shadow disappeared. After 38 months' observation, a new nodular shadow was detected in the left upper lung field in March 1997. A tumor was found in left B 3 by bronchoscopy, and biopsy revealed squamous cell carcinoma. Because of his advanced age and hypoxia, he has had no active treatment. This was a rare case of small cell lung cancer with long term survival, treated only by radiation, in which a different histologic type of carcinoma appeared in the same radiation field. (author)

Bronchoscopic resection of endobronchial inflammatory myofibroblastic tumor: A case report and systematic review of the literature

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Animesh Ray

2014-01-01

Full Text Available Inflammatory myofibroblastic tumour (IMT is a rare tumour affecting the tracheo-bronchial tree in the adult population. The clinical presentation of this tumour is diverse and diagnosis can be definitively clinched by histopathological examination. Treatment of this tumour usually requires surgical resection with bronchoscopic resection being described in few cases. We describe a 32 year old male presenting with hemoptysis who was diagnosed to have IMT. Resection of the tumour was done with the help of rigid bronchoscopy. Post-resection, hemoptysis stopped and no recurrence of tumour was noted on subsequent follow-up. We also present a systematic review of literature of all the cases of tracheo-bronchial IMT treated with bronchoscopic resection and conclude it to be a useful alternative to surgery in such cases.

Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

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Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

2014-05-15

Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

Infectious Causes of Right Middle Lobe Syndrome.

Science.gov (United States)

Rashid, Aatif; Nanjappa, Sowmya; Greene, John N

2017-01-01

Right middle lobe (RML) syndrome is defined as recurrent or chronic obstruction or infection of the middle lobe of the right lung. Nonobstructive causes of middle lobe syndrome include inflammatory processes and defects in the bronchial anatomy and collateral ventilation. We report on 2 case patients with RML syndrome, one due to infection with Mycobacterium avium complex followed by M asiaticum infection and the other due to allergic bronchopulmonary aspergillosis. A history of atopy, asthma, or chronic obstructive pulmonary disease has been reported in up to one-half of those with RML. The diagnosis can be made by plain radiography, computed tomography, and bronchoscopy. Medical treatment consists of bronchodilators, mucolytics, and antimicrobials. Patients whose disease is unresponsive to treatment and those with obstructive RML syndrome can be offered surgical treatment.

Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

International Nuclear Information System (INIS)

Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik

2014-01-01

Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

Medical image of the week: right neck mass with thoracic extension

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Siddiqi TA

2013-05-01

Full Text Available A 28-year-old female with a history of chronic pancreatitis s/p total pancreatectomy and auto-islet cell transplantation developed a progressively enlarging right neck mass of 4 weeks duration. Coccidioides IgM antibodies were negative and IgG antibodies were positive by immunoassay (EIA, with titers 1:4 by complement fixation (CF. Fine needle aspiration with subsequent excisional biopsy of the right neck mass was performed and showed reactive lymphoid hyperplasia without fungal elements. Bronchoscopy with right upper lobe endobronchial biopsy and 4R lymph node endobronchial ultrasound-fine needle aspiration revealed granulomatous inflammation and Coccidioides spherules on Gomori's methenamine silver stain. Fungal cultures from the right neck mass fine needle aspiration, endobronchial biopsy, and 4R lymph node grew Coccidioides after three weeks of culture.

Invasive tracheobronchial aspergillosis in a patient with systemic lupus erythematosus-dermatomyositis overlap syndrome.

Science.gov (United States)

Sada, Mitsuru; Saraya, Takeshi; Tanaka, Yasutaka; Sato, Shinji; Wakayama, Megumi; Shibuya, Kazutoshi; Uchiyama, Takashi; Ogata, Hideo; Takizawa, Hajime; Goto, Hajime

2013-01-01

A 45-year-old man was referred to our hospital with a 3-month history of dyspnea, polyarthralgia, myalgia and weight loss. He was diagnosed with systemic lupus erythematosus/dermatomyositis overlap syndrome with lung involvement, which presented as organizing pneumonia. However, a bronchoscopic examination revealed the presence of multiple plaque-like white lesions with ulcers on the bronchial membrane, located mainly in the central airway. The pathological specimens obtained from bronchoscopy showed numerous filamentous fungal hyphae that were aggressively invading the bronchial walls, suggesting a diagnosis of invasive tracheobronchial aspergillosis. The present case, along with a review of the literature, demonstrates that invasive tracheobronchial aspergillosis can occur in patients who do not appear to be immunosuppressed. This case of aspergillosis should thus be recognized as an extremely rare presentation of an Aspergillus infection.

An unusual case of foreign body aspiration mimicking cavitary tuberculosis in adolescent patient: Thread aspiration

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Cakir Erkan

2012-05-01

Full Text Available Abstract Foreign body aspiration continues to be a serious problem in childhood and adolescent period with significant rate of morbidity and rarely mortality. Half of the foreign body aspiration cases have no history of aspiration. The main foreign bodies inhaled are food fragments and different kinds of metallic objects. A 12-year-old girl was referred to the pediatric pulmonology department for chronic cough and hemoptysis. She had persistent infiltration and cavitary lesion mimicking cavitary tuberculosis. There was no contact history with tuberculosis in her family and acid resistant bacillus was not found in the sputum examination. Flexible bronchoscopy was performed for persistent infiltration and hemoptysis and inflamed thread was found in right lower lobe bronchus. This is the first case of thread inhalation mimicking cavitary tuberculosis in an adolescent patient.

Contribution of cobalt 57 labelled bleomycin in the diagnosis of pulmonary round intraparenchymatous lesions

International Nuclear Information System (INIS)

Vaillant, G.; Bertrand, A.; Robert, J.; Hocquart, C.; Zuck, P.; Anthoine, D.; Lamy, P.

1975-01-01

One hundred and eleven patients with a round lesion within the lung parenchyma were submitted to a lung scan using cobalt 57 labelled bleomycin. In all cases, the diagnosis of benign or malignant disease was made definitely by bronchoscopy, fiber endoscopy, transparietal needle biopsy or thoracotomy. Out of 89 neoplasic foci, 87 took up labelled bleomycin with a fixation ratio greater than 13. On the other hand, the 22 benign round foci, except for the large silico-tuberculous nodule, remained silent on radio-isotope scanning. The great value of scanning using cobalt 57 labelled bleomycin in the detection of the malignant or benign nature of round images within the lung is emphasized, the clinical and radiological pre-operative diagnosis remains one of the most difficult in lung disease problems [fr

Endoscopic Resection of Tracheal Tumor in an Elderly Woman Under Extracorporeal Membrane Oxygenation

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Yi-Ying Chiang

2011-03-01

Full Text Available Anesthetic management of patients with difficult airway is challenging, especially in patients who present with near total occlusion of the airway. Tracheal tumors occur more frequently in elderly patients who are more prone to hypoxic injury. Reliable ventilation and oxygenation are mandatory for a safe and sound intervention. Herein, we report on a 71-year-old woman with a large tracheal tumor occluding approximately 90% of the tracheal lumen. Extracorporeal membrane oxygenation under local anesthesia was used during electrocautery resection of the tumor because of the possibility of fatal airway collapse due to the degree of occlusion and location of the tumor. After the tumor had been successfully resected by means of bronchoscopy, an endotracheal tube was inserted, and the patient was weaned from extracorporeal membrane oxygenation.

Metastatic melanoma after 23 years of primary ocular melanoma.

LENUS (Irish Health Repository)

Karde, Supriya Ramesh

2016-11-23

We describe a case of 52-year-old man who presented with an episode of tonic-clonic seizures. He had right ocular melanoma 23 years ago with subsequent enucleation which was the standard treatment at that time. CT scans of the brain and of the thorax-abdomen-pelvis revealed widespread metastatic lesions in the brain, lung and liver. Further investigations including bronchoscopy with cytopathology uncovered that the metastatic disease was a recurrence of ocular melanoma. He received palliative radiotherapy and died 6 months later. Ocular melanoma is often associated with fulminant metastatic disease after a period of dormancy. Thus, despite successful treatment of the localised disease at initial presentation, an effort is needed for optimal long-term follow-up plan in order to improve survival in case of recurrence.

Uncommon presentation of pulmonary aspergilloma

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Baradkar V

2009-01-01

Full Text Available Cases of pulmonary aspergilloma without any predisposing factors are rarely reported. Clinical presentation varies from case to case. Here, we report a case of pulmonary aspergilloma in a 60-year-old male patient who was admitted to the Intensive Respiratory Care Unit with spontaneous pneumothorax. The patient had a history of dyspnea on exertion since 9 months and mild haemoptysis since the last 6 months. A computerised tomographic scan of the lungs showed a lesion in the left main bronchus along with obstructive emphysema of the right lung, moderate pneumothorax and mediastinal emphysema. Bronchoscopy was performed and the biopsy samples were processed for histopathological examination and culture on Sabouraud′s dextrose agar, which yielded growth of Aspergillus flavus. Repeat sputum samples also yielded the growth of A. flavus . The patient responded to intravenous liposomaamphotericin B and intercostal drainage.

Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

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Ming-Ju Tsai

2011-03-01

Full Text Available Strongyloidiasis is endemic in tropic and subtropic areas, but is currently seldom encountered in developed area like Taiwan. We present an elder man with acute respiratory distress syndrome complicating Strongyloides stercoralis hyperinfection. There was no significant clue initially for diagnosing this patient as having S. stercoralis hyperinfection. Neither peripheral eosinophilia nor significant hemoptysis was noted. Bronchoscopy played a critical role to define the unexpected cause of his progressive pulmonary infiltrates. The correct diagnosis was soon made by recognition of the worm in bronchioloalveolar lavage cytology, and specific treatment was initiated promptly. For a septic patient with progressive pulmonary infiltrates, bronchoscopic studies including cytology may be necessary for defining the cause. Hyperinfection strongyloidiasis should be considered as a cause of acute respiratory distress syndrome in immunocompromised patient, especially with the presence of chronic gastrointestinal symptoms.

Evaluation of workers exposed to dust containing hard metals and aluminum oxide.

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Schwarz, Y; Kivity, S; Fischbein, A; Abraham, J L; Fireman, E; Moshe, S; Dannon, Y; Topilsky, M; Greif, J

1998-08-01

Fourteen worker exposed to hard metals and aluminum oxide were evaluated. Six heavily exposed workers underwent bronchoscopy and bronchoalveolar lavage, and five workers underwent transbronchial biopsy. Microchemical analysis of transbronchial biopsies showed a high lung burden of exogenous particles, especially metal related to their hard metals exposure. Lung tissue and cellular changes, which were associated with exposure to hard metal and aluminum oxide, corresponded well with the microanalytic test results. Three workers had at biopsy diffuse interstitial inflammatory changes: two of them were asymptomatic with normal chest X-ray films, and one had clinically evident disease with severe giant cell inflammation. Two other workers showed focal inflammation. The worker showing clinical disease and one asymptomatic worker with interstitial inflammatory changes had evaluated bronchoalveolar lavage fluid-eosinophilia counts. These two were father (with clinical disease) and son (asymptomatic).

Diffuse bronchiectasis as the primary manifestation of endobronchial sarcoidosis

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Paul D. Hiles

2017-01-01

Full Text Available Sarcoidosis is an idiopathic disease that most commonly involves the lungs and is characterized by granulomatous inflammation. Bronchiectasis is one pulmonary manifestation of sarcoidosis, although it is almost always observed as traction bronchiectasis in the setting of fibrotic lung disease. A 50-year-old woman was evaluated for chronic cough and bronchiectasis with a small amount of peripheral upper lobe honeycombing and no significant pulmonary fibrosis or lymphadenopathy. After an extensive laboratory and imaging evaluation did not identify a cause of her bronchiectasis, bronchoscopy was performed to assess for primary ciliary dyskinesia and revealed a diffuse cobblestone appearance of the airway mucosa. Endobronchial biopsies and lymphocyte subset analysis of bronchoalveolar lavage fluid were consistent with a diagnosis of sarcoidosis. We believe endobronchial sarcoidosis should be included in the differential diagnosis of patients presenting with bronchiectasis.

Percutaneous tracheostomy: a comprehensive review

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Rashid, Ashraf O.

2017-01-01

Tracheostomy is a common procedure. It can be done surgically or percutaneously by dilating the stoma using Seldinger technique. Percutaneous tracheostomy (PT) is now routinely performed by surgeons and non-surgeons such as intensivists and anesthesiologists in the intensive care units (ICU) all over the world. Although obesity, emergent tracheostomy, coagulopathy, inability to extend the neck and high ventilator demand (HVD) were initially thought to be a relative contraindication, recent data suggest safety of PT in these patient population. Ultrasound can be helpful in limited cases to identify the neck structure especially in patients with a difficult anatomy. Bronchoscopy during PT can shorten the duration and avoid complications. PT has favorable complication rate, lower infection rate, shorter procedural duration and is cost-effective. Experience with the technique and careful planning is needed to minimize any avoidable potential complication. PMID:29214070

Iatrogenic tension pneumothorax in children: two case reports

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Mayordomo-Colunga Juan

2009-06-01

Full Text Available Abstract Introduction Two cases of iatrogenic tension pneumothorax in children are reported. Case presentations Case 1: A 2-year-old boy with suspected brain death after suffering multiple trauma suddenly developed intense cyanosis, extreme bradycardia and generalized subcutaneous emphysema during apnea testing. He received advanced cardiopulmonary resuscitation and urgent bilateral needle thoracostomy. Case 2: A diagnostic-therapeutic flexible bronchoscopy was conducted on a 17-month-old girl, under sedation-analgesia with midazolam and ketamine. She very suddenly developed bradycardia, generalized cyanosis and cervical, thoracic and abdominal subcutaneous emphysema. Urgent needle decompression of both hemithoraces was performed. Conclusion In techniques where gas is introduced into a child's airway, it is vital to ensure its way out to avoid iatrogenic tension pneumothorax. Moreover, the equipment to perform an urgent needle thoracostomy should be readily available.

Foreign body aspiration masquerading as difficult asthma

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Rai S

2007-01-01

Full Text Available It is important to assess patients of difficult/therapy resistant asthma carefully in order to identify whether there are any correctable factors that may contribute to their poor control. It is critical to make a diagnosis of asthma and to exclude other airway diseases. A 65-years-old lady presented with repeated acute episodes of dyspnoea and wheezing. She was on regular medication for bronchial asthma for 18 years. There was no history of foreign body aspiration or loss of consciousness. Her chest radiograph was normal. She showed poor response to corticosteroids and bronchodilators. Fibreoptic bronchoscopy (FOB showed intracordal cyst of the left vocal cord and 1cm size irregular piece of betel nut in right main bronchus, which was removed endoscopically with the help of dormia basket, following which her condition improved and asthma was controlled on inhaled bronchodilators.

Tracheobronchial Foreign Body Aspiration: Dental Prosthesis

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Ataman Köse

2014-01-01

Full Text Available It is important to extract foreign bodies for avoiding life-threatening complications. They can lead to death if they are not treated. Different signs and symptoms could occur according to the complete or partial airway obstruction. Foreign body aspiration is a rare incident in adults. The organic foreign materials such as foods are found to be aspirated more commonly and are usually settled in the right bronchial system. However, dental prosthesis and teeth aspirations are rare in literature. In our study, a 52-year-old male patient who had aspirated the front part of his lower dental prosthesis accidentally is presented and the foreign body is extracted by using rigid bronchoscopy. There are many causes of aspiration but dental prosthetic aspirations should be kept in mind during sleep. For this reason, dental apparatus must be taken out while asleep.

An unusual cause for recurrent chest infections.

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Lobo, Ronstan

2012-10-01

We present a case of an elderly non-smoking gentleman who, since 2005, had been admitted multiple times for recurrent episodes of shortness of breath, wheeze, cough and sputum. The patient was treated as exacerbations of chronic obstructive pulmonary disease (COPD) and\\/or lower respiratory tract infections. Bronchoscopy was done which revealed multiple hard nodules in the trachea and bronchi with posterior tracheal wall sparing. Biopsies confirmed this as tracheopathia osteochondroplastica (TO). He had increasing frequency of admission due to methicillin-resistant Staphylococcus aureus and pseudomonas infections, which failed to clear despite intravenous, prolonged oral and nebulised antibiotics. The patient developed increasing respiratory distress and respiratory failure. The patient died peacefully in 2012. This case report highlights the typical pathological and radiological findings of TO and the pitfalls of misdiagnosing patients with recurrent chest infections as COPD.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma.

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Noh, Dongsub; Lee, Chan-Kyu; Hwang, Jung Joo; Cho, Hyun Min

2018-04-01

Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

Low Prevalence of Chronic Beryllium Disease among Workers at a Nuclear Weapons Research and Development Facility

Energy Technology Data Exchange (ETDEWEB)

Arjomandi, M; Seward, J P; Gotway, M B; Nishimura, S; Fulton, G P; Thundiyil, J; King, T E; Harber, P; Balmes, J R

2010-01-11

To study the prevalence of beryllium sensitization (BeS) and chronic beryllium disease (CBD) in a cohort of workers from a nuclear weapons research and development facility. We evaluated 50 workers with BeS with medical and occupational histories, physical examination, chest imaging with HRCT (N=49), and pulmonary function testing. Forty of these workers also underwent bronchoscopy for bronchoalveolar lavage (BAL) and transbronchial biopsies. The mean duration of employment at the facility was 18 yrs and the mean latency (from first possible exposure) to time of evaluation was 32 yrs. Five of the workers had CBD at the time of evaluation (based on histology or HRCT); three others had evidence of probable CBD. These workers with BeS, characterized by a long duration of potential Be exposure and a long latency, had a low prevalence of CBD.

Transnasal tracheobronchial stenting for malignant airway narrowing under local anesthesia: Our experience of treating three cases using this technique

International Nuclear Information System (INIS)

Medhi, Jayanta; Handique, Akash; Goyal, Amit; Lynser, Donbok; Phukan, Pranjal; Sarma, Kalyan; Padmanabhan, Aswin; Saikia, Manuj Kumar; Chutia, Happy

2016-01-01

To study the technical feasibility of tracheobronchial stenting via transnasal route under bronchoscopy and fluoroscopic guidance in severe malignant airway strictures using self-expandable nitinol stents. We describe three patients with malignant airway strictures, treated entirely via transnasal route under local anesthesia using bronchoscopic and fluoroscopic guidance. Nasal route allowed convenient access to the airway for the bronchoscope across the stricture and a guidewire was introduced through its working channel. The 18F tracheal stent and the 6F bronchial stent assembly could be easily introduced and deployed under bronchoscopic (reintroduced through the other nostril) and fluoroscopic guidance. We achieved technical success in all the three patients with immediate relief of dyspnea. Transnasal airway stenting with self-expandable nitinol stent using bronchoscopic and fluoroscopic guidance under local anesthesia is a safe and effective method with minimal patient discomfort

Recurrent respiratory papillomatosis with pulmonary involvement

International Nuclear Information System (INIS)

Ikawa, Marcos Hiroyuki

2008-01-01

A five-year-old girl developed hoarseness with gradual worsening at the age of eight months. Three months later, she underwent bronchoscopy in which papillomas in the vocal cords, larynx and trachea were observed. Because of serious bronchospasm crises and respiratory failure, she needed several hospitalizations, definitive tracheostomy and multiple endoscopic procedures for papilloma excision. The most recent chest radiography (Figure A) and computed tomography (CT) scans (Figures B and C) showed a nodule inside the trachea and multiple pulmonary nodules, cysts and consolidations. The anatomopathological findings from curettage of the lesions revealed benign squamous-cell papillomas. Recurrent respiratory papillomatosis (RRP) is directly related to the human papillomavirus (HPV). Its spread to the lower airways is uncommon, with involvement of trachea and/or proximal bronchi in 5% of the patients, and extension to the lungs in only 1% of the cases. (author)

Recurrent respiratory papillomatosis with pulmonary involvement; Papilomatose respiratoria recorrente com envolvimento pulmonar

Energy Technology Data Exchange (ETDEWEB)

Ikawa, Marcos Hiroyuki [Universidade Federal de Sao Paulo, SP (Brazil). Escola Paulista de Medicina. Dept. de Diagnostico por Imagem; Meirelles, Gustavo Souza Portes [Centro de Medicina Diagnostica Fleury, Sao Paulo, SP (Brazil)]. E-mail: gmeirelles@gmail.com

2008-01-15

A five-year-old girl developed hoarseness with gradual worsening at the age of eight months. Three months later, she underwent bronchoscopy in which papillomas in the vocal cords, larynx and trachea were observed. Because of serious bronchospasm crises and respiratory failure, she needed several hospitalizations, definitive tracheostomy and multiple endoscopic procedures for papilloma excision. The most recent chest radiography (Figure A) and computed tomography (CT) scans (Figures B and C) showed a nodule inside the trachea and multiple pulmonary nodules, cysts and consolidations. The anatomopathological findings from curettage of the lesions revealed benign squamous-cell papillomas. Recurrent respiratory papillomatosis (RRP) is directly related to the human papillomavirus (HPV). Its spread to the lower airways is uncommon, with involvement of trachea and/or proximal bronchi in 5% of the patients, and extension to the lungs in only 1% of the cases. (author)

Tracheal epithelial-myoepithelial carcinoma associated with sarcoid-like reaction: A case report

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Dong, Huawei; Tatsuno, Brent K.; Betancourt, Jaime; Oh, Scott S.

2014-01-01

Epithelial-myoepithelial carcinomas are rare tumors that primarily originate in the salivary glands but have also been found in the tracheobronchial tree. We report the first case of epithelial-myoepithelial carcinoma associated with sarcoidosis. A 61 year old Hispanic man presented with altered mental status and hypercalcemia. Imaging revealed diffuse intra-thoracic and intra-abdominal lymphadenopathy. A diagnostic bronchoscopy was performed where an incidental tracheal nodule was discovered and biopsied. Pathology was consistent with epithelial-myoepithelial carcinoma. Lymph node biopsy demonstrated non-caseating granulomas consistent with sarcoidosis. Patient underwent tracheal resection of the primary tumor with primary tracheal reconstruction. Hypercalcemia subsequently normalized with clinical improvement. Repeat CT imaging demonstrated complete resolution of lymphadenopathy. Our findings are suggestive of a possible paraneoplastic sarcoid-like reaction to the epithelial-myoepithelial carcinoma with associated lymphadenopathy and symptomatic hypercalcemia. PMID:26029574

Case of coccidioidomycosis in Ireland.

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Duggan, Patrick Thomas; Deegan, Alexander P; McDonnell, Timothy J

2016-08-11

Coccidioidal infection is a well-recognised cause of pulmonary disease in certain parts of the south-western USA, Central and South America; however, it is rarely encountered elsewhere in the world. We describe the case of a previously healthy man presenting to a Dublin hospital with fever, dry cough and chest pain, following a visit to the western USA. Despite treatment with broad-spectrum antimicrobials, the patient developed progressive bilateral pulmonary infiltrates and a large pleural effusion. After extensive investigations including CT, bronchoscopy and pleural fluid analysis, a diagnosis of pulmonary coccidioidomycosis was made. Following the initiation of appropriate antifungal therapy, the patient made a full recovery. This case was of interest due to the rarity of the disease outside its areas of endemicity and the unusual findings associated with its diagnosis. 2016 BMJ Publishing Group Ltd.

Isolated pauci-immune pulmonary capillaritis

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Ashok Kumar Mehrotra

2015-01-01

Full Text Available A young house wife presented with low grade fever, cough, haemoptysis and SOB of unknown aetiology for 40 days duration. Respiratory system examination revealed diffuse crepts and rhonchi. Other organ system examination did not reveal any abnormality. X-ray chest PA view and CT thorax showed diffuse bilateral necrotising nodular lesions of various sizes with small pleural effusion. She also had low resting oxygen saturation with falling haematocrit. Her Serum was week positive for p-ANCA and negative for MPO-ANCA. Bronchoscopy revealed continuous bloody aspirates. We could not isolate any organisms in any of the specimens from her and she was unresponsive to any of the antibiotics either. Based on the clinical, laboratory data, radiological features and positive outcome to pulse therapy of methylprednisolone and cyclophosphamide, she was diagnosed as a case of IPIPC.

Eficácia e tolerabilidade de próteses na via aérea

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Carla Valente

2010-05-01

of airway stent insertion with rigid bronchoscopy (23 patients was carried out over a two year period (2006–2007 at the Diagnostic and Therapeutic Techniques Unit.We assessed indication, efficacy, tolerability, complications and exact insertion based on chest CT imaging. In all situations Dumon flexible silicon stents (Tracheobronxane ® were used, with the need for complementary techniques such as laser therapy and mechanical dilation having been previously evaluated by flexible bronchoscopy.The authors conclude that stent insertion has no complications and good tolerability in the majority of advanced stage oncological situations with indication for palliative management. Palavras-chave: Próteses traqueobrônquicas, broncoscopia rígida, Key-words: Tracheobronchial stent, rigid bronchoscopy

Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

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Andrea de Melo Alexandre Fraga

2008-02-01

years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. RESULTS: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age, 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%, auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%, and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts. In the follow-up period, 29% presented complications (most commonly pneumonia, which were found to be associated with longer aspiration time (p = 0.03. Mechanical ventilation was required in 7 children (10.1%, and multiple bronchoscopies were performed in 5 (7.2%. CONCLUSION: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher the risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention programs aimed at children younger than 3 years of age.

The application of MDCT in the diagnosis of chest trauma.

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Błasińska-Przerwa, Katarzyna; Pacho, Ryszard; Bestry, Iwona

2013-01-01

Traumas are the third most common cause of death worldwide, after cardiovascular diseases and neoplasms, and the main cause of death of patients under 40 years of age. Contemporary image diagnosis of chest trauma uses chest X-ray (CXR), multidetector computed tomography (MDCT), transthoracic and transoesophageal ultrasound (USG), X-ray angiography and magnetic resonance. The aim of the present study was to evaluate MDCT results in the examination of posttraumatic chest injuries and to compare the results of CXR and MDCT in chosen chest traumatic injuries. The sixty patients with chest trauma included in the study were diagnosed at the Department of Radiology of the Institute of Tuberculosis and Lung Diseases between May 2004 and October 2007. MDCT was performed in all patients. Two groups with different types of injury (blunt or penetrating chest trauma) were distinguished. The analysis of injuries in both groups was conducted depending on the mechanism of trauma. The detection of 20 selected injuries at CXR and MDCT was compared. Moreover, the compatibility of MDCT with the results of intraoperative assessment and bronchoscopy was analysed. The influence of MDCT on the treatment modality was also assessed. History of blunt chest trauma was found in 51 patients (group 1) and of penetrating trauma in 9 patients (group 2). The most frequent injuries among group 1 were lung contusion and rib fractures, and among group 2 it was pericardial hematoma. Compared to MDCT, the sensitivity and specificity of CXR were 66.7 and 58%, respectively. Change of treatment modality was observed after MDCT in 83% of patients. The sensitivity and specificity of MDCT in diagnosing tracheobronchial injury, compared to bronchoscopy, were 72.7% and 100%, respectively. Compatibility of MDCT results and intraoperative assessment was observed in 43% of patients, and the main reason for discrepancy was underdiagnosis of diaphragm injury in MDCT. MDCT was a valuable diagnostic method in

Bronchial Thermoplasty in Severe Asthma: Best Practice Recommendations from an Expert Panel.

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Bonta, Peter I; Chanez, Pascal; Annema, Jouke T; Shah, Pallav L; Niven, Robert

2018-01-01

Bronchial thermoplasty (BT) is a bronchoscopic treatment for patients with severe asthma who remain symptomatic despite optimal medical therapy. In this "expert best practice" paper, the background and practical aspects of BT are highlighted. Randomized, controlled clinical trials have shown BT to be safe and effective in reducing severe exacerbations, improving quality of life, and decreasing emergency department visits. Five-year follow-up studies have provided evidence of the functional stability of BT-treated patients with persistence of a clinical benefit. The Global Initiative for Asthma (GINA) guidelines state that BT can be considered as a treatment option for adult asthma patients at step 5. Patient selection for BT requires close collaboration between interventional pulmonologists and severe asthma specialists. Key patient selection criteria for BT will be reviewed. BT therapy is delivered in 3 separate bronchoscopy sessions at least 3 weeks apart, covering different regions of the lung separately. Patients are treated with 50 mg/day of prednisolone or equivalent for 5 days, starting treatment 3 days prior to the procedure. The procedure is performed under moderate-to-deep sedation or general anesthesia. At bronchos-copy a single-use catheter with a basket design is inserted through the instrument channel and the energy is delivered by a radiofrequency (RF) generator (AlairTM Bronchial Thermoplasty System). BT uses temperature-controlled RF energy to impact airway remodeling, including a reduction of excessive airway smooth muscle within the airway wall, which has been recognized as a predominant feature of asthma. The treatment should be performed in a systemic manner, starting at the most distal part of the (sub)segmental airway, then moving proximally to the main bronchi, ensuring that the majority of the airways are treated. In general, 40-70 RF activations are provided in the lower lobes, and between 50 and 100 activations in the upper lobes combined

The prognostic importance of CXCR3 chemokine during organizing pneumonia on the risk of chronic lung allograft dysfunction after lung transplantation.

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Michael Y Shino

Full Text Available Since the pathogenesis of chronic lung allograft dysfunction (CLAD remains poorly defined with no known effective therapies, the identification and study of key events which increase CLAD risk is a critical step towards improving outcomes. We hypothesized that bronchoalveolar lavage fluid (BALF CXCR3 ligand concentrations would be augmented during organizing pneumonia (OP and that episodes of OP with marked chemokine elevations would be associated with significantly higher CLAD risk.All transbronchial biopsies (TBBX from patients who received lung transplantation between 2000 to 2010 were reviewed. BALF concentrations of the CXCR3 ligands (CXCL9, CXCL10 and CXCL11 were compared between episodes of OP and "healthy" biopsies using linear mixed-effects models. The association between CXCR3 ligand concentrations during OP and CLAD risk was evaluated using proportional hazards models with time-dependent covariates.There were 1894 bronchoscopies with TBBX evaluated from 441 lung transplant recipients with 169 (9% episodes of OP and 907 (49% non-OP histopathologic injuries. 62 (37% episodes of OP were observed during routine surveillance bronchoscopy. Eight hundred thirty-eight (44% TBBXs had no histopathology and were classified as "healthy" biopsies. There were marked elevations in BALF CXCR3 ligand concentrations during OP compared with "healthy" biopsies. In multivariable models adjusted for other injury patterns, OP did not significantly increase the risk of CLAD when BAL CXCR3 chemokine concentrations were not taken into account. However, OP with elevated CXCR3 ligands markedly increased CLAD risk in a dose-response manner. An episode of OP with CXCR3 concentrations greater than the 25th, 50th and 75th percentiles had HRs for CLAD of 1.5 (95% CI 1.0-2.3, 1.9 (95% CI 1.2-2.8 and 2.2 (95% CI 1.4-3.4, respectively.This study identifies OP, a relatively uncommon histopathologic finding after lung transplantation, as a major risk factor for CLAD