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PubMed2004

CT fluoroscopy-guided bronchoscopic dye marking for resection of small peripheral pulmonary nodules.

STUDY OBJECTIVE: To determine the diagnostic reliability and safety of a new marking technique using transbronchoscopic dye injection under CT fluoroscopy for preoperative localization of a small pulmonary nodule. DESIGN: Prospective study. SETTING: Hyogo Medical Center for Adults and Shizuoka Cancer Center in Japan. PATIENTS: Seventeen patients who had a peripheral pulmonary nodule < 15 mm in size on CT scans that was suspected to be difficult to localize by visual inspection and manual palpation at our institutes between April 2000 and October 2002. INTERVENTIONS: After a bronchoscope was inserted orally under local anesthesia and was introduced into the related bronchus of the target nodule, a Teflon sheath catheter with metal tip was inserted transbronchoscopically and was advanced into the visceral pleura. By monitoring CT fluoroscopy, the catheter tip was positioned at the nearest pleural surface of the nodule, and 0.5 mL indigo carmine was injected under deep inspiratory breathhold. CT scans were obtained to confirm the relationship between the injected dye area and the nodule. MEASUREMENTS AND RESULTS: The dye injections were performed completely in all 17 patients, who subsequently underwent lung resection guided by the dye staining. There were no complications or harmful effects of the surgery. The area of injected dye was demonstrated as a hazy focal lesion about 10 mm beneath the pleura on the high-resolution CT scan, and was clearly visible as a patchy dark blue area about 20 mm in size on the visceral pleura at surgery. The mean distance between the nodule and the dye was 20 mm on the CT scan (distance range, 0 to 30 mm). The mean examination time with this technique was approximately 35 min (range, 25 to 45 min). The mean CT fluoroscopic time was 60 s (range, 30 to 120 s). CONCLUSIONS: Our transbronchial "tattooing" technique is safe and reliable. We think it is superior to previous marking methods.

Adult↗
PubMed1975

Bronchial brushing through the flexible fiberoptic bronchoscope in the diagnosis of peripheral pulmonary lesions.

Bronchial brushing was performed concomitantly with transnasal flexible fiberoptic bronchoscopy in 44 patients with localized peripheral pulmonary lesions and absence of visible bronchial abnormality down to subsegmental level. Fluoroscopic confirmation of brush placement was obtained. A diagnosis of malignancy was made by bronchial brushing in 12 of 23 patients (52 percent) proved to have neoplasm, although diagnostic accuracy rose to six of seven patients (86 percent) in the final quarter of the study. There was no relationship between diagnostic accuracy and tumor location. Diagnostic accuracy was highest for squamous cell carcinoma, intermediate for adenocarcinoma, and lowest for undifferentiated carcinoma. A diagnosis of tuberculosis was made in two of 21 patients found not to have malignancy, and bronchial brushing was the only procedure to yield diagnostic material in these two patients. There were no false-positive cytologic examinations and no complications. Fluoroscopic control of placement of the bronchial brush passed through the fiberoptic bronchoscope allows a single, highyield, diagnostic procedure to be performed with minimal risk to the patient. In selected cases, thoracotomy may be avoided by this procedure.

Adenocarcinoma↗
PubMed1975

Differentiation between hydropneumothorax and destroyed lung by thoracoscopy with a fiberoptic bronchoscope.

In a 39-year-old man radiologic examination could not distinguish definitely between a hydropneumothorax and total destruction of one lung. Introduction of a fiberoptic bronchoscope through the opening for the chest drainage tube permitted direct inspection of the air space. A definite diagnosis of a destroyed lung was made, permitting appropriate modification of the treatment.

Adult↗
PubMed1975

Transbronchial lung biopsy via the fiberoptic bronchoscope. Experience with 107 consecutive cases and comparison with bronchial brushing.

Transbronchial lung biopsy (TBB) was performed during fiberoptic bronchoscopy under fluoroscopic guidance in 107 patients. TBB was diagnostic in 17 of 21 (81 percent) cases with localized malignant lesions greater than 4 cm in diameter and bronchial brushing was positive in 12 (57 percent). TBB was diagnostic in 14 of 24 (58 percent) cases with localized malignant lesions equal to or less than 4 cm in diameter, whereas brush biopsy was positive in 7 (29 percent). In 13 cases with suspected Pneumocystis carinii pneumonia, the combination of TBB and brush biopsy was diagnostic of P carinii pneumonia in all 11 patients; TBB was diagnostic in 10 and brush biopsy diagnostic in 5. Cytomegalovirus pneumonitis was diagnosed in the other two cases. In 20 patients with localized infiltrates or nodules, a TBB diagnosis of acute or chronic inflammation excluded malignancy in 15 of 18 cases (follow-up 3 to 24 months) and tuberculosis was diagnosed in 2. Malignancy was found in one patient with acute inflammation on TBB. TBB accurately diagnosed 23 of 29 (79 percent) cases of diffuse lung disease. Following TBB, one patient had pneumothorax and nine patients had hemoptysis not requiring treatment. TBB and bronchial brushing via the flexible fiberoptic bronchoscope offer good diagnostic accuracy and a low complication rate in both diffuse and localized lung diseases.

Adolescent↗
PubMed1977

Cryosurgery of bronchopulmonary structures. An approach to lesions inaccessible to the rigid bronchoscope.

Cryonecrosis of the upper lobe of the lung and bronchi was safely inudced in healthy dogs by application of the cryoprobe to serosal surfaces or, through a bronchotomy, to the mucosal surfaces under direct vision. Seven days after cryosurgery, hyperemia of the bronchus was seen. By 14 days the bronchus at the target site was covered with cuboidal epithelium. Reappearance of normal ciliated epithelium occurred by 180 days after cryosurgery. Cartilage remained intact, and there was no evidence of formation of a stricture or other gross alteration of bronchial architecture. In the lung there was coagulation necrosis; and by 14 days after cryosurgery, there was fibrosis in the target area. There were no complications of the pleural space. Cryosurgery of tissues at the margins of the bronchotomy does not impair healing. Cryosurgery may reduce the necessity for extensive surgery in selected patients with bronchopulmonary tumors, including those inaccessible to the rigid bronchoscope. Clinically, eight patients with recurrent bronchogenic tumors have received palliation by transbronchoscopic cryosurgery.

Animals↗
PubMed1981

Bronchoscopic biopsy and brushing with fluoroscopic guidance in nodular metastatic lung cancer.

Forty-five patients with endoscopically invisible metastatic cancer of the lung underwent flexible fiberoptic bronchoscopic examination under fluoroscopic guidance, with biopsy specimens and brushing being obtained. In all patients, the lesions were single or multiple nodules. A diagnostic specimen was obtained by biopsy or brushing (or both) in 53 percent, by biopsy alone in 47 percent, and by brushing alone in 6 percent. Brushings were diagnostic in three patients when the biopsy specimen was normal. Washings did not add to the overall diagnostic value of the procedure. In 36 patients, the lesions were 2 cm or greater, yielding diagnostic specimens in 23 patients (64 percent).

Adenocarcinoma↗
PubMed1983

Bronchoscopic therapy with neodymium-yttrium-aluminum-garnet laser during intravenous anesthesia. Effect on arterial blood gas levels, pH, hemoglobin saturation, and production of abnormal hemoglobin.

Photoresection with the neodymium-yttrium-aluminum-garnet (Nd-YAG) laser has been shown to be an effective bronchoscopic treatment for patients with obstructive lesions of the airway. We monitored levels of arterial blood gases, carbon monoxide, methemoglobin, and sulfmethemoglobin, and the hemoglobin oxygen saturation by ear oximeter in patients during intravenous anesthesia. The measurements were made after induction but before treatment with the Nd-YAG laser, during treatment, and immediately after treatment. Thirteen patients were entered into the study, ten of whom were used for statistical analysis. Partial arterial oxygen pressure decreased significantly during treatment (p less than 0.001). The alveolar-arterial oxygen pressure difference increased significantly during treatment (p less than 0.0025). The partial arterial carbon dioxide pressure increased significantly (p less than 0.005). The pH decreased significantly (p less than 0.02). No statistically significant change was found in the levels of carbon monoxide, methemoglobin, or sulfmethemoglobin. Comparison of arterial hemoglobin oxygen saturation and hemoglobin oxygen saturation by ear oximeter revealed no statistically significant difference in the two methods. During the procedure, careful attention must be given to the patient's oxygenation and ventilation. These variables can be monitored satisfactorily during general anesthesia by the use of an ear oximeter and end tidal carbon dioxide analyzer.

Adult↗
PubMed1985

Kaposi's sarcoma of the tracheobronchial tree. Clinical, bronchoscopic, and pathologic features.

Two homosexual men with disseminated Kaposi's sarcoma presented with paroxysms of a nonproductive cough probably related to the presence of tumor in the airways. At bronchoscopy, multiple, flat, brightly red to violaceous lesions were seen throughout the tracheobronchial tree. In both patients the bronchial biopsies were nondiagnostic, and one patient had excessive bleeding after the procedure. Autopsies confirmed the presence of Kaposi's sarcoma in the trachea and bronchi. The bronchoscopic appearance of Kaposi's sarcoma of the tracheobronchial tree is characteristic, and bronchial biopsy is probably unnecessary when the diagnosis of Kaposi's sarcoma has already been made by biopsy of more accessible lesions. Furthermore, bronchial biopsy may be hazardous because of excessive bleeding.

Adult↗
PubMed1985

Combined bronchoscopy and esophagoscopy using a flexible fiberoptic bronchoscope.

A method is described for the performance of combined bronchoscopy and esophagoscopy using a simple modification of the standard flexible fiberoptic bronchoscope. This technique allows safe, simple, and effective examination of the esophagus after the completion of bronchoscopy in patients in whom this examination is indicated.

Bronchoscopy↗
PubMed1985

Neodymium-YAG laser treatment of intrabronchial lesions. A new mapping technique via the flexible fiberoptic bronchoscope.

We report the results of the treatment of 45 patients (38 with malignant and seven with benign disease) with intrabronchial lesions using the neodymium-YAG laser via the flexible fiberoptic bronchoscope. Multiple treatment sessions were used with treatment intervals varying from four days to four weeks. Additional debridement procedures were also necessary in select cases. (There was total of 109 treatments in 45 patients). Over 70 percent (81 of 109) of all treatments were done without intubation and with sedation techniques, and topical lidocaine application similar to that used in standard fiberoptic bronchoscopy. Laser treatment of the less extensive segmental lesion resulted in very meaningful palliation and laser therapy need not be reserved for extensive central disease only. In our judgment, this can most safely be done with a "real time, intrabronchial mapping technique." The Mill Rose (W-22-13) transbronchial needle was used intraoperatively to perforate blind intrabronchial obstructions. Renografin (Ren-M-60 M) was then hand injected to locate and fluoroscopically visualize the postobstructive bronchial remnant. Precise laser penetration into the postobstructive remnant was then possible by following the same pathway. This technique greatly extended our ability to safely perforate segmental and even blind central obstructing lesions. In our judgment, without a "real time intrabronchial mapping technique," vascular and bronchial perforations would be more likely when treating the more distal lobar and segmental obstructions.

Aged↗
PubMed1988

Lidocaine concentrations in bronchoscopic specimens.

We measured lidocaine concentrations in bronchoscopic specimens and found that bronchoalveolar lavage (BAL) concentrations (16 +/- 7 micrograms/ml) were lower than those in bronchial washings (967 +/- 379 micrograms/ml [p less than 0.001]). Lidocaine concentrations in bronchial washings obtained "early" (991 +/- 505 micrograms/ml) compared with "late" (943 +/- 580 micrograms/ml) in the procedure did not differ (p = NS). High lidocaine concentrations sufficient to inhibit growth in culture of mycobacterial and fungal pathogens (greater than 5,000 micrograms/ml) occurred in one early and two late bronchial washings but no BAL specimens. No correlation between lidocaine dose and measured concentrations was noted in any specimen category; however, highest bronchial washing concentrations occurred with the use of greater than 250 mg of lidocaine. We conclude that BAL specimens are suitable for culturing pathogens that may be inhibited by lidocaine. Furthermore, collecting bronchial washings late in the procedure or limiting the lidocaine dosage do not reliably decrease measured lidocaine concentrations.

Bronchoalveolar Lavage Fluid↗
PubMed1991

Closure of a bronchopleural fistula with bronchoscopic instillation of tetracycline.

Persistent bronchopleural fistulas (BPF) due to infection, trauma, or thoracic surgical procedures are often difficult to manage. We report a patient with fulminant Staphylococcus aureus pneumonia complicated by chronic BPF formation which prevented weaning from mechanical ventilation due to severe air leak. Fistula closure was obtained by instillation of tetracycline into the fistula via a fiberoptic bronchoscope using a balloon catheter and blood clot occlusion technique. This closed the BPF and allowed successful weaning from mechanical ventilation.

Adolescent↗
PubMed1999

Bronchoscopic therapy for mucosa-associated lymphoid tissue lymphoma of the trachea.

The tracheal tumor of a 74-year-old female was detected on bronchoscopy and histologically diagnosed as mucosa-associated lymphoid tissue (MALT) lymphoma. We successfully treated the tumor with endoscopic neodyminum-yttruim-aluminium-garnet (Nd-YAG) laser photoresection followed by local ethanol injection. This is the first case in which tracheal MALT lymphoma was successfully treated with bronchoscopy. Bronchoscopic therapy seems to be one of the most valuable strategies for treatment of MALT lymphomas of the central airway.

Aged↗
PubMedDate not supplied

Primary diffuse tracheobronchial amyloidosis treated by bronchoscopic Nd-YAG laser irradiation.

A case of primary diffuse tracheobronchial amyloidosis in a 45-year-old woman is reported. Because of tracheal stenosis immediately beneath the vocal cords, due to amyloid deposits, she was treated with Nd-YAG laser irradiation. Immediately after treatment, symptoms such as cough, wheezing, and shortness of breath on exertion improved. Bronchoscopic Nd-YAG laser irradiation proved useful for the removal of amyloid deposits from the trachea in this patient.

Airway Obstruction↗
PubMed1996

Three-dimensional helical CT of the tracheobronchial tree: evaluation of imaging protocols and assessment of suspected stenoses with bronchoscopic correlation.

OBJECTIVE: To assess the accuracy of three-dimensional (3D) helical CT of normal airways, we evaluated different imaging protocols in test objects and patients. The clinical value of 3D helical CT was composed with bronchoscopy in patients with suspected stenoses, especially before and after endobronchial procedures. SUBJECTS AND METHODS: Solid test objects--one of central airways and one of peripheral airways--were scanned and assessed for volume defects and stairstep artifacts. Fifty helical studies were performed in 36 patients. We evaluated these images for visualization of segmental bronchi; frequency of artifacts; and presence, localization, and degree of stenoses. Bronchoscopic correlation was available for 40 CT examinations. Follow-up 3D helical CT after endobronchial procedures was performed in nine patients. RESULTS: In test objects, thin sections reduced volume artifacts. Overlapping sections mainly diminished stairstep artifacts. In vivo, overlapping sections were superior to contiguous sections for good visualization of the origin (96% versus 89%, p < .01) and of the course (75% versus 54%, p < .001) of segmental bronchi. Three-dimensional helical CT allowed us to assess accurately 36 of 36 central stenoses that were seen on bronchoscopy; however, on 3D helical CT, we missed two of three segmental stenoses. At bronchoscopy, 18 stenoses could not be passed, whereas 3D helical CT provided details for possible endobronchial procedures: length of stenosis, patency (12/18), and spatial orientation of distal bronchi. Follow-up 3D helical CT documented the efficacy of endobronchial treatment. CONCLUSION: Three-dimensional helical CT based on thin overlapping sections accurately visualized the normal airways down to the origin of the segmental bronchi and central stenoses. When it complements bronchoscopy, 3D helical CT allows visualization beyond stenoses, supports planning of endobronchial procedures, and may even substitute for bronchoscopy after endobronchial procedures.

Adult↗
PubMed2001

Clinical and microbiologic findings in dogs with bronchoscopically diagnosed tracheal collapse: 37 cases (1990-1995).

OBJECTIVE: To investigate the role of bacteria in bronchoscopically diagnosed tracheal collapse in dogs by evaluating qualitative results of bacteriologic cultures. DESIGN: Retrospective study. ANIMALS: 37 dogs with tracheal collapse. PROCEDURE: Clinical records for dogs with tracheal collapse confirmed with bronchoscopy were reviewed. A protected catheter brush was used to obtain samples for bacteriologic culture from the large airways. RESULTS: Results of bacterial culture were negative for 5 of 29 dogs. For 24 dogs, 1 (n = 10), 2 (6), or > or = 3 (8) species of bacteria were isolated. Pseudomonas spp were isolated most frequently (17/29), and a single Pseudomonas sp grew in 7 samples. Other bacteria included Enterobacter spp (4/29), Citrobacter spp (3/29), and Moraxella spp, Klebsiella spp, Bordetella spp, or Acinetobacter spp (2/29 dogs each). Anaerobic and aerobic cultures yielded positive results in samples from 2 dogs. Cytologic results were available for 13 dogs with positive results of bacteriologic culture; epithelial cells were reported most commonly. Five samples had a small number of neutrophils; bacteria were identified cytologically in 2 of 5 samples that contained neutrophils. Bacteria were also seen in 2 samples that lacked inflammatory cells. CONCLUSIONS AND CLINICAL RELEVANCE: Bacteria are commonly isolated from samples obtained via airway brushing in dogs with tracheal collapse; however, in the absence of cytologic confirmation of inflammation or infection, an association between bacteria and clinical signs of tracheal collapse cannot be established.

Animals↗
PubMed2005

Polypoid endobronchial lung cyst with bronchoscopic removal: a case report.

Pulmonary bronchogenic cyst in adults is rare and the typical appearance is a sharply circumscribed, round or oval nodule or mass, usually in the medial third of the lungs. Bronchial polyps are rare histopathologically distinct nonneoplastic endobronchial lesions and are classified as multiple papillomas, solitary papillomas, and inflammatory polyps. We herein report a patient with polypoid endobronchial lung cyst. A 68-yr-old woman presented with a discomfort and pain in the right upper chest of four weeks' duration. Chest radiography revealed a cystic lesion in the right upper lung. Computed tomography revealed a 4 x 5 cm sized large cyst. Neither enlarged mediastinal lymph nodes nor extrabronchial involvements were observed. Flexible bronchoscopy revealed a peduncular polyp about 2 cm in length originating from the anterior segment of right upper lung. After bronchoscopic removal of polyp, cystic lesion of the right upper lung disappeared.

Aged↗