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PubMed2002

CT virtual bronchoscopy of the central airways in patients with Wegener's granulomatosis.

OBJECTIVES: To compare CT virtual bronchoscopy (VB) to CT alone and to conventional bronchoscopy for evaluation of central airway stenoses in patients with Wegener's granulomatosis. DESIGN: Prospective observer study, in which 18 thin-section helical CT scans of the trachea and bronchi of 11 patients with Wegener's granulomatosis were obtained. VB was performed using surface rendering and was evaluated by one bronchoscopist and one radiologist in a blinded fashion. Bronchoscopic correlation within an average of 1.8 days of CT was available. MEASUREMENTS AND RESULTS: VB displayed 188 of 198 bronchi (95%). Thirty-two of 40 stenoses (80%) were detected by VB by at least one of two physicians (double reading), and 22 of 40 stenoses (55%) were detected by a third physician reading only the CT. CONCLUSIONS: VB depicts bronchi to the segmental level and detects the majority of central airway stenoses in patients with Wegener's granulomatosis. A team approach is useful to attain optimal clinical benefit from VB for these patients.

Adult↗
PubMed2002

Rigid bronchoscopy and stenting for esophageal cancer causing airway obstruction.

BACKGROUND: Thirty percent of patients with esophageal cancer have malignant involvement of the major airways, leading to respiratory distress and life-threatening major airway obstruction. Tracheobronchial stenting has been reported to be effective in providing sustained relief from obstruction. METHODS: We conducted a chart review of all patients with advanced inoperable esophageal cancer who had malignant tracheobronchial obstruction requiring rigid bronchoscopy and airway stenting at our institution between June 1998 and July 2001. Outcome measures, which included survival, efficacy, and complications, were recorded. RESULTS: There were 11 patients (4 women) with a mean age of 61 years. Five patients had distant metastases at the time they underwent rigid bronchoscopy. Four patients who required mechanical ventilation for respiratory failure were successfully weaned off mechanical ventilation after the stenting procedure. All patients with dyspnea had immediate relief of respiratory symptoms, which was sustained for seven patients (64%). The mean duration of survival was 61 days. Two patients required repeat procedures, one for stent dislodgment on extubation and the other for stent migration. CONCLUSION: Stenting in patients with malignant tracheobronchial obstructions due to advanced esophageal cancer achieves immediate, dramatic, and sustainable relief in respiratory symptoms, conferring a survival benefit in patients whose conditions are otherwise deemed to be terminal.

Aged↗
PubMed2002

Cigarette smoking, preinvasive bronchial lesions, and autofluorescence bronchoscopy.

STUDY OBJECTIVES: Autofluorescence bronchoscopy (AFB), when used as an adjunct to standard white light bronchoscopy (WLB), enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions. The current study was undertaken in order to define the population in which the rate of detection is higher using AFB. DESIGN AND PATIENTS: Two hundred forty-four consecutive patients, who were symptomatic smokers or patients who previously had been treated for lung cancer or head and neck cancers, underwent WLB and AFB. All patients with endoscopic abnormalities underwent biopsies. Data concerning smoking history were prospectively registered. RESULTS: We report the prevalence of high-grade or invasive lesions at the time of examination. On a lesion-by-lesion analysis, 92 low-grade lesions, 42 high-grade lesions (ie, moderate dysplasia, severe dysplasia, and carcinoma in situ), and 39 invasive carcinomas were diagnosed. There was no effect of age, gender, and age at smoking initiation on the prevalence of preinvasive or invasive lesions. The 10 patients who previously had undergone surgery for lung cancer and exhibited high-grade preinvasive lesions had a history of carcinoma of the epidermoid histologic type (p = 0.01). These 10 patients displayed multiple lesions in the bronchial tree (mean No. of lesions, 1.8 per patient). In current smokers, the prevalence of high-grade or invasive lesions were both related to the number of pack-years smoking had occurred (p = 0.01) and to the duration of smoking (p = 0.01). In contrast, the prevalence of preinvasive lesions in former smokers was related to a history of epidermoid carcinoma. CONCLUSIONS: AFB should be recommended in patients with a history of epidermoid carcinomas of the lung. Current smokers with a prolonged smoking history appear to comprise a population in which the rate of detection of preneoplastic lesions is high with AFB.

Adult↗
PubMed2003

Comparative evaluation of super high-resolution CT scan and virtual bronchoscopy for the detection of tracheobronchial malignancies.

OBJECTIVES: Novel imaging modalities are currently available for the noninvasive evaluation of the tracheobronchial tree. This study was undertaken to compare the diagnostic potentials of conventional CT scanning, super high-resolution CT (SHR-CT) scanning, and virtual bronchoscopy (VB) directly with fiberoptic bronchoscopy (FB) for the detection of tracheobronchial neoplasms. DESIGN: Prospective observer study, in which 44 consecutive patients with thoracic malignancies were evaluated using several diagnostic imaging modalities. Images of the thorax were interpreted by individuals blind to the results of FB for the detection of endoluminal, obstructive, or mucosal lesions. MEASUREMENTS AND RESULTS: Image acquisition and simulation of the tracheobronchial anatomy were created successfully in all patients. Thirty-two patients who underwent both SHR-CT scanning and VB had correlative FBs within 1 month. In all nine patients who had a normal anatomy, SHR-CT scanning and VB accurately correlated with the FB findings. However, CT scanning demonstrated two false-positive obstructive lesions in one patient. Twenty-three patients had a total of 35 abnormal FB findings. The sensitivities of SHR-CT scanning and VB for the detection of endoluminal, obstructive, and mucosal lesions were 90%, 100%, and 16%, respectively. The overall sensitivities and specificities of SHR-CT scanning and VB were 83% and 100%, respectively. In contrast, CT scanning had sensitivities of 50%, 72%, and 0% for the detection of endoluminal, obstructive, and mucosal lesions with an overall sensitivity and specificity of 59%, and 85%, respectively. There was no case in which conventional CT scanning was better at detecting lesions than either SHR-CT scanning or VB. CONCLUSIONS: SHR-CT scanning and VB are accurate, noninvasive methods for identifying obstructions and endoluminal lesions within the respiratory tract. Thus, these novel imaging techniques are valuable as complementary modalities to FB, providing information that is useful for the detection and management of airway malignancies.

Adult↗
PubMed2004

Bronchoscope reprocessing and infection prevention and control: bronchoscopy-specific guidelines are needed.

BACKGROUND: It has been recommended that bronchoscopists familiarize themselves with national recommendations for bronchoscope reprocessing practices, but the extent of guideline awareness is unclear. METHODS: We distributed a survey to practicing bronchoscopists at two meetings. Questions addressed infection control issues related to bronchoscopy and specific reprocessing recommendations. RESULTS: A total of 46 surveys were completed by medical directors of bronchoscopy suites (26%) and attending bronchoscopists (74%) who had graduated from medical school a median of 22 years ago and performed a median of 19 procedures per month. Sixty-five percent of respondents, including 55% of directors, were not familiar with national reprocessing recommendations, and 39% did not know the approach to reprocessing at their own institution. Respondents who did > 20 procedures per month trended toward being more likely to be aware of guidelines (54% vs 26%, p = 0.09) and were less likely to answer "do not know" to more than one question about specific reprocessing details (25% vs 70%, p = 0.003). Seventy-eight percent of respondents did not know local practices for at least one of the reprocessing details. Forty-six percent of respondents stated their institutions followed recommendations that records be kept of the specific bronchoscope used in each case. CONCLUSIONS: Many experienced bronchoscopists are unfamiliar with national guidelines and local practices related to bronchoscope reprocessing. Publication of bronchoscope-specific, comprehensive reprocessing guidelines in the pulmonary literature may help increase familiarity with this crucial process.

Bronchoscopes↗
PubMed2004

Interventional bronchoscopy in the management of airway stenosis due to tracheobronchial tuberculosis.

STUDY OBJECTIVES: To assess the efficacy and complications of interventional bronchoscopic techniques in treating airway stenosis due to tracheobronchial tuberculosis. DESIGN: Case series. SETTING: Respiratory care centers at two tertiary care referral teaching hospitals in Japan, Hiroshima City Hospital and Okayama Red Cross Hospital. PATIENTS AND INTERVENTIONS: A total of 30 patients were admitted to the hospital with a diagnosis of tracheobronchial tuberculosis between January 1991 and January 2002. Of those 11 patients received interventional bronchoscopy, including stent placement, laser photoresection, argon plasma coagulation (APC), balloon dilatation, cryotherapy, and endobronchial ultrasonography (EBUS). One patient with complete bronchial obstruction underwent a left pneumonectomy. RESULTS: Six patients underwent stent placement after balloon dilatation, while the remaining five patients underwent only balloon dilatation. In six patients, Dumon stents were successfully placed to reestablish the patency of the central airways. Two patients first had Ultraflex stents implanted but had problems with granulation tissue formation and stent deterioration caused by metal fatigue due to chronic coughing. Dumon stents then were placed within the Ultraflex stents after the patient had received treatment with APC and mechanical reaming using the bevel of a rigid bronchoscope. In four patients, EBUS images demonstrated the destruction of bronchial cartilage or the thickening of the bronchial wall. The main complications of Dumon stents are migration and granulation tissue formation, necessitating stent removal, or replacement, and the application of cryotherapy to the granuloma at the edge of the stent. CONCLUSION: Interventional bronchoscopy should be considered feasible for management of tuberculous tracheobronchial stenosis. Dumon stents seem to be appropriate, since removal or replacement is always possible. Ultraflex stents should not be used in these circumstances because removal is difficult and their long-term safety is uncertain. EBUS could provide useful information in evaluating the condition of the airway wall in cases of tracheobronchial tuberculosis with potential for bronchoscopic intervention.

Bronchi↗
PubMed2005

Visceral pleural perforation in two cases of ultrathin bronchoscopy.

Recently, ultrathin bronchoscopes with a thinner external diameter, greater visual range, improved visibility, and a larger working channel have been developed. The utility of a 2.8-mm diameter ultrathin bronchoscope in diagnosing peripheral pulmonary nodules has been reported by some authors. While the feasibility of approaching peripheral pulmonary lesions is attractive, peculiar complications that have not been experienced with standard bronchoscopy may occur. We report two cases in which pneumothoraces occurred because their visceral pleuras were perforated with an ultrathin bronchoscope during the procedure. The peculiar mechanism of pneumothorax in relation to ultrathin bronchoscopy is discussed.

Aged↗
PubMed2005

Alkaptonuria diagnosed by flexible bronchoscopy.

A 68-year-old white man was evaluated for failure to wean from mechanical ventilation after cardiac surgery. Bronchoscopy performed prior to percutaneous dilatational tracheotomy revealed circumferential strikingly dark-colored airways, most prominent in the trachea and mainstem bronchi, extending distally into all airways with overlying desiccated black secretions. Histologic examination of bronchial mucosal biopsy samples and the desiccated secretions showed acute bronchitis and necrotic debris, respectively. This finding and the patient's history led to testing for plasma homogentisic acid, which was found to be elevated at 12.6 mug/mL, establishing the first diagnosis of alkaptonuria made using flexible bronchoscopy.

Aged↗
PubMed2006

Cavitating invasive pulmonary aspergillosis visualized and diagnosed by ultrathin bronchoscopy.

A definitive diagnosis of invasive pulmonary aspergillosis (IPA), which usually occurs in immunocompromised patients, is often difficult. We report two cases of cavitating IPA in a peripheral pulmonary region in patients who were receiving corticosteroids, in whom the cavity was successfully visualized and sampled during ultrathin bronchoscopy. Ultrathin bronchoscopy provides a new option for definitive diagnosis of cavitating IPA.

Aged↗
PubMed1982

Effects on respiratory patterns during bronchoscopy by the Sanders attachment technique.

The purpose of this study was to rationalize the choice of injector and bronchoscope sizes during bronchoscopy under general anesthesia using the Sanders attachment technique. Arterial Po2 and Pco2, FIo2, and peak inspiratory pressure at the tip of the bronchoscope were plotted against the ratio (RI/B) of the internal diameters of the injector and the bronchoscope in seven dogs undergoing bronchoscopy under general anesthesia. Peak inspiratory pressure, FIo2, and PaO2, increased, and PaCO2 decreased with an increase in RI/B. A working table is proposed to predict the optimal RI/B.

Anesthesia, General↗
PubMed1983

Lung cancer cell type as a determinant of bronchoscopy yield.

The accuracy of diagnosis of lung cancer obtained by fiberoptic bronchoscopy utilizing sputum cytology and bronchial biopsy depends on the size, location, and number of biopsy samples taken from the tumor. We have found that the accuracy of diagnosis also depends upon the histologic type of cancer. Fiberoptic bronchoscopy (brushings, washing, and biopsies) was performed and sputum cytology and bronchial tissue was obtained from 51 patients with histologically-proven lung cancer. The bronchial biopsy was more sensitive than the bronchial washing and brushing techniques in detecting primary bronchogenic and metastatic carcinoma. It was positive in ten of ten patients with small cell carcinoma, 12 out of 20 cases of squamous cell carcinoma, three of four cases of adenocarcinoma, and three of four patients with large cell cancer. The bronchial biopsy yield was influenced by the histologic cell type with the highest diagnostic yield being found with small cell carcinoma.

Adenocarcinoma↗
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

Fiberoptic bronchoscopy in the evaluation of lung abscesses.

To define the results of flexible fiberoptic bronchoscopy (FFB) in patients with lung abscess and to characterize those patients most likely to have an underlying carcinoma, we retrospectively studied the records of 52 consecutive patients undergoing FFB at our institution between 1975 and 1982. Nineteen patients (36.5 percent) had an associated bronchogenic carcinoma (group 1); 33 (63.5 percent) had no malignancy (group 2). The FFB aided in diagnosing 73.7 percent of group 1 patients, but added no information in group 2 patients. Group 1 and 2 patients differed significantly with respect to prevalence of systemic symptoms (15.8 percent vs 51.5 percent, p less than 0.01); predisposition to aspiration pneumonia (26.3 percent vs 60.6 percent, p less than 0.01); mean presenting white blood cell count (10.9 vs 14.2, p less than 0.05); mean oral temperature at presentation (37.5 vs 38.3 degrees C, p less than 0.05); and the prevalence of extensive infiltrates on the initial chest roentgenogram (17.0 percent vs 83.6 percent, p less than 0.05). Based on these data, we believe that by carefully considering the available clinical information, it is possible to identify those patients whose lung abscesses are likely to be related to bronchogenic carcinoma. Such individuals should be promptly evaluated. It is not necessary, however, to routinely order bronchoscopy for all patients with lung abscess.

Adult↗
PubMed1989

Bronchoscopy to evaluate hemoptysis in older men with nonsuspicious chest roentgenograms.

Six of 106 older men with hemoptysis and a nonsuspicious chest roentgenogram who underwent fiberoptic bronchoscopy were found to have cancer. Four of the five bronchogenic carcinomas appeared to be surgically resectable. Cancer patients were significantly older, had smoked within the last five years, and had a significantly higher frequency of central abnormalities on chest roentgenogram. Six additional bronchogenic carcinomas were diagnosed at follow-up. Two of these were probably present but not detected at the time of bronchoscopy. We conclude that (1) hemoptysis with a nonsuspicious chest roentgenogram carries an appreciable risk of cancer in older men with substantial smoking histories, (2) these cancers are often resectable, (3) a chest roentgenogram in which the central lung fields are obscured in any way should not be considered negative in patients with hemoptysis, and (4) a negative bronchoscopic examination does not exclude the possibility of cancer in these patients.

Aged↗
PubMed1989

Rapid mucosal absorption of topical lidocaine during bronchoscopy in the presence of oral candidiasis.

Local anesthetic agents are topically applied during diagnostic procedures such as bronchoscopy. These routine procedures are associated with only rare reports of drug toxicity or extensive systemic drug absorption. We report a case of rapid systemic absorption and elevated plasma lidocaine concentrations following a fiberoptic bronchoscopy procedure in a man with oral candidiasis and lung cancer.

Absorption↗
PubMed1990

Diagnostic fiberoptic bronchoscopy and protected brush culture in patients with community-acquired pneumonia.

A model for performing fiberoptic bronchoscopy as a supplement to noninvasive diagnostic methods, in patients with community-acquired pneumonia, was prospectively studied. Twenty-four patients underwent bronchoscopy, seven pilot patients and 17 of 277 (6 percent) consecutive patients with CAP. Indications for FOB were early therapy failure (less than or equal to 72h)(n = 7), late therapy failure (greater than 72h)(n = 11), or before start of antibiotic therapy in severely ill or immunocompromised patients (n = 6). Samples were obtained by aspiration of bronchial secretion and with a protected brush catheter from which quantitative cultures with a detection level of 10(4) colony forming units per ml were performed. Results concluded that FOB, with the use of quantitative PB-cultures, offered a safe and specific diagnostic tool, which on special indications, can be of great value in the management of patients with CAP.

Adolescent↗
PubMed1990

Bronchoscopy specimens in adults with AIDS. Comparative yields of cytology, histology and culture for diagnosis of infectious agents.

Bronchoscopy specimens from 183 known/suspected acquired immunodeficiency syndrome patients were evaluated for pathogens. In each case, transbronchial biopsies were evaluated and bronchoalveolar lavage material was cultured for viruses, fungi and mycobacteria and examined cytologically. A specimen was considered positive for a pathogen if detected by any one of the methods (TBB or BALC or culture). BALC was more sensitive for Pneumocystis carinii than TBB (90 of 92 vs 67 of 80 cases). TBB and BALC had poor sensitivities for cytomegalovirus detection (six of 79 and ten of 91 cases, respectively): 80 of 91 CMV cases were detected by culture only. Nineteen of 26 MB cases were positive by culture only: BALC and TBB detected only three of 26 and five of 23 cases, respectively. Three cryptococcosis cases were detected by culture only. One coccidioidomycosis case was positive by BALC and culture. Culture and BALC in combination detected 212 of 216 all significant pathogens. We believe that TBB is not routinely necessary in AIDS-related bronchoscopies in the absence of suspicion of neoplasia.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Diagnosis of tracheal injury in mechanically ventilated premature infants by flexible bronchoscopy. A pilot study.

Flexible bronchoscopy (FB) is uniquely suited for the study of large airway lesions in the ventilated premature infant. However, no standardized clinical scoring system of distal tracheal injury exists and the adverse consequences of FB in ventilated premature infants are not well described. Using a prototype Olympus fiberoptic ultrathin bronchoscope with a directable tip and an outer diameter of 2.2 mm, we serially scored distal tracheal injury in conventionally ventilated premature infants on the basis of mucosal and obstructive changes observed at bronchoscopy. In addition, we prospectively evaluated the incidence of adverse cardiovascular and pulmonary effects during, immediately after, and within 1 h of FB. We performed 21 FBs in eight conventionally ventilated premature infants with birth weight of 1,239 +/- 438 g and gestational age of 30 +/- 3 weeks. The carina and mainstem bronchi were easily visualized in all infants using the prototype bronchoscope. During the first several days of life, moderate-to-severe distal tracheal mucosal injury occurred frequently, while moderate-to-severe obstructive injury occurred infrequently. Distal mucosal injury appeared to improve during the fourth week of life. Mild distal obstructive injury began to appear during the second week of life. Adverse consequences of FB observed in our patient population included transient hypoxemia and bradycardia during FB, changes in systolic blood pressure immediately and within 1 h after FB, and emesis immediately after FB. Serious adverse cardiovascular or pulmonary effects were not observed. We conclude that FB can be performed safely with appropriate monitoring and is a useful tool in the clinical assessment and serial evaluation of distal tracheal injury in ventilated premature infants. We speculate that moderate-to-severe distal tracheal mucosal injury may be associated with the development of later obstructive injury. On the basis of this preliminary study, further prospective investigations of tracheal injury in ventilated premature infants appear to be warranted.

Blood Pressure↗