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PubMed1985

Sensitivity, specificity, and predictive values of bronchoscopy in neoplasm metastatic to lung.

Bronchoscopic examination to diagnose lung metastases has not been as rewarding as in primary lung cancer. Despite a lower expected yield, we believe the procedure has value in certain patients, ie, those with clinical findings of endobronchial disease. To determine better the value of bronchoscopy in this population, we retrospectively reviewed records of patients at five community teaching hospitals over a 66-month period. These patients all underwent fiberoptic bronchoscopy. They had a history of prior nonpulmonary malignancy and an abnormal chest roentgenogram suspicious for recurrent malignant disease, or they presented with abnormal chest roentgenographic findings and further evaluation showed the lung disease to be metastatic. Bronchoscopy for metastatic lung disease was most likely diagnostic in patients with primary colorectal cancer (79 percent) and breast cancer (57 percent), and least likely in patients with genitourinary tract cancer (33 percent). Hemoptysis, signs of local airway obstruction, or a roentgenogram showing either atelectasis or diffuse lung disease especially favored a positive biopsy. Bronchoscopy is a valuable diagnostic procedure in selected patients with metastatic lung disease.

Adolescent↗

PubMed2005

Therapeutic flexible bronchoscopy in child with cystic fibrosis.

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 findings:by aspiration of tracheo-bronchal truncus it was found hyperemia and a lot of mucous sticky secretion inside of tracheobronchal tree, especially middle lobe right side, lingual and basals part of the lungs. It was performed broncho-alveolar lavage and given steroids on the place of changed inflamed mucous membrane of the bronchi. It was also given pulmozyme to destroid mucous and make better spontaneously expectorations. Control chest x ray was performed and it was better.

Bronchoalveolar Lavage↗

PubMed1998

Virtual bronchoscopy in children: early clinical experience.

OBJECTIVE: Virtual bronchoscopy is a new noninvasive technique that provides an internal view of the tracheobronchial tree. The purpose of our study was to assess the role of this technique as compared with fiberoptic bronchoscopy in the evaluation of suspected compression or narrowing of the trachea and main bronchi in children. CONCLUSION: Preliminary results suggest that virtual bronchoscopy may have a useful complementary role to fiberoptic bronchoscopy in evaluation of the tracheobronchial tree of children.

Adolescent↗

PubMed1989

Fiberoptic bronchoscopy for diagnosis of opportunistic pulmonary infections after bone marrow transplantation.

As a part of the diagnostic procedure for 16 suspected pulmonary infections in 15 marrow transplant recipients fiberoptic bronchoscopy with bronchoalveolar lavage (BAL), transbronchial lung biopsy (TBB) and brushing were performed. Cytomegalovirus (CMV) was the most common microorganism and CMV pneumonia was diagnosed in 8/16 (50%) episodes of pulmonary disease studied. Pneumonias were diagnosed as caused by Candida or Aspergillus species in 6 episodes and by gram-positive cocci in 2 cases. Adenovirus and Pneumocystis carinii was also isolated in 1 patient each. Three noninfectious diseases (pulmonary oedema, idiopathic pneumonia and pulmonary embolism) were diagnosed by methods other than bronchoscopy. The use of fiberoptic bronchoscopy with BAL and TBB allowed correct identification of 14/18 microorganisms involved. Brushing was less useful. Four patients' pneumonias had a multiple etiology. The bronchoscopy methods used were well tolerated even by patients whose condition was poor.

Adult↗

PubMed1997

[Application of rigid bronchoscopy in airway management after lobectomy of lung].

OBJECTIVE: Application of rigid bronchoscopy in airway management after lobectomy of lung was recommended, and its significance was discussed. METHODS: Bronchoscopies were performed in three patients scheduled for lobectomy of lung undergoing epidural plus general anesthesia. Each patient was examined two times. The first examination was done after anesthetic induction and intubation. The second was given at the end of operation. RESULTS: Rigid bronchoscopy under general anesthesia could clearly show the inner structures of trachea, bronchi and location of carcinoma. Under direct version, the secretion and sludged blood in the trachea and bronchi after lobectomy could be scavenged. CONCLUSION: It was suggested that with the use of bronchoscopy the complications including postoperative atelectasis and bronchial-pleural fistulization could be reduced.

Adult↗

PubMed1999

A new hybrid renderer for virtual bronchoscopy.

PURPOSE: To improve the diagnosis of pathologic modified airways, a new hybrid visualization system has been developed and tested based on digital image analysis and synthesis of spiral CT as well as the visual simulation of bronchoscopy. METHOD/MATERIALS: 20 patients with pathologic modifications of the airways (tumors, lung transplantation) were examined with Spiral-CT. The shape of the airways and the lung tissue is defined by an automatic volume growing method and a following geometric reconstruction by the computation of geometric primitives. This is the basis of a multidimensional display system which visualizes volumes, surfaces and computation results simultaneously. The enable the intuitive and immersive inspection of the airways a virtual reality system, consisting of two graphic engines, a head mounted display system, data gloves and specialized software was integrated. RESULTS: In 20 cases the extension of the pathologic modification of the airways could be visualized with the virtual bronchoscopy. The user interacts with and manipulates the 3D model of the airways in an intuitive and immersive way. In contrast to previously proposed virtual bronchoscopy systems the described method permits truly interactive navigation, detailed quantitation of anatomic structures and a "see through" the bronchial wall. The system enables a user oriented and fast inspection of the volumetric image data. CONCLUSIONS: To support radiological diagnosis with additional information a virtual bronchoscopy was developed. It enables the immersive and intuitive interaction with 3D Spiral CTs by truly 3D navigation in the airways. The system was tested with 20 Spiral-CTs of bronchial tumors and obstructions and is well suited for the inspection of structures beyond the bronchialtree.

Algorithms↗

PubMed2000

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

PURPOSE: 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. MATERIAL AND METHODS: 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). RESULTS: 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%). CONCLUSION: 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.

Bronchoscopy↗

PubMed1999

[Fiberoptic bronchoscopy in diagnosis and treatment of inhalation injury].

OBJECTIVE: To explore the morphological standard of diagnosing inhalation injury, the feasibility of early diagnosis and the topical therapy of inhalation injury through fiberoptic bronchoscopy. METHODS: In one hundred and forty four patients with inhalation injury that were admitted in 10 years were examined with bronchoscopy, and the results were analysed. RESULTS: Diagnostic criteria and classification were obtained with the aid of the bronchoscopy. It was found feasible to make early diagnosis within 8 h and also to exercise treatments in the form of suction, irrigation, etc. CONCLUSION: Bronchoscopy plays an important role in the early diagnosis and treatment of inhalation injury, and it should be used more extensively in patients suspected to have inhalation injury.

Adolescent↗

PubMed2001

Laser bronchoscopy.

Because the lung cancer epidemic shows no signs of abating, little doubt exists that the need for interventional bronchoscopists will persist for many years to come. The Nd:YAG laser and the rigid bronchoscope remain crucial weapons in the fight against lung cancer. With more than 4000 published interventions pertaining to it, this combination is ideal for treating central airways obstruction. The safety and efficacy of laser bronchoscopy has been well established, and the reported incidence of complications is impressively low. If complications were to arise, a skilled bronchoscopist can manage them easily by using the beneficial attributes of the rigid bronchoscope. Many complications can be avoided by implementing the established safety procedures and techniques. A solid understanding of laser physics and tissue interactions is a necessity to anyone performing laser surgery. The team approach, relying on communication among the bronchoscopist, anesthesiologist, laser technician, and nurses, leads to a safer and more successful procedure. It is important to remember, however, that this is typically a palliative procedure, and therefore the focus should be on alleviating symptoms and improving quality of life. Unfortunately, because not every patient is a candidate for laser bronchoscopy, there are specific characteristics of endobronchial lesions that make them more or less amenable to resection. Each year a promising new technology is being developed, such as argon plasma coagulation, cryotherapy, and endobronchial electrosurgery. Although it is unclear what role these technologies will have, prospective controlled studies must be done to help clarify this question. The future may lay in combining these various technologies along with Nd:YAG laser bronchoscopy to maximize the therapeutic, palliative, and possibly even curative effect. As the experience of the medical community with Nd:YAG laser bronchoscopy continues to grow and as more health-care professionals are made aware of its therapeutic capability, fewer patients with cancer will need to suffer and die from the complications of airway obstruction.

Anesthesia↗

PubMed2001

[CT virtual bronchoscopy in the diagnosis of central lung cancer].

OBJECTIVE: To evaluate the clinical application of CT virtual bronchoscopy(VB) in the diagnosis of centrally located lung cancer. METHODS: Forty-five cases confirmed by fiberoptic bronchoscopy and pathology underwent volume scanning using spiral CT (HiSpeed Advantage CT/i. GE Medical Systems, U.S.A). The patients examined included 33 with central lung cancer, 8 with post-operative residual bronchial stumps, 2 with post-radiotherapy lung cancer, and 2 with tracheal carcinoma. Data were transferred to computer workstation (GE Advantage Windows 3.1) and CT virtual bronchoscopic (CTVB) images with pseudocolor encoding were generated using Navigator Smooth soft-ware. RESULTS: CTVB could reveal 100% segmental bronchus and 80% subsegmental bronchus simulating fiberoptic bronchoscopy. The tumors appeared as masses or nodules, causing bronchial wall thickening and occlusions. Post-operative residual bronchial stumps showed smooth end without recurrence of tumors or appeared as nodular protrusion if tumor recurred. The post-radiotherapy bronchial wall was uneven and there was narrowing of bronchial lumen. CONCLUSION: CTVB is a noninvasive method of observing the airway. It stimulates the images observed under fiberoptic bronchoscopy and com be used partly in lieu of it. Associated with multiplanar reformat, CTVB can demonstrate extraluminal invasion of the tumor. The limitations of CTVB are that it is not possible to observe mucosal abnormalities and perform biopsy.

Adult↗

PubMedDate not supplied

Bronchoscopy and anesthesia for preschool-aged patients: a review of 228 cases.

Pediatric bronchoscopy is a complicated, high-risk procedure. From May 2000 to May 2002, we performed bronchoscopy in 228 preschool-aged children (newborn to 6 years old) under general anesthesia with a Storz-Hopkins rigid pediatric bronchoscope. The final diagnosis and complications during anesthesia were recorded. The most common findings from bronchoscopic examination were subglottic stenosis (or granuloma) (67, 29.4%), laryngomalacia (64, 28.1%), tracheal stenosis (or malacia) (29, 12.7%), pneumonia (23, 10.1%), and atelectasis (16, 7.0%). The main complications during anesthesia were arrhythmias, oxygen desaturation, and CO2 retention (high end-tidal CO2). The most serious complication was pneumothorax in one patient. Either endotracheal intubation or tracheostomy was required in 61% of the patients in this series to secure a patent airway after bronchoscopy. Bronchoscopy is necessary as a diagnostic and therapeutic tool for certain airway diseases or anomalies in pediatric patients. It requires cooperation between the endoscopist and anesthesiologist to insure the patient's safety.

Anesthesia, General↗

PubMed2003

Local experience in paediatric flexible bronchoscopy.

All children who underwent flexible bronchoscopy in the respiratory unit at Paediatric Institute, Hospital Kuala Lumpur from June 1997 to June 2002 were reviewed. A hundred and ten children underwent the procedure under sedation or general anaesthesia. The median age of these children was eight months. (Q1 3, Q3 30) The commonest indication for performing flexible bronchoscopy was for chronic stridor (50 cases) followed by persistent or recurrent changes such as lung infiltrates, atelectasis and consolidation on the chest radiographs (22). Laryngomalacia was found to be the commonest cause of stridor in 29 children. Two patients were diagnosed with pulmonary tuberculosis. With regard to safety, three procedures were abandoned due to recurrent desaturation below 85%. One of these patients had severe laryngospasm that required ventilation for 48 hours but recovered fully. Two neonates developed pneumonia requiring antibiotics following bronchoscopy. No patients developed pneumothorax or bleeding following the procedure. Bronchoscopy is a safe procedure when performed by well-trained personnel. Since it is an invasive procedure the benefits must outweigh the risks before it is performed.

Bronchoscopy↗

PubMed2004

Flexible fiberoptic bronchoscopy. Diagnostic yield.

OBJECTIVE: Fiberoptic bronchoscopy is a minimally invasive procedure with a high diagnostic yield. The aim of this study was to document the usefulness of the procedure in the diagnosis of various respiratory disorders in a Middle East country. METHODS: Data on all bronchoscopies carried out in Chest Diseases Hospital, Kuwait from January 1996 to December 1998 were retrospectively collected. RESULTS: Out of 968 cases, only 620 (64%) patients had a full follow up. Suspected pulmonary tuberculosis (TB) (51.6%), unresolving pneumonia (16.1%), hemoptysis with a normal chest radiograph (8.4%), lung mass (7.7%) and hilar lymphadenopathy (3.2%) were the most common indications. Eleven percent of patients who underwent bronchoscopy had a normal chest radiograph, the reason being hemoptysis in 75.4%, inhalation injury in 21.8% and suspected upper airway obstruction in 2.9%. In smear negative suspected TB cases, 22.5% proved to have active disease. Acid fast bacillus was identified in bronchoalveolar lavage, either by smear or culture, in 44 (73.3%) patients with suspected pulmonary TB and in 6 (54.5%) patients with miliary shadows. An underlying cause was identified in 28 (28%) patients with unresolving pneumonia. Ninety-four percent of cases with clinical impression of bronchogenic carcinoma could be diagnosed. Transbronchial biopsy was diagnostic in 79% patients with diffuse parenchymal lung disease. No complications other than transient hypoxemia and controllable bleeding were noticed. CONCLUSION: Generally, the indications for flexible fiberoptic bronchoscopy remained similar to elsewhere. Unlike western series, the majority of the cases were for the diagnosis of pulmonary infections especially TB.

Adult↗

PubMed1992

Fibreoptic bronchoscopy and bronchoalveolar lavage in the investigation of the immunocompromised lung.

The records of 18 immunocompromised patients with recent onset of pulmonary disease who had fibreoptic bronchoscopy and bronchoalveolar lavage over a two year period (1989-90) were reviewed. The underlying diseases were human immunodeficiency virus (HIV) infection (n = 7), organ transplantation (n = 9), and chemotherapy for malignancy (n = 2). Four patients were receiving prophylactic therapy and 12 had been started on empirical therapy for infection. Patients proceeded to bronchoscopy either because of atypical disease presentation or failure to respond to empirical therapy. Bronchoscopy with bronchoalveolar lavage was diagnostic in 13/18 (72%) patients and provided clinically useful information in 16/18 (89%). There was one diagnostic failure (6%); Pneumocystis carinii pneumonia in an HIV positive patient receiving nebulised pentamidine prophylaxis was missed. Transbronchial biopsies were not routinely performed and provided additional diagnostic information in only 1/6 (17%) patients. Overall, the commonest diagnoses were Pneumocystis carinii pneumonia (61%) and cytomegalovirus pneumonitis (28%). There were no complications of the procedures. In this highly selected setting of diagnostic or therapeutic uncertainty, fibreoptic bronchoscopy with bronchoalveolar lavage remains an effective and safe technique for evaluating pulmonary disease in immunocompromised patients.

Adult↗

PubMedDate not supplied

[Bronchoscopy in thoracic trauma].

Thoracic trauma often bears difficult problems of diagnosis and treatment. This paper reports 87 procedures on 20 severe thoracic injured patients, who have also suffered multiple injuries, to whom was performed bronchoscopy. These cases were regarding gender, age, traumatic cause, associated injuries and dynamic endo-bronchial aspect. There are detailed technique used in bronchoscopy and bronchoscopic suction, additional diagnostic procedures, technical tips, incidents and are also reported close and follow up results in these cases. We discuss indications of bronchoscopy and broncho-aspiration in thoracic trauma from diagnostic and treatment point of view. Conclusions underline major role of bronchoscopy in the management of severe thoracic trauma.

Adolescent↗

PubMed2006

[Children's bronchoscopy and bronchoalveolar lavage on endogenic foreign body in bronchus].

OBJECTIVE: To investigate the clinical effect of Children's bronchoscopy and bronchoalveolar lavage on endogenic foreign body in bronchus. METHOD: (1) Three hundred and thirty-seven cases had bronchoscopy and bronchoalveolar lavage whose chest X-ray diagnoses were bronchopneumonia with one or two lobe emphysema and/or pulmonary atelectasis, in which 22 cases had severe pneumonia with heart failure and respiratory failure. All cases had no history of foreign bodies' inhalation and become more dyspnea after a three-day treatment of antibiotics. Three hundreds and thirty one cases of bronchoalveolar lavages were divided into two groups randomly using saline or azythromycin, saline group had 126 cases (aged 0 approximately 10 years, mean age, 3 years ); azithromycin group had 211 cases(aged 0 approximately 8 years, mean age, 3.1 years). RESULT: There were 331 cases of endotracheal endogenous purulent emboli, 126 cases in left lung, 178 in right, and 27 cases in both sides. Judging from nature of emboli, 305 cases were mucus, 4 cases were milk valve, 22 cases were white membrane of plastic bronchitis. In azithromycin group, 172 cases (81.2%) were cured, 39 cases (18. 8%) showed effective, the total effective rate was 100 percent. In saline group, 96 cases were cured, 24 cases showed effective, the total effective rate was 100 percent. There wasn't statistically significant between two groups in total effective rate. The average hospitalization time had a statistical significance between saline group (11 days) and azithromycin group (6 days). Two cases of complication of pneumothorax happened in operation. They recovered through closed drainage of thoracic cavity and 3 cases dead. CONCLUSION: Bronchoscopy and bronchoalveolar lavage could shorten the course of endogenic foreign body in bronchus; especially it has significance to those cases of respiratory path obstruction with heart and respiratory failure. Plastic bronchitis could be determined by bronchoscopy and a pathologic histologic examination thereafter.

Bronchi↗

PubMed2006

[Diagnosis of the laryngeal or tracheobronchial lesions by fiberoptic bronchoscopy for anesthesiologists].

Flexible fiberoptic endoscopic equipment is a useful visualization aid for diagnosis of laryngeal or tracheobronchial lesions and for intubation in patients with difficult airway. It also determines double-lumen tube position. In an intensive care unit, fiberoptic bronchoscopy is the cornerstone of the causal diagnosis in acute respiratory failure and laryngo-tracheobronchial trauma. However, for many anesthesiologists, its use tends to be limited to fiberoptic intubation and anesthetic management of thoracic surgery. Therefore, this review focuses on diagnostic strategies of laryngeal or tracheobronchial lesions by fiberoptic bronchoscopy for anesthesiologists. It also refers to the equipment and the strategy in performing fiberoptic bronchoscopy for anesthesiologist. We anesthesiologists need to attain proficiency in diagnostic skill in fiberoptic bronchoscopy as specialists of airway managent in acute settings as well as the operating room.

Bronchial Diseases↗

PubMed1991

Fibreoptic bronchoscopy--a Malaysian experience.

Two hundred and ninety-three bronchoscopies were done for 285 patients (78% males, 22% females) at Hospital University Sains Malaysia between 1984 and 1988. The mean age was 56.4 years (range 13 to 90 years). 70.2% of patients underwent bronchoscopies to confirm or exclude the diagnosis of carcinoma of the bronchus, out of which 58% were confirmed to have bronchial carcinoma. 77% of the 98 patients with visible endobronchial tumours had biopsy specimens diagnostic of malignancy. Brushing and washing cytology increased the positive yield to 92%. The commonest histological type of bronchial carcinoma identified was squamous cell carcinoma (48.1%), followed by small cell carcinoma (27.1%), anaplastic/undifferentiated carcinoma (12.9%), adenocarcinoma (9.4%) and large cell carcinoma (2.4%). Bronchoscopy for the investigation of haemoptysis identified the commonest cause as 'bronchitis'. There were no complications noted in our series. Notable differences of our experience compared to that of the western series were the high percentage of bronchoscopy done for infective respiratory disorders and the younger age of our patients.

Adolescent↗