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PubMed1983

Effect of bronchoscopy on localization of gallium-67 citrate.

Bronchoscopy, bronchoalveolar lavage (BAL), and 67Ga lung scans are frequently performed for diagnosis or follow-up of patients with sarcoidosis, interstitial pneumonitis, lymphoma, infections, and bronchogenic carcinoma. Because many patients undergo all 3 of these procedures, it is important to determine what effects bronchoscopy and/or BAL may have on gallium imaging. Because 67Ga accumulates in neutrophils at the site of an inflammatory lesion as well as in those circulating in the vascular compartment, it seems reasonable to postulate that bronchoscopy could cause migration of labeled neutrophils into the lung, resulting in false positive gallium scans. To test this hypothesis, we studied 5 patients with varying chronologic relationships of 67Ga injection, gallium scanning, and bronchoscopy with BAL. In all patients, the repeat 67Ga lung scans remained normal or showed no change after bronchoscopy and BAL. We conclude that bronchoscopy with or without BAL does not cause increased 67Ga uptake by the lung.

Adult↗

PubMed2002

Endobronchial ultrasound in therapeutic bronchoscopy.

Endobronchial ultrasound (EBUS) has been introduced as an adjunct to diagnostic bronchoscopy as it allows evaluation of the submucosal and parabronchial structures. Its use in therapeutic bronchoscopy has not been assessed. A large observational study of the value of EBUS in therapeutic bronchoscopy is presented here. From January 1998-January 2001 all patients undergoing therapeutic bronchoscopy and EBUS were evaluated prospectively. Patient demographics, indication for bronchoscopy, interventional treatments used and changes in therapy as influenced by the use of EBUS were documented. A total 2,446 therapeutic bronchoscopies were performed. In 1,174 cases EBUS was used (29% mechanical tumour debridement, 20% airway stenting, 13% Neodymium:yttrium aluminium garnet (Nd:YAG) laser use, 23% argon plasma coagulation, 11% brachytherapy, 2% foreign body removal and 2% endoscopic abscess drainage). EBUS guided or changed therapy significantly in 43% of cases. Changes included adjustment of stent dimensions, termination of tumour debridement when nearing vessels, and referral for surgical interventions rather than endoscopic treatment. Complications associated with EBUS use were minimal. No patient undergoing EBUS guided tumour destruction experienced severe bleeding or fistula formation. In summary, endobronchial ultrasound was easily performed and changed or guided therapeutic decisions during therapeutic bronchoscopic procedures in a substantial number of cases. As this may result in better outcomes, it has become a standard adjunct in the authors practice.

Adult↗

PubMed2003

Is preparation for bronchoscopy optimal?

The results of a questionnaire survey, of the current preparation for and practice of diagnostic bronchoscopy in England and Wales, are reported in this paper. The British Thoracic Society (BTS) has recently published guidelines on bronchoscopy and these provide a consensus statement on the current evidence base. There is no specific guidance on drugs or techniques, although it is recommended that all patients should be offered sedation, except where there are contraindications. In the present survey, there was a response rate of 76%, (344 responses to 452 questionnaires) and the median number of bronchoscopies performed per session was 5 (interquartile range 4-6). Most operators use lignocaine gel to the nose (65%), spray to the throat (70%), followed by the "spray as you go" method (84%), recommended by the BTS. Atropine is routinely used by 13% contrary to the guidelines and despite concerns about its side-effects. Most operators use sedation with midazolam (85%) or a wide variety of combinations of sedative, analgesic, and anaesthetic agents (27%), and 27% perform unsedated bronchoscopies, with only 0.1% routinely performing unsedated bronchoscopies. A total 251 (77%) responders stated they assessed adequacy of sedation, with most using patient observation alone (149 (46%)). Only three operators assessed sedation using a formal sedation score. Thus, most centres routinely perform sedated bronchoscopies and the systematic level of monitoring is poor. The current controversies about sedation and safe sedation practice are discussed. There is a need for more evidence to allow more specific guidance to be produced in this difficult area.

Adult↗

PubMed1998

Comparison of three-dimensional virtual endoscopy with bronchoscopy in patients with oesophageal carcinoma infiltrating the tracheobronchial tree.

Virtual endoscopy (VE) is a technique for performing simulated bronchoscopy using helical CT data of the tracheobronchial tree. In order to evaluate a virtual three-dimensional (3D) endoluminal procedure for the tracheobronchial tree, comparison was made between bronchoscopy, axial CT images and minimal intensity projections (MIP). 21 patients were referred for helical CT because of oesophageal carcinoma shown by bronchoscopy to infiltrate into the trachea or bronchi. Axial CT images obtained on a helical scanner were transferred to a Sparc20 workstation. VE was compared with the axial CT images and the MIP concerning additional information on the location and degree of stenosis gained after 3D reconstruction of the inner surface of the tracheobronchial tree. The accuracy of this VE system was compared with bronchoscopy. Follow-up was performed in two patients to evaluate the tracheobronchial system after stent implantation. All stenoses were identified by VE with no statistically significant difference in detection of location or grading of the stenosis to real time bronchoscopy. Passage of subtotal stenosis was only possible with VE. VE is suitable for following up stent implantation. Submucosal lesions of the tracheobronchial tree could not be detected by VE. There was no statistically significant difference regarding the location of the stenoses between VE, axial CT slices, MIP and bronchoscopy. The VE showed only a statistically significant difference with regard to the degree of stenosis which was underrated on axial CT slices and MIPs. Pitfalls including mucus plugs and wall defects due to the wrong threshold value were a limitation of VE. VE is presently too time-consuming to use in every patient with an infiltrating tumour into the tracheobronchial tree. In conclusion, while VE cannot replace endoscopy of the tracheobronchial tree or the oesophagus, it is an accurate and non-invasive method for identifying endoluminal tumours, grading stenoses and visualizing the tracheobronchial tree beyond stenoses in a small number of patients who are not amenable to endoscopy.

Aged↗

PubMed2000

Serum lidocaine concentrations in asthmatics undergoing research bronchoscopy.

STUDY OBJECTIVES: To determine how often serum lidocaine concentrations (SLC) fall into the potentially toxic range (> 5 mg/L) in asthmatics undergoing research bronchoscopy, and to determine whether subject or procedure characteristics are associated with higher SLC. DESIGN: Prospective, observational study. SETTING: Academic research center. PARTICIPANTS: Fifty-one volunteers with mild to moderate asthma enrolled in three separate bronchoscopy protocols to study airway inflammation in asthma. INTERVENTIONS: Lidocaine was administered topically to the upper airway and tracheobronchial tree to achieve local anesthesia for bronchoscopy. Venous blood was sampled during bronchoscopy, 30 min after upper airway anesthesia was completed (time 1), and 30 min after bronchoscopy was completed (time 2). MEASUREMENTS AND RESULTS: The mean total amount of lidocaine administered was 600 +/- 122 mg (8.2 +/- 2.0 mg/kg). No signs or symptoms of lidocaine toxicity were observed in any of the subjects. SLC ranged between 0.10 and 2.90 mg/L at time 1 and 0.50 and 3.20 mg/L at time 2. SLC was significantly correlated with the total amount of lidocaine (milligrams/kilogram) administered at both points (time 1, r = 0.33, p = 0.021; time 2, r = 0.33, p = 0.023). No statistically significant relationship was observed between SLC and subject age, sex, weight, baseline FEV(1), procedure length, or study protocol. No statistically significant relationship was found between subject FEV(1) and either total lidocaine dose or procedure length. CONCLUSIONS: An average total dose of 600 mg (8.2 mg/kg) of lidocaine appears to be safe in mild to moderate asthmatics undergoing research bronchoscopy.

Academic Medical Centers↗

PubMed2000

Three-dimensional CT-guided bronchoscopy with a real-time electromagnetic position sensor: a comparison of two image registration methods.

STUDY OBJECTIVES: To compare two different image registration methods for accurately displaying the position of a flexible bronchoscope on a previously acquired three-dimensional CT scan during bronchoscopy. SETTING: Bronchoscopy suite of a university hospital. PATIENTS: Fifteen adult patients scheduled for nonemergent bronchoscopy. METHODS: A miniature electromagnetic position sensor was placed at the tip of a flexible bronchoscope. Previously acquired three-dimensional CT scans were registered with the patient in the bronchoscopy suite. Registration method 1 used multiple skin fiducial markers. Registration method 2 used the inner surface of the trachea itself for registration. Method 1 was objectively assessed by measuring the error distance between the real skin marker position and the computer display position. Methods 1 and 2 were subjectively assessed by the bronchoscopist correlating visual bronchoscopic anatomic location with the computer display position on the CT image. RESULTS: The error distance (+/- SD) from known points for registration method 1 was 5.6 +/- 2.7 mm. Objective error distances were not measured for method 2 because no accurate placement of the bronchoscope sensor could be correlated with CT position. Subjectively, method 2 was judged more accurate than method 1 when compared with the fiberoptic view of the airways through the bronchoscope. Additionally, method 2 had the advantage of not requiring placement of fiducial markers before the CT scan. Respiratory motion contributed an error of 3.6 +/- 2.6 mm, which was partially compensated for by a second tracking sensor placed on the patient's chest. CONCLUSION: Image registration method 2 of surface fitting the trachea rather than method 1 of fiducial markers was subjectively judged to be superior for registering the position of a flexible bronchoscope during bronchoscopy. Method 2 was also more practical inasmuch as no special CT scanning technique was required before bronchoscopy.

Biopsy↗

PubMed2001

Plastic bronchitis and the role of bronchoscopy in the acute chest syndrome of sickle cell disease.

STUDY OBJECTIVES: To review the prevalence, clinical features, and role of bronchoscopy in patients with plastic bronchitis during the acute chest syndrome (ACS) of sickle cell disease (SCD). DESIGN: Eight-year review of clinical experience. SETTING: Tertiary referral children's hospital. PATIENTS: Twenty-six pediatric inpatients with 29 ACS episodes requiring diagnostic bronchoscopy. RESULTS: Of the pediatric inpatients with ACS who underwent bronchoscopy, plastic bronchitis was diagnosed in 21 of 29 episodes (72%). There was no difference in clinical features between the patients with and without plastic bronchitis. Bronchoscopy was an essential diagnostic tool, but its therapeutic benefits were doubtful. CONCLUSIONS: This is the first report of the prevalence of plastic bronchitis in patients with ACS of SCD. In our patient population, this condition was found to be common. The role of diagnostic bronchoscopy is essential. A large series, multicenter study is required to determine whether bronchoscopy and BAL are therapeutically beneficial when added to currently practiced supportive care.

Acute Disease↗

PubMed2001

Virtual reality bronchoscopy simulation: a revolution in procedural training.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models. CONCLUSION: A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.

Bronchoscopy↗

PubMed2002

An outbreak of bronchoscopy-related Mycobacterium tuberculosis infections due to lack of bronchoscope leak testing.

BACKGROUND: Bronchoscopy-related transmission of Mycobacterium tuberculosis is rarely reported. In August 1999, five M tuberculosis-positive bronchial washing culture findings were noted in patients who underwent bronchoscopy in July in a hospital that reported only eight M tuberculosis-positive culture findings from 1995 to 1998, prompting further investigation. METHODS: A case was defined as a M tuberculosis-positive culture finding from specimens obtained from patients who underwent bronchoscopy during January to August of 1999. Bronchoscopy and laboratory records, procedures, and practices were reviewed. M tuberculosis isolates were compared using restriction fragment length polymorphism (RFLP) analysis. RESULTS: During July 1999, 19 bronchoscopic procedures were performed in 19 patients. Bronchial washing specimens for mycobacterial culture were obtained from 18 patients. Ten cases were identified. Two case patients, including the index patient, had signs and symptoms of active tuberculosis prior to bronchoscopy. M tuberculosis infections developed in two more case patients despite starting a standard four-drug antituberculous regimen within 3 weeks after bronchoscopy. Six case patients had positive culture findings but no evidence of infection. All M tuberculosis isolates were antituberculosis-drug susceptible, and all but one were indistinguishable by RFLP analysis. Three bronchoscopes were used during the outbreak period; one bronchoscope was used in 9 of the 10 case patients (relative risk, 8.1; 95% confidence interval, 1.3 to 52). A hole was discovered in the sheath of this bronchoscope. Leak testing, a critical step in bronchoscope reprocessing, was not routinely performed at this institution. CONCLUSIONS: M tuberculosis contamination of the bronchoscope occurred during the index patient's procedure. The hole in the sheath provided access to a space that was difficult to mechanically clean and chemically disinfect. The reprocessing recommendations of bronchoscope manufacturers, including leak testing after each use, should be closely followed.

Adult↗

PubMed2004

Safety and efficacy of ketamine sedation for infant flexible fiberoptic bronchoscopy.

OBJECTIVE: To describe our experience with ketamine sedation during infant flexible fiberoptic bronchoscopy. DESIGN: Retrospective chart review. Infants were sedated with midazolam and ketamine with or without fentanyl. The sedation regimen, final procedure performed, procedure duration, and complications were recorded. Complication rates between infants 6 months of age and between infants with upper vs lower airway symptoms were compared by chi(2) test with a contingency table. RESULTS: Fifty-nine procedures were performed in 55 patients aged 6.1 +/- 3.1 months (mean +/- SD). Sedation was achieved with ketamine and midazolam (n = 30) or ketamine, midazolam, and fentanyl (n = 29). Bronchoscopy with BAL was performed in 44 patients and bronchoscopy alone in 3 patients. In 11 patients, severe upper airway obstruction and/or anomalies prevented subglottic passage of the bronchoscope. One patient could not be adequately sedated. There were no major complications. Minor complications occurred in 14 patients (23.7%), most commonly mild hypoxemia (n = 9). Brief central apnea developed in three patients. Complication rates were unaffected by age or indication for bronchoscopy. CONCLUSIONS: Infant flexible fiberoptic bronchoscopy can be safely and effectively performed using ketamine sedation. Complications, especially mild hypoxemia, appear more common in infants, likely due to smaller airway diameter. Regardless of the sedative(s) used, additional vigilance is required when performing bronchoscopy in this population.

Anesthetics, Dissociative↗

PubMed2006

The safety of bronchoscopy in a pulmonary fellowship program.

STUDY OBJECTIVE: To determine the complication rate from supervised training bronchoscopy in a single pulmonary fellowship program, and to examine the effects of fellow and faculty experience on this complication rate. DESIGN: A retrospective review of preexisting quality improvement data from one center for the time period July 1, 1991, until June 30, 2005, was performed. The data were stratified based on the fellow year group and the staff experience level. The types of complications were recorded. SETTING: The study was performed at an accredited pulmonary and critical care fellowship program at a military medical center in the United States. PARTICIPANTS: Fifty-one pulmonary and critical care medicine fellows and 20 staff supervising physicians performed the bronchoscopies that were included in this study. RESULTS: A total of 3,538 training bronchoscopies were performed during the study period with 73 complications for a complication rate of 2.06%. The most common complication was pneumothorax. The overall complication rates for first-year fellows (1stYFs), second-year fellows, and third-year fellows were not significantly different from the total complication rate. Training bronchoscopies supervised by junior staff had a complication rate not significantly different from that of senior staff. The cumulative complication rate for the first trimester for 1stYFs was 3.1%, whereas the cumulative complication rate for the second plus the third trimester for 1stYFs was 1.57% (p < 0.05). CONCLUSIONS: Training bronchoscopy performed during a pulmonary fellowship is a safe procedure in a supervised setting. Patients undergoing bronchoscopy performed by novice bronchoscopists have an increased complication rate during the first trimester of bronchoscopist training.

Bronchoscopy↗

PubMed1977

Fiberoptic bronchoscopy and culture bacteria from the lower respiratory.

Forty-five specimens were obtained by sequential translaryngeal aspiration and fiberoptic bronchoscopy from 31 clinically unifected patients with lung cancer in order to evaluate the reliability of routine fiberoptic bronchoscopy for culture of the lower respiratory tract. Bacteria were recovered brom 98 percent (44) of the specimens obtained via fiberoptic bronchoscopy and from 58 percent (26) of the specimens obtained by the preceding translaryngeal aspiration. The microorganisms grown from cultures of specimens obtained by fiberoptic bronchoscopy consisted of mixtures of both nonpathogenic and potenitally pathogenic bacteria. Potentially pathogenic bacteria were present in 87 percent (39) of the specimens from fiberoptic bronchoscopy and 31 percent (14) of specimens from translayngeal aspiration. The results of cultures from the two procedures agreed completely in only a single instance. Culture of washings or secretions obtained by routine fiberoptic bronchoscopy is not recommended because it provides inaccurate and clinically confusing information about the presence or types of bacteria in the lower respiratory tract prior to instrumentation.

Aged↗

PubMed1989

Bronchoscopy in the diagnosis of pulmonary histoplasmosis.

Although histoplasmosis is the most common fungal infection of the lungs in the United States, there are no reports evaluating the efficacy of fiberoptic bronchoscopy in the diagnosis of this disease. We reviewed all cases of histoplasmosis diagnosed at our institution from 1972 to 1987. Of 469 patients, 71 underwent fiberoptic bronchoscopy and had culture/histologic proof of histoplasmosis established by fiberoptic bronchoscopy or other means. A diagnosis of pulmonary histoplasmosis could be made without thoracotomy in only 27. Among those not requiring thoracotomy, diagnosis of pulmonary histoplasmosis was confirmed by fiberoptic bronchoscopy and cultures of sputum, gastric washings, blood, bone marrow, and urine. In this subgroup, fiberoptic bronchoscopy was the only positive diagnostic method in eight of 27 patients. We conclude that fiberoptic bronchoscopy is a useful adjunct to other noninvasive measures yielding diagnostic material in most cases, except for solitary pulmonary nodule where it is rarely helpful.

Adolescent↗

PubMed1991

Bronchoscopy with bronchoalveolar lavage in tuberculosis and fungal infections.

STUDY OBJECTIVE: To determine the utility of bronchoscopy with bronchoalveolar lavage for diagnosing M tuberculosis and fungal infections. DESIGN: Retrospective review of patients over a six-year period. SETTING: In- and outpatients of one University hospital and affiliated Veterans Administration Medical Center. PATIENTS: Those who were subsequently found to have either M tuberculosis or fungal infections. INTERVENTIONS: Bronchoscopy with bronchoalveolar lavage specimens were compared to prebronchoscopy sputum, when available. Specimens were sent for smear and culture for both acid-fast bacilli and fungi. In the case of lavage, an aliquot also was studied for cellular differential. MEASUREMENTS AND RESULTS: For TB, sputum was smear-positive in 6/47 (34 percent) and culture positive in 24/47 (51 percent), while bronchoscopy was smear positive in 34/50 (68 percent) and culture positive in 46/50 (92 percent). For fungal infections, no sputum was smear-positive and only 1/22 (5 percent) was sputum culture-positive, while bronchoscopy was smear-positive in 14/41 (34 percent) and culture positive in 35/41 (85 percent). Bronchoscopy washings and BAL provided complementary specimens. Eighty-three patients had adequate lavages and the cellularity was significantly different from controls (lymphocytes: TB 18 +/- 11.2 percent [mean +/- SD]; fungal: 13 +/- 11.1 percent; controls 6 +/- 3.1 percent; p less than 0.001; neutrophils: TB 9 +/- 11.5 percent; fungal: 6 +/- 9.1 percent controls: 2 +/- 1.5 percent, p less than 0.01); however, there was overlap and no pattern was characteristic for TB or fungal infections. CONCLUSION: Bronchoscopy with BAL is useful in diagnosing tuberculosis and fungal infections.

Bronchoalveolar Lavage Fluid↗

PubMed1987

Comparison of CT and fiberoptic bronchoscopy in the evaluation of bronchial disease.

CT was compared to fiberoptic bronchoscopy in a large series of patients to study the value of CT for visualizing bronchial disease. CT scans were available for review in 64 cases in which focal airway disease was identified with fiberoptic bronchoscopy and in 38 patients in whom the airways appeared normal at bronchoscopy. CT was positive in 59 of 64 cases in which lesions were detected endoscopically. If the results are analyzed according to the extent of involvement of individual bronchi, CT successfully identified 88 (90%) of 98 lesions. CT correctly excluded disease in 35 (92%) of 38 cases that were subsequently verified to be normal by fiberoptic bronchoscopy. In no case was the diagnosis of malignancy missed by CT. While extremely accurate in detecting focal lesions, CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal, or extrinsic (peribronchial). In three cases CT failed to detect submucosal extension into the left mainstream bronchus, which has important implications concerning the value of CT in staging bronchial malignancy. It is concluded that CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in selected cases when there is low clinical suspicion of endobronchial disease and as a complementary procedure to fiberoptic bronchoscopy for outlining the exact location of major mediastinal and hilar vessels, lymph nodes, and tumor in relation to adjacent airways.

Bronchial Diseases↗

PubMed2002

Multidetector CT virtual bronchoscopy to grade tracheobronchial stenosis.

OBJECTIVE: The purpose of this study was to compare the efficacy of noninvasive multidetector CT (virtual bronchoscopic images, axial CT slices, coronal reformatted images, and sagittal reformatted images) in depicting and allowing accurate grading of tracheobronchial stenosis with that of flexible bronchoscopy. MATERIALS AND METHODS: Multidetector CT and flexible bronchoscopy were used to examine 200 bronchial sections obtained from 20 patients (15 patients with bronchial carcinoma and five without central airways disease). Multidetector CT was performed using the following parameters: collimation, 4 x 2 mm, pitch, 1.375; and reconstruction intervals, 2 mm. Postprocessing was performed using surface rendering and multiplanar reformatted images. CT images were independently interpreted by two radiologists. The tracheobronchial stenoses revealed on flexible bronchoscopy were graded by a pulmonologist. RESULTS: Virtual bronchoscopic findings, axial CT scans, and multiplanar reformatted images were highly accurate (98% accuracy for virtual bronchoscopic images, 96% for axial slices and coronal reformatted images, and 96.5% for sagittal reformatted images) in revealing tracheobronchial stenosis. In allowing accurate grading of tracheobronchial stenosis, images from virtual bronchoscopy correlated closely (r = 0.91) with those of flexible bronchoscopy. Because use of virtual bronchoscopic images reduced the overestimation of stenosis, these images allowed better assessment of stenosis than did axial CT slices (r = 0.84) or multiplanar reformatted images (r = 0.84) alone. CONCLUSION: Multidetector CT virtual bronchoscopy is a reliable noninvasive method that allows accurate grading of tracheobronchial stenosis. However, it should be combined with the interpretation of axial CT images and multiplanar reformatted images for evaluation of surrounding structures and optimal spatial orientation.

Adult↗

PubMed2001

[Pediatric fiberoptic bronchoscopy. Analysis of a decade].

OBJECTIVE: To review the contribution of new advances in flexible bronchoscopy to the management of respiratory problems in children. METHODS: Over a 10-year-period, 536 flexible bronchoscopies were performed under sedation and local anesthesia in 433 children aged from 5 days to 14 years. Data on symptomatology, underlying diseases, indications, sedation, instrumentation, findings and complications were prospectively collected and stored in a database for later analysis. RESULTS: Underlying disease was found in 300 children (69.3 %). The most common indications for flexible bronchoscopy were persistent atelectasis (n 166), stridor (n 134), tuberculosis (n 66), suspected foreign body (n 61), persistent wheezing (n 55), middle lobe syndrome (n 47) and opportunistic pneumonias (n 41). In 178 patients the procedures were performed on an outpatient basis. One hundred forty-seven bronchoalveolar lavages, 10 bronchial biopsies, and 8 selective bronchographies were performed. Airway anomalies were found in 447 procedures (83.4 %) and 32 pathogenic organisms were identified. In 13 patients cytological study of the samples obtained guided the diagnosis of noninfectious lung disease. Therapeutic interventions were performed in 54 (10.1 %) flexible bronchoscopies. The most important of these were aspiration of bronchial secretions (n 31), removal of foreign bodies (n 6), selective intubation (n 5), and balloon dilatation of bronchial stenosis (n 2). The procedure was diagnostically or therapeutically useful in 391 procedures (79.2 %). CONCLUSION: Although rigid bronchoscopy is currently the procedure of choice in most therapeutic interventions, flexible bronchoscopy is very useful in improving airway exploration and understanding of respiratory disorders in children.

Adolescent↗

PubMedDate not supplied

[Evaluation of tracheobronchial lesions with spiral CT: comparison between virtual endoscopy and bronchoscopy].

INTRODUCTION: The aim of this study is to describe the scanning parameters for virtual bronchoscopy in the evaluation of the tracheobronchial tree and to compare the results of this examination with the endoscopic findings. MATERIAL AND METHODS: 27 patients with tracheobronchial neoplasms suspected at preliminary clinical and chest film findings or postoperative follow-up for malignant disease were evaluated with spiral CT of the chest and bronchoscopy. Virtual endoscopy was performed on the pulmonary volume involved by the lesion, using narrow axial images (thickness 2 mm, table index 3 mm, reconstruction index 1 mm.) so as to obtain MPR, MIP and 3D reconstructions with 3D Endo Vew program (Philips Medical System, Eindhoven, Holland). We compared these reconstructions and the findings the normal spiral CT scanning with the corresponding endoscopic examinations. RESULTS: In all patients we were able to study the lobar and segmental bronchi in all patients and in 2 we also evaluated the subsegmental bronchi. 25 lesions in 23 patients were shown by virtual endoscopy (8 occlusions, 8 stenosis, 5 compressions, 3 flogosis with endobronchial mucus, 1 bronchocele) and in 4 patients the examinations were negative. The bronchoscopy was negative in 4 patients and positive in 23 patients with 25 lesions, but we had agreement in 23/27 patients (85,1%). In 2 patients virtual endoscopy showed the lesions in a different bronchus compared to bronchoscopy. In one patient we interpreted the obstruction as neoplastic instead of mucus inside the bronchi and in the last patient bronchoscopy was not performed due to his old age and the virtual endoscopy showed total obstruction of a segmental bronchus. DISCUSSION AND CONCLUSIONS: The results show that virtual endoscopy can study the tracheobronchial tree as far as the segmental bronchi, and sometimes also the subsegmental bronchi and the bronchi below a closed obstruction. In addition, it can evaluate the extraluminal location of the lesions. For these reasons virtual endoscopy provides a road map for bronchoscopy as a guide for transbronchial biopsy and for endobronchial treatment planning. The limitation of this technique is its inability to evaluate the mucosal surface and distinguish flogosis from neoplastic lesions by biopsy. It can be used however in the postoperative follow-up both for cancer and transplant, when immediate biopsy is not necessary.

Adenocarcinoma↗