Shigehisa Kajikawa

Real-time endobronchial ultrasound-guided transbronchial needle aspiration is useful for diagnosing sarcoidosis.

Background and objective:  Several studies of real‐time endobronchial ultrasound (EBUS)‐guided transbronchial needle aspiration (TBNA) have reported a sensitivity of approximately 90% in the diagnosis of mediastinal and hilar malignancies. However, few studies have addressed its role in the diagnosis of sarcoidosis. The aim of the present study was to assess the utility of EBUS‐TBNA in confirming a pathological diagnosis of sarcoidosis.

Novel thin bronchoscope with a 1.7-mm working channel for peripheral pulmonary lesions

In the present study, the authors evaluated the diagnostic utility of a novel thin bronchoscope with a 1.7-mm working channel for peripheral pulmonary lesions. A total of 118 patients were included in this prospective study. Bronchoscopic examination was performed using a 5.9-mm standard bronchoscope. If no visible endobronchial lesion was found, transbronchial biopsies were performed with 1.5-mm biopsy forceps under fluoroscopic guidance and the bronchus were washed with 10–20 mL of saline solution, using a prototype 3.5-mm thin bronchoscope with a 1.7-mm working channel. Endobronchial lesion was visualised with the standard bronchoscope in 16 patients, and the other 102 patients underwent biopsies with the thin bronchoscope. The mean bronchus levels reached with the standard bronchoscope and the thin bronchoscope were 2.3 and 4.3 generations, respectively. Endobronchial abnormality was revealed with the thin bronchoscope in a further 14 patients. Diagnostic material was obtained in 50 of 68 (74%) patients with malignant disease and 18 of 30 (60%) patients with benign disease. Four patients did not return to follow-up. The diagnostic yield was 57%, even in lesions <20 mm. There were no major complications. In conclusion, bronchoscopy using a 3.5-mm thin bronchoscope with a 1.7-mm working channel is useful and safe for the diagnosis of peripheral pulmonary lesions.

Endobronchial Ultrasound-Guided Transbronchial Biopsy Using Novel Thin Bronchoscope for Diagnosis of Peripheral Pulmonary Lesions

Background: The aim of this study was to evaluate the diagnostic utility of endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) using a novel 3.4-mm thin bronchoscope and a 1.4-mm ultrasonic probe for peripheral pulmonary lesions. Methods: A total of 86 patients with suspected peripheral lesions were included in this prospective study. EBUS-TBBs were performed using a prototype 3.4-mm thin bronchoscope and a 1.4-mm radial ultrasonic probe under fluoroscopic guidance. Results: Twelve patients with endobronchial lesions within the segmental bronchi and three patients who did not return to follow-up were excluded from this analysis. Thus, a total of 71 patients with peripheral pulmonary lesions (mean size, 31.2 ± 12.7 mm) were included in the final analysis. The mean bronchus level reached with the thin bronchoscope was 4.6 generations. Diagnostic histologic specimens were obtained in 49 of 71 patients (69%:80% for malignant lesions and 52% for benign lesions). A definitive diagnosis of malignancy for lesions ≥20 mm and lesions <20 mm was made in 82% (31 of 38) and 67% (four of six), respectively. There were no significant complications. Conclusion: The EBUS-TBB using a 3.4-mm thin bronchoscope and a 1.4-mm radial probe is feasible, accurate, and safe for the diagnosis of peripheral pulmonary lesions.

Double Y-Stent Placement for Tracheobronchial Stenosis

The silicone stent has been widely used to re-establish airway patency for patients with airway stenosis. The ideal shape of the stent should be well adapted to the tracheobronchial anatomic structures, and its optimal length should cover the entire inner wall of the stenotic airway. Although the silicone Y-stent was developed as a dedicated prosthesis for main carinal stenosis, we often encounter patients with tracheobronchial stenosis that cannot be treated by a single silicone Y-stent. The present study reports 2 cases of malignant disease who underwent double Y-stent placement on the involved carina between the right upper lobe bronchus and the bronchus intermedius as well as on the involved main carina as a unit. The procedure provided successful palliation.

Disseminated cryptococcosis presenting as mediastinal and hilar lymphadenopathy in an immunocompetent patient

We herein report a rare case of disseminated cryptococcosis presenting as mediastinal and hilar lymphadenopathy in a young immunocompetent man. A previously healthy 26‐year‐old man presented with persistent headache and nonproductive cough. Chest computed tomography indicated mediastinal and hilar lymphadenopathy. Cryptococcal lymphadenitis and meningitis was confirmed by endobronchial ultrasound‐guided transbronchial needle aspiration and central spinal fluid examination, respectively. He received liposomal amphotericin B and flucytosine followed by fluconazole and finally improved.

A Case of Bronchial Asthma Complicated by Epidural Emphysema

are caused by trauma or iatrogenic interventions, and to the best of our knowledge, only 17 cases associated with bronchial asthma have been reported in the literature up to February 2012. The mechanism by which this condition is considered to develop is the exfoliation of transudative air in the posterior mediastinum space due to high bronchoalveolar pressure, and the subsequent invasion of the epidural space. Epidural emphysema rarely causes neurological symptoms and improves spontaneously with conservative treatment in most cases [1, 2] . A 22-year-old man with an asthma attack was transported by ambulance to our emergency room. He had a past history of asthma but had not received a medical examination regularly. He complained of severe dyspnea, coughing and upper chest pain for several days. On admission, he showed severe hypoxia requiring supplemental oxygen at a rate of 6 liters/min, but no neurological symptoms. Chest computed tomography (CT) showed pneumomediastinum and radiolucent space in the spinal canal suggesting epidural emphysema ( fig. 1 ). He received conservative treatment for bronchial asthma including a corticosteroid and bronchodilator for 3 days, whereupon his symptoms improved. The follow-up CT 7 days later revealed that the air in the epidural space and mediastinum had disappeared. Epidural emphysema, which shows the presence of air in the spinal epidural space, is a rare entity. Most cases Published online: May 23, 2012

Pleomorphic Adenoma of the Trachea

Pleomorphic adenoma is a common neoplasm of salivary glands, but its occurrence in the trachea is very rare [1] . Tracheal tumors, including tracheal pleomorphic adenoma, often cause obstructive symptoms such as dyspnea and wheezing mimicking asthma, leading to delay in diagnosis [2] . Because of the rarity, consensus with regard to clinical behavior, management or prognosis is A 55-year-old man with a tracheal tumor was referred to our institution for bronchoscopic diagnosis and treatment. He had a 2-year history of dyspnea with wheezing, and was given a diagnosis of asthma by his family doctor. His symptoms were not alleviated by treatment for asthma so he was referred to another hospital for further evaluation. A chest CT revealed a polypoid tumor narrowing the distal trachea ( fig. 1 ). Positron emission tomography showed slight fluorodeoxyglucose uptake of the tumor, but no other abnormalities were found. Therapeutic bronchoscopy under general anesthesia was performed using a rigid and flexible bronchoscope, which showed a polypoid, lobulated, glossy tumor with telangiectatic surface protruding from the anterior wall of the trachea ( fig. 2 ). The tumor was resected with argon plasma coagulation, electrocautery and rigid bronchoscopic coring. A diagnosis of pleomorphic adenoma was made on the histopathology with a sheet-like structure of myoepithelial and epithelial cells embedded in a myxomatous stroma and no mitotic figures ( fig. 3 ). The patient experienced immediate relief of his respiratory symptoms with pulmonary function improvement (FEV 1 from 0.79 to 2.86 l, peak expiratory flow from 1.44 to 6.43 l/s), and was discharged 5 days after the procedure. He has since been under careful observation and there has been no evidence of recurrence in bronchoscopy and chest CT at 7 months after the procedure. Published online: April 1, 2010

Endobronchial ultrasound echoic image of pulmonary hamartoma

A 62‐year‐old man with an indicated chest radiographic abnormality was referred to our hospital for more thorough examinations. Endobronchial ultrasound‐guided transbronchial needle aspiration was performed because of a mass at the left hilum. Endobronchial ultrasound images showed scattered high‐density spots in a low echoic and mosaic density. The pathological findings revealed pulmonary hamartoma. Subsequently, the mass was resected and comparison of ultrasound findings and pathological findings indicated that the scattered high echoic spots appeared to reflect cartilaginous tissues and bronchial epithelium inside the tumor.

Ein Fall von Asthma bronchiale mit epiduralem Emphysem als Komplikation

Ein 22-jähriger Mann wurde mit einem Asthmaanfall vom Rettungswagen in unsere Notaufnahme gebracht. Er hatte eine Vorgeschichte von Asthma, sich jedoch nicht regelmäßig einer medizinischen Untersuchung unterzogen. Er klagte über schwere Atemnot, Husten und Schmerzen im oberen Brustbereich, die seit mehreren Tagen anhielten. Bei der Aufnahme zeigte er eine schwere Hypoxie, die mit Sauerstoffgabe bei einer Rate von 6 l/min behandelt wurde, aber keine neurologischen Symptome. Eine Computertomographie (CT) des Thorax zeigte ein Pneumomediastinum und einen strahlendurchlässigen Raum im Spinalkanal, was auf ein epidurales Emphysem hindeutet (Abb. 1). Das Asthma bronchiale wurde 3 Tage lang konservativ mit einem Kortikosteroid und Bronchodilatator behandelt, worauf sich die Symptome besserten. Das Nachsorge-CT nach 7 Tagen ergab, dass die Luft im Epiduralraum und Mediastinum verschwunden war. Beim epiduralen Emphysem, bei dem Luft im spinalen Epiduralraum vorhanden ist, handelt es sich um ein seltenes Krankheitsbild. Die meisten Fälle werden durch ein Trauma oder iatrogene

Experten-Beirat / Impressum

Copyright: