The “Territorial Domain” of Hemoptysis

Abstract

To the Editor: We would like to reply to the editorial commentary1Tucker GF Olsen AM Andrews Jr, AH et al.The flexible fiberscope in bronchoscopic perspective.Chest. 1973; 64: 149Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar that was prompted by our recent article: “The Evaluation of Hemoptysis with Fiberoptic Bronchoscopy.”2Smiddy JF Elliott RC The evaluation of hemoptysis with fiberoptic bronchoscopy.Chest. 1973; 64: 158Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar Many valid comparisons were made between the two types of bronchoscopes by the editors. It is quite understandable that the advocates of the rigid bronchoscope are upset when their “territorial domain” is subjected to yet another infringement: “the evaluation of hemoptysis.” In their reactionary zeal they failed to note that in both of our illustrative cases the rigid bronchoscope failed to localize the site of bleeding, while success was achieved with the fiberscope. The major point of our article was the introduction of the technique of segmental and subsegmentai lavage to localize and/or visualize the site of bleeding. This is an extremely valuable diagnostic aid in the management of the patient with hemoptysis. Such a technique is beyond the capabilities of the rigid scope. Many competent endoscopists would object to the statement that “the rigid bronchoscope should be the instrument of choice for examination of the major airways.”1Tucker GF Olsen AM Andrews Jr, AH et al.The flexible fiberscope in bronchoscopic perspective.Chest. 1973; 64: 149Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar On more than one occasion this past year, we have visualized, photographed, and biopsied small nodular tumors in the mainstem bronchi with the fiberscope, when these same lesions were not even visualized by an expert endoscopist using the rigid bronchoscope. The editorial stresses that the fiberscope (a closed instrument) may actually obstruct the airway of the patient when not passed through a rigid bronchoscope or endotracheal tube. If simple precautionary measures and good judgment are followed, this should not be a problem. In a survey of 24,521 fiberoptic procedures, not one operator related such a problem.3Smiddy JF, Credle WF, Elliott RC: Complications of Fiberoptic Bronchoscopy. In pressGoogle Scholar We readily agree with Tucker et al that the fiberoptic bronchoscope has several disadvantages, and that at the present time there is a place for both the rigid bronchoscope and the fiberscope. However, we are not alone in feeling that the characteristics of the fiberoptic bronchoscope are so superior, that as we meet the challenge of developing new techniques with this instrument, it will eventually replace the conventional bronchoscope now in use.4Wilson JAS The flexible fiberoptic bronchoscope (editorial).Ann Thor Surg. 1972; 14: 686Abstract Full Text PDF PubMed Scopus (5) Google Scholar