Transbronchial Diagnosis of A Pulmonary Peripheral Small Lesion Using an Ultrathin Bronchoscope with Virtual Bronchoscopic Navigation

Abstract

We report a patient with a pulmonary peripheral small lesion that was diagnosed using an ultrathin bronchoscope with virtual bronchoscopic (VB) navigation. In a 83-year-old man with pulmonary emphysema, chest computed tomography (CT) revealed a small lesion (18 × 14 mm) in the periphery of right segment 3. For diagnostic bronchoscopy, the area from the segmental bronchus to the lesion was examined by thin-section CT, and VB images up to the 11th bronchus as the route to the lesion were produced. Using these VB images, an ultrathin bronchoscope (external diameter, 2.8 mm) was inserted into the target bronchus. Because the VB images were in good agreement with the real bronchoscopic images, the ultrathin bronchoscope could be inserted readily at the 10th bronchus under direct vision. In addition, after confirming the positioning of the bioptome at the lesion by thin-section CT, a biopsy was acquired, and a diagnosis of pneumonia was made. This diagnostic method using an ultrathin bronchoscope with VB navigation is more accurate and can be performed in a shorter time than conventional bronchoscopy, and may be useful for evaluating pulmonary peripheral lesions.