Endobronchial Abnormalities Research Articles

Chest Roentgenographic Guidelines in the Selection of Patients for Fiberoptic Bronchoscopy

We conducted this study to define the value of fiberoptic bronchoscopy (FOB) in the evaluation of chest radiographic abnormalities and to provide guidelines for fiberoptic bronchoscopy on the basis of chest radiographic appearances. Fiberoptic bronchoscopy without fluoroscopy was carried out in 530 patients, 455 male and 75 female, aged 19 to 85 years, during a 1-year period at Chest Department, Veterans General Hospital, Taipei. Of 530 patients, 19 (3.6 percent) had normal chest radiographs, and the remaining 511 (96.4 percent) patients had abnormal chest radiographs. Overall diagnostic yield of FOB was 55.4 percent in patients with abnormal chest radiographs and 52.6 percent in patients with normal chest radiographs. On the basis of radiographic findings, patients with lobar collapse (87.0 percent), hilar abnormalities (81.8 percent), pericardial effusions (66.7 percent), mass lesions (> 4 cm) (65.7 percent), and pleural effusions (64.9 percent) were most frequent to obtain a positive diagnosis via bronchoscopy (p < 0.001). Of 530 patients; mass lesion was the most frequent abnormality on bronchoscopy and had the highest incidence of providing a positive diagnosis (36.2 percent) (p < 0.001). A predilection of mass lesion on bronchoscopy was seen for chest radiographic features of lobar collapse (64.8 percent) and mass (> 4 cm) (47.0 percent) (p < 0.001). Of 19 patients with normal chest radiographs, a correct diagnosis was made in 4 (21.1 percent) with bronchoscopic findings of mass lesions, 3 (15.8 percent) with endobronchial abnormalities, and 3 (15.8 percent) patients with abnormal bronchial mucosa. Indeed, the decision to perform bronchoscopy should be guided by many factors other than chest radiograph. In this study, however, emphasis has been placed on the incidence of positive diagnosis via bronchoscopy on the basis of chest radiographic patterns. In this respect, we believe that in patient with lobar collapse, hilar abnormality, pericardial effusion, mass lesion (> 4 cm), and pleural effusion on the chest radiograph bronchoscopy should be considered.

Utility of Repeated Fiberoptic Bronchoscopy for Suspected Malignancy

We retrospectively evaluated records of 1598 fiberoptic bronchoscopies (FBs) performed on 1,391 patients (PTs) between Jan 1, 1986 and Dec 31, 1990. We found a progressive increase from 11 percent to 20 percent in the use of repeated fiberoptic bronchoscopy (RFB). Of the 254 RFBs, 151 were done in PTs with known or suspected intrathoracic malignant neoplasms. The 78 (of 151) RFBs performed in PTs with previously diagnosed malignant neoplasms were used to guide additional therapy. The other major indication for RFB (67 of 151) was to evaluate new suspicious lesions that had not been diagnosed on the initial FB. RFB specimens were positive in 36, false-negative in 24, and true-negative in 7 PTs. For some PTs, RFB could probably have been avoided if at initial FB physicians had (1) used fluoroscopy to direct transbronchial lung biopsies in PTs expected to have normal airways, (2) performed transbronchial needle aspiration in all PTs with extraluminal disease or mediastinal adenopathy, and (3) obtained bronchial biopsy specimens from all PTs with endobronchial lesions. In PTs whose initial FB specimens were nondiagnostic despite visualization of endobronchial or extraluminal abnormalities, RFB was associated with a significant diagnostic yield and obviated the need for more morbid, surgical staging procedures.

Pulmonary Manifestations of Disseminated Cryptococcosis in Patients with AIDS

Forty-eight patients with disseminated cryptococcosis and AIDS were retrospectively studied to define the pulmonary manifestations. Cryptococcus neoformans (CN) was first isolated from a pulmonary site in 12 patients. Disseminated disease was subsequently documented in all these patients. Symptoms and roentgenographic manifestations (normal, nodular/circumscribed infiltrates, pleural effusions, lobar consolidation) were diverse. Interstitial infiltrates predicted the presence of another opportunistic lung infection besides cryptococcosis in five patients (three untreated and two treated patients). Infectious causes other than cryptococcosis were established by culture and clinical course in five of the ten patients who developed chest roentgenographic abnormalities during amphotericin B therapy. Endobronchial abnormalities were identified in four patients at bronchoscopy. Bronchoalveolar lavage (9/9) and pleural fluid (3/3) cultures were sensitive tests for detection of pulmonary involvement with CN.

Clinical Spectrum of Endobronchial Tuberculosis in Elderly Patients

We describe 11 elderly patients with bacteriologically proved endobronchial tuberculosis, representing 15% of our 73 geriatric patients with pulmonary tuberculosis in the period 1980 to 1987. In seven (64%) of the 11 patients, an incorrect diagnosis was initially made. Cough, mostly nonproductive, was invariably present, and general symptoms (fever, anorexia, weight loss) predominated over specific pulmonary symptoms. The radiographic features were rather "unusual": in only two (18%) of the 11 cases, apicoposterior consolidations with or without cavitation were found. Fiberoptic bronchoscopy showed a range of endobronchial abnormalities that included ulcerations, mass lesions, and fibrostenoses. Antituberculous treatment generally led to satisfactory results. Still, residual bronchostenosis was observed in four (57%) of seven patients in whom a control bronchoscopy was done. In one of these four patients, a pneumonectomy had to be performed for uncontrollable retro-obstructive infections, and in another, repeated endoscopic dilatations were effective. In elderly patients, endobronchial tuberculosis should be considered in the differential diagnosis, especially in the presence of chronic cough. In these patients, the chest roentgenogram may be clear or suggestive of bronchial carcinoma or pneumonitis.

Clinical spectrum of endobronchial tuberculosis in elderly patients

We describe 11 elderly patients with bacteriologically proved endobronchial tuberculosis, representing 15% of our 73 geriatric patients with pulmonary tuberculosis in the period 1980 to 1987. In seven (64%) of the 11 patients, an incorrect diagnosis was initially made. Cough, mostly nonproductive, was invariably present, and general symptoms (fever, anorexia, weight loss) predominated over specific pulmonary symptoms. The radiographic features were rather "unusual": in only two (18%) of the 11 cases, apicoposterior consolidations with or without cavitation were found. Fiberoptic bronchoscopy showed a range of endobronchial abnormalities that included ulcerations, mass lesions, and fibrostenoses. Antituberculous treatment generally led to satisfactory results. Still, residual bronchostenosis was observed in four (57%) of seven patients in whom a control bronchoscopy was done. In one of these four patients, a pneumonectomy had to be performed for uncontrollable retro-obstructive infections, and in another, repeated endoscopic dilatations were effective. In elderly patients, endobronchial tuberculosis should be considered in the differential diagnosis, especially in the presence of chronic cough. In these patients, the chest roentgenogram may be clear or suggestive of bronchial carcinoma or pneumonitis.

Diagnosis of bacterial pulmonary infections with quantitative protected catheter cultures obtained during bronchoscopy

Quantitative bacteriology was performed on specimens collected by protected catheter fiberoptic bronchoscopy from 172 patients. Of the patients who had pneumonia, 75 of 78 (96%) had one or more species present at greater than or equal to 10(3) CFU/ml, whereas 2 of 35 (6%) control patients had organisms present in that quantity. In addition, 66% of the control specimens yielded no isolates by this technique. All of the 11 patients with bronchitis had greater than or equal to 10(3) CFU/ml. Quantitative bacteriology revealed high levels of colonization in patients without infection and endobronchial structural disease. The data suggest that bacterial counts of greater than or equal to 10(3) CFU/ml in suspended secretions collected with a protected catheter brush were diagnostic of the bacteriological etiology of lower respiratory tract infections in patients without endobronchial structural abnormalities.