Transbronchial Biopsy Research Articles

Case report: Primary cardiac synovial sarcoma with suspected connective tissue disease diagnosed by EBUS-TBMB

Primary cardiac synovial sarcoma (PCSS) most commonly originates in the right atrium of the heart and is exceptionally rare. Although biomarkers of autoimmune diseases, such as antinuclear antibodies (ANAs), have been reported as potential indicators of certain tumors, the association between PCSS and ANAs remains unclear. Herein, we describe a case of pleural effusion that was initially considered to be due to connective tissue disease (CTD) but was finally diagnosed as PCSS through endobronchial ultrasound-guided transbronchial mediastinum biopsy (EBUS-TBMB). Clinicians need to update their knowledge regarding the potential association between PCSS and ANAs. This case report also emphasizes the importance of EBUS-TBMB, under the guidance of positron emission tomography/computed tomography (PET/CT), in the diagnosis of this rare tumor in an unusual location.

The diagnostic value and safety of transbronchial frozen lung biopsy compared with transbronchial clamp biopsy in peripheral lung lesions.

The diagnostic value and safety of transbronchial frozen lung biopsy compared with transbronchial clamp biopsy in peripheral lung lesions.

Clinical predictors for restrictive allograft syndrome: a nested case-control study.

Risk factors for restrictive allograft syndrome (RAS), a severe phenotype of chronic lung allograft dysfunction after lung transplantation, are currently not well known. In this retrospective nested case-control-study, we analyzed 69 RAS patients and 69 matched non-CLAD controls to identify clinical risk factors for RAS. RAS patients demonstrated overall higher blood eosinophils (p=0.02), increased bronchoalveolar eosinophils (p<0.001) and lymphocytes (p=0.03), and a higher incidence of infections, particularly Pseudomonas (p=0.003), invasive fungal disease (p<0.001, mainly Aspergillus species), SARS-CoV-2 (p<0.001) and CMV (p=0.04), compared to non-CLAD controls. Anti-HLA antibodies, especially persistent donor-specific antibodies (p<0.001), especially targeting HLA-DQ and HLA-DR loci, and antibody-mediated rejection (p<0.001), were strongly associated with later RAS. Histopathological lung injury patterns on transbronchial biopsy (p<0.001), and persistent chest CT opacities in absence of pulmonary dysfunction (p<0.001) were identified as early indicators of later RAS. Proactive detection and management of these risk factors could help mitigate future decline in allograft function, and reduce progression to clinical RAS. Future studies should explore early treatment strategies targeting these modifiable factors to preserve allograft function and improve long-term outcomes for lung transplant recipients.

Predictors of Severe Coughing and Its Impact on Bronchoalveolar Lavage and Transbronchial Lung Biopsy in Patients with Diffuse Lung Disease: Evaluation of Bronchoscopy Safety

Background/Objectives: Bronchoscopy is an invasive procedure, and patient coughing during the examination has been reported to cause significant distress. This study aimed to identify predictors of coughing severity and assess its impact on the procedure during bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB). Methods: We conducted a prospective study involving 119 consecutive patients with diffuse lung disease who underwent BAL and TBLB at Kyorin University Hospital from April 2019 to December 2023. Cough severity was scored on a scale of 0 to 3, with scores of 0–1 considered mild and 2–3 considered severe. Multivariate logistic regression analysis was performed to identify factors associated with severe coughing during the procedure. Results: Severe coughing was significantly associated with Grade 2 or higher bleeding (OR 6.230, 95% CI 2.220–17.400, p &lt; 0.001), fewer TBLB specimens collected (OR 0.708, 95% CI 0.530–0.945, p = 0.019), and pre-procedural dyspnea (OR 2.560, 95% CI 1.110–5.870, p = 0.027). Conclusions: Severe coughing during bronchoscopy is associated with increased bleeding and reduced specimen collection. For patients with pre-procedural dyspnea, proactive cough management may improve procedural safety and outcomes.

Donor-derived cell-free DNA for detection of acute rejection in lung transplant recipients

IntroductionAcute rejection is a significant risk factor for developing chronic lung allograft dysfunction. Current monitoring tools, transbronchial biopsies and HLA antibody determination, have limitations in detecting acute rejection. This study aims to explore the potential utility of donor-derived cell-free DNA (ddcfDNA) as a non-invasive biomarker for detecting acute rejection in lung transplant recipients (LTR).MethodsWe developed a molecular method based on digital droplet PCR to determine the total amount and the proportion of ddcfDNA. Using blood samples collected sequentially post-transplant from a cohort of 81 LTR, we compared median levels of %ddcfDNA in patients with acute cellular rejection (ACR), antibody-mediated rejection (AMR), infection, or decline in pulmonary function (FEV1).ResultsMedian %ddcfDNA levels were significantly higher in groups with ACR (1.92% [0.70%, 2.30%], p=0.0006), AMR (1.27% [0.34%, 2.29%], p=0.0009), isolated lymphocytic bronchiolitis (0.54% [0.23%, 2.18%], p=0.03), and infection or prolonged ventilation over 30 days (0.50% [0.22%, 2.35%], p=0.005) versus stable allograft function group (0.26% [0.09%, 0.60%]). %ddcfDNA levels were also elevated in patients with FEV1 loss compared to those with stable or improving FEV1 after 12 months (1.98% vs. 1.36%, p=0.04). An optimal cut-off of 0.73% for %ddcfDNA was calculated to detect ACR and AMR with 80% specificity and 68% sensitivity.Discussion%ddcfDNA is a promising biomarker for identifying allograft injury due to acute rejection in LTR and could be a valuable tool for monitoring allograft health.

Chronic lung allograft dysfunction after lung transplantation - prevention, diagnosis and treatment in 44 European centers

BackgroundThere is limited data on optimal management of chronic lung allograft dysfunction (CLAD). We aimed to describe the variability of diagnostic and therapeutic practices in Europe.MethodsA structured questionnaire was sent to 71 centers in 24 countries. Questions were related to contemporary clinical practices for work-up, monitoring and treatment of CLAD. Number of lung transplant (LTx) procedures, patients in follow-up were collected.ResultsForty-four centers (62%) responded from 20 countries, representing 74% of European activity. The prevalence of CLAD was estimated at 9.1 cases per million population (25th and 75th percentiles 4.4–15.7). Preferred initial work-up for probable CLAD consisted of chest CT (inspiratory 91%, expiratory 74%), donor-specific antibody (DSA) measurement (86%), bronchoalveolar lavage (BAL) (85%), and transbronchial biopsy (81%). For monitoring of definite CLAD, inspiratory CT (67%), DSA (61%), and BAL (43%) were preferred. Body plethysmography was unavailable for 16% of cases. Prophylaxis was based on preventing infections (CMV 99%, inhaled antibiotics 70% and antifungals 65%), tacrolimus-based immunosuppression (96%), azithromycin (72%), and universal proton pump inhibitor treatment (84%). First-line treatment of CLAD was based on azithromycin (82%) and steroid augmentation (74%). Photopheresis was used in 26% of cases.ConclusionCurrent European practice CLAD detection is based on spirometry, inspiratory CT and DSA, with limited access to plethysmography and expiratory CT. Prophylactic treatment is based on azithromycin, tacrolimus-based immunosuppression, and treatment of risk factors. No single treatment strategy is universally used, highlighting the need for an effective treatment of CLAD. The preferred first-line strategy is azithromycin and steroid augmentation.

Confocal laser en domicroscopy as a navigation method for transbronchial biopsy in patients with disseminated lung diseases

Introduction. Disseminated lung diseases (DLD) encom-pass a wide range of pathologies characterized by diffuse changes in both lungs. Despite the high level of infor-mativeness (94–100%) of surgical video-assisted thora-coscopic (VATS) biopsy, the risk of serious complications and mortality associated with this procedure drives the search for safer yet sufficiently accurate alternatives. Bronchoscopic biopsy (forceps and cryobiopsy) leads to fewer complications; however, its diagnostic value remains inconsistent (16–80%). One promising avenue for improving the accuracy of this minimally invasive ap-proach is the use of confocal laser endomicroscopy (CLE) to guide bronchoscopic biopsy. Objective. To conduct a preliminary assessment of the diagnostic value of CLE in guiding and selecting the target site for transbronchial forceps biopsy. Material and methods. A single-center prospective randomized study. Eligibility criteria: age over 18 years with multiple lung lesions observed in more than two segments on chest CT. Exclusion crite-ria: any confirmed disease at the time of examination, specifically HIV infection and/or any kind of malignant neoplasm, or patient refusal. The study included 170 pa-tients in the main group and 192 in the control group. Results. The diagnostic yield was 97.1% in the main group and 78.1% in the control group (p&lt;0.05). Com-plications included pulmonary hemorrhage in 2.6% of the main group and 2.08% of the control group (p&gt;0.05), and pneumothorax in 1.0% of the main group and 1.56% of the control group (p&gt;0.05). Conclusion. The use of CLE for navigation in transbronchial lung biopsy signifi-cantly increases the diagnostic yield without raising the overall complication rate, making it feasible to continue and further develop this method

Transbronchial Needle Aspiration via Ultrathin Bronchoscope Improves Diagnostic Yield for Peripheral Lung Lesions: Randomized Sequencing Trial.

Peripheral pulmonary lesions (PPLs) are frequently identified and require diagnostic sampling. Diagnostic yield of radial endobronchial ultrasound (rEBUS) guided bronchoscopic biopsies is suboptimal, despite ultrasound confirmation of navigation success. Pairing ultrathin bronchoscopy and peripheral transbronchial needle aspiration (pTBNA) may improve yield. We prospectively recruited consecutive patients undergoing Olympus MP190F ultrathin bronchoscopy with rEBUS-guided sampling of PPLs. Cases were randomized to pTBNA (Olympus Periview FLEX) either before or after the usual transbronchial forceps biopsy (TBLBx) and brush. Diagnostic yield from cytology or histopathology, clinical outcomes to a minimum 24 months follow-up and complications were recorded. One hundred one sampled lesions were included (pTBNA first 61, pTBNA last 40). Overall diagnostic yield was 66.3%, with no significant difference between groups (64% vs. 70% P=0.528) or prespecified subgroups according to sampling order. Seventy lesions had an end diagnosis of malignancy, of which 50 were correctly diagnosed (71.4%). TBLBx (49/96, 49%) and pTBNA (48/101, 47.5%) had the highest individual positive yield. For 12 (11.9%) participants, pTBNA was the only positive sample. Lesions <20mm and those with eccentric rEBUS image seemed to benefit most from this approach. Rapid on-site cytologic examination (ROSE) was associated with both positive procedural diagnosis (P=0.019) and pTBNA-positive samples (P=0.004). Pneumothorax occurred in 4% and moderate bleeding in 5%. Thirteen percent had an unplanned admission within 1 month of bronchoscopy. Adding pTBNA to conventional sampling through an ultrathin bronchoscope guided by rEBUS, improved diagnostic yield (11.9% additional diagnoses). The sampling sequence did not affect the yield of pTBNA.

A case report of pulmonary paragonimiasis diagnosed via the deterioration of pulmonary cavities during high-dose corticosteroid therapy for chronic eosinophilic pneumonia

A 32-year-old Chinese woman with a cough and bloody sputum was diagnosed with chronic eosinophilic pneumonia. After starting corticosteroid therapy, chest radiography showed improvement in the bilateral infiltrative shadow. However, chest image findings showed worsening of the bilateral infiltrative shadow and pulmonary cavities during the 20 mg/day of oral prednisolone therapy. Transbronchial lung biopsy and bronchoalveolar lavage were repeated, and the patient was diagnosed with pulmonary paragonimiasis. After starting praziquantel treatment, chest radiography findings and clinical symptoms improved. Careful follow-up during corticosteroid therapy is important to judge whether transient improvement and true deterioration of radiological findings.

Systematic Reporting of Eosinophils in Transbronchial Biopsies After Lung Transplantation Defines a Distinct Inflammatory Response.

Descriptions of eosinophils in transbronchial biopsy (TBBx) pathology reports after lung transplantation (LTx) are associated with poor long-term outcomes. The absence of routine reporting and standardization precludes accurate assessment of this histologic predictor. A systematic reporting scheme for the presence of TBBx eosinophils after LTx was implemented. This report aims to assess this scheme by describing the presence, pattern, and gradation of TBBx eosinophils and clinical associations. A prospective cross-sectional study of all TBBx reports was performed including all patients presenting for a surveillance or diagnostic TBBx between January 2020 and June 2023. Each TBBx was systematically reported in a blinded manner. Mixed-effects logistic regression was performed to measure the association between concurrent clinical and histologic features, and the presence of TBBx eosinophils. A total of 410 TBBx reports from 201 patients were systematically reported. In 43.8% recipients, any TBBx eosinophils were detected and in 17.1% recipients, higher-grade eosinophils (≥3 per high power field) were present. Adjusted analysis showed that retransplantation, A- and B-grade cellular rejection, positive bronchoalveolar lavage (BAL) bacterial microbiology, and elevated blood eosinophil count were independently associated with the presence of any TBBx eosinophils. Diagnostic "for-cause" procedures were independently associated with higher quantities of TBBx eosinophils. Systematic reporting demonstrates that TBBx eosinophils are a distinct inflammatory response associated with rejection, infection, and peripheral eosinophilia. Although these findings require multicenter external validation, standardized reporting for TBBx eosinophils may assist in identifying recipients at risk of poor outcomes and provides a platform for mechanistic research into their role after lung transplantation.

The reality of bronchoscopy care in Germany: a survey by the German Respiratory Society

In September 2022, sites where bronchoscopy was carried out were systematically surveyed regarding structural and process quality features in an anonymized DGP survey with 33 questions. The data collected were analyzed descriptively. Of the 196 participating sites, bronchoscopies were performed regularly at 180 sites. The majority were standard secondary care (n=51) and tertiary care (n=43) hospitals (range of services: diagnostic bronchoscopy, predominantly (80%) including endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA). Extended treatment options were guaranteed for acute cases at >90% of these locations. University hospitals (n=24) and specialist pulmonary hospitals (n=35) also offered more complex diagnostic procedures and therapeutic-interventional techniques. The performance figures were significantly higher in the specialist pulmonary hospital (specialist pulmonary hospitals: 62%: >2000 bronchoscopies/year; university hospitals: 25%: >2000 bronchoscopies/year; p<0.001). In the practice setting (n=21, partly in co-operation with hospitals) , <500 bronchoscopies/year were performed.Intensive care units were available in 97% of the hospitals; 88% of the hospitals had fluoroscopy facilities in the bronchoscopy room. Propofol (91%) and/or midazolam (62%) were the preferred drugs for sedation. At 21% of the sites, >200 bronchoscopies under ventilation/year were performed. BAL and transbronchial forceps biopsies were mainly performed via the nasal or oral approach, EBUS-TBNA via a bronchoscopy tube or the oral approach, the EBUS mini-probe/navigation, cryotechnique or more complex interventions via the rigid tube or a bronchoscopy tube. ASA >2 led to involvement of a second physician at 46% of clinical sites, at 47% of sites at an ASA classification >3. The majority of bronchoscopic examinations are performed in respiratory departments at secondary care centres as well as maximum care hospitals. For more complex procedures, cooperation with hospitals specialized in bronchoscopy (e.g. university hospital or a specialist lung clinic) is advisable.

CT-augmented digital tomosynthesis image reconstruction in image-guided bronchoscopy interventions.

Transbronchial needle biopsy is crucial for diagnosing lung cancer, yet its efficacy depends on accurately localizing the target lesion and biopsy needle. Digital tomosynthesis (DTS) is considered a promising imaging modality for guiding bronchoscopy procedures due to its low radiation dose and small footprint relative to cone-beam computed tomography (CBCT). However, the image quality of DTS is still not sufficient for an accurate guidance, mainly due to its limited-angleacquisition. Preoperative computed tomography (CT) scans are often performed prior to bronchoscopy interventions for diagnosis or to plan the procedure. The CT images are of high quality and are characterized by a high spatial resolution compared to intraoperative DTS images. These patient-specific prior CT images and the intraoperative DTS images share a fair amount of anatomical information. The main differences only stem from patient positioning and respiratory motion. When these differences are addressed properly, prior CT images augment intraoperative DTS image reconstruction with strong prior knowledge and potentially enhance DTS imagequality. We propose in this work a prior-aided DTS image reconstruction technique leveraging prior CT images to improve DTS image quality. This technique is based on a recently published deformable CT-to-DTS image registration algorithm which is customized for bronchoscopy interventions. The main idea is to register a prior CT image to an intermediate DTS image reconstructed using the standard iterative algebraic reconstruction technique (ART), then to re-reconstruct the DTS image using ART and the registered prior CT image as a firstestimation. The proposed prior-aided reconstruction method was tested on a physical phantom and six patient bronchoscopy datasets. Real DTS data acquired with a pseudo-linear (PL) scan geometry and simulated DTS data generated according to a spherical ellipse (SE) scan geometry were considered. Results evaluated qualitatively by visual inspection and quantitatively by computing Pearson's correlation (PC) with respect to the reference CBCT images suggest significant improvements in image quality using the prior-aided DTS reconstruction compared to the standard zero-initialized ART reconstruction. PC coefficients of the six patient datasets were on average and using a zero-initialized ART reconstruction with SE data and PL data, respectively, and and using the proposed prior-aided reconstruction with SE data and PL data,respectively. While the initial estimation in iterative reconstruction algorithms is often overlooked, we proved that initial estimation is of critical importance in DTS image reconstruction and we have demonstrated the profound advantages of integrating prior CT images in intraoperative DTS image reconstruction. CT-augmented DTS offers a viable alternative to CBCT in guiding bronchoscopy interventions at a fraction of the radiation dose. Further clinical studies are needed to validate improved diagnosticyield.

Transesophageal endosonography in the diagnosis of sarcoidosis: a narrative review.

Transesophageal endosonography, including endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA), has been applied to the diagnosis of benign as well as malignant diseases. This narrative review summarizes the recent use of EUS-(B)-FNA in diagnosing sarcoidosis. A comprehensive and systematic online literature search of PubMed was conducted using the keywords ("sarcoidosis"), and ("EUS" OR "EUS-FNA" OR "EUS-B" OR "EUS-B-FNA" OR "endoscopic ultrasound guided fine needle aspiration" OR "endoscopic ultrasound using the EBUS scope guided fine needle aspiration" OR "endoscopic ultrasound using the EBUS bronchoscope" OR "transesophageal" OR "transesophageal endoscopic ultrasound guided fine needle aspiration" OR "transesophageal bronchoscopic ultrasound guided fine needle aspiration"). Most EUS-FNA procedures were performed under moderate sedation, primarily using midazolam, with 22-gauge needles. The diagnostic sensitivity of sarcoidosis in mediastinal lymph node sampling is as high as 75-100% for EUS-FNA and 70-86% for EUS-B-FNA, much higher than that of traditional bronchoscopic procedures, such as transbronchial lung biopsy (TBLB) and conventional transbronchial needle aspiration (TBNA). The complications associated with EUS-(B)-FNA have thus far included only a few cases of mediastinitis, successfully treated with antibiotics, as well as lymph node hematoma, and sore throat. EUS-FNA and EUS-B-FNA provide high diagnostic yields in patients with sarcoidosis. The safety profile is acceptable, although there is a slight risk of infectious complications. EUS-B-FNA, a minimally invasive and well-tolerated procedure, offers a viable alternative to endobronchial ultrasound-guided TBNA (EBUS-TBNA) for the diagnosis of sarcoidosis, particularly in patients with cough and poor respiratory function; this procedure can easily be performed by pulmonologists.

Transition from Transbronchial Forceps to Cryobiopsy After Lung Transplantation: A Single-Centre Experience.

The gold standard for histological acute cellular rejection diagnosis is transbronchial forceps biopsy (FB), but in recent years, transbronchial cryobiopsy (CB) has been increasingly used. This study aims to compare the diagnostic rate and safety of FBs and CBs performed in two different periods. We retrospectively reviewed our case history for the two biopsy procedures: 251 FBs (223 for surveillance purposes and 28 for clinical indication) and 218 consecutive CBs (159 for surveillance purposes and 59 for clinical indication). All biopsies were scored according to the ISHLT criteria. Diagnostic yield was higher in the CB group for all the parameters considered: a grade of acute rejection (AR) was detected in 95.0% vs. 84.5% in the CB vs. FB groups (p < 0.001). The diagnostic rate of airway inflammation was 65.1% vs. 51.8% (p = 0.005), and 89.0% vs. 64.9% (p < 0.001) for chronic rejection. Pneumothorax requiring chest drainage occurred in 4% of the CB group and 3% of the FB group. Moderate and severe bleeding complicated CB and FB procedures in seven (3%) and three cases (1%), respectively. Transbronchial cryobiopsies improved the diagnostic yield in the monitoring of the lung allograft. The complication rate did not increase significantly in CBs vs. FBs.

Diagnostic value and safety of transbronchial cryobiopsy in postoperative complications after lung transplantation

Objective: To compare the diagnostic rate and safety of postoperative complications between transbronchial cryobiopsy (TBCB) and transbronchial lung biopsy (TBLB) in patients with lung transplantation. Methods: A retrospective analysis of patients who underwent TBCB or TBLB in the Department of Lung Transplantation in China-Japan Friendship Hospital from June 2017 to June 2024 was conducted to determine the postoperative complications and analyze clinical characteristics, procedures, diagnostic rates and safety. Results: Thirty-five and 153 patients with lung transplantation received TBCB and TBLB, respectively. Patients who received TBCB had lower preoperative oxygenation index (t'=2.4, P<0.01). Meanwhile, the pathological diagnosis rate (85.7% vs. 45.7%, χ²=18.27, P<0.01) and clinical diagnosis rate (94.2% vs. 69.9%, χ²=8.80, P<0.01) of patients who received TBCB were significantly higher than those who received TBLB. There was no significant difference in the incidence of severe bleeding (2.9% vs. 0.7%, χ²=1.3, P=0.86) and pneumothorax (0 vs. 3.9%, χ²=0.43, P=0.24) between patients receiving TBCB and TBLB. The most common complications after lung transplantation in the group of TBCB were chronic lung allograft dysfunction (45.4%, 15/33), antibody mediated rejection (18.2%, 6/33) and organizing pneumonia (12.2%, 4/33). While antibody mediated rejection (29.9%, 32/107), chronic lung allograft dysfunction (16.8%, 18/107), and pneumonia (16.8%, 18/107) were more frequent in the patients who received TBLB. Conclusions: TBCB has a high diagnostic value for postoperative complications after lung transplantation, with an acceptable complication rate of bleeding and pneumothorax.

Transbronchial cryo-nodal biopsies in children: A case series.

Transbronchial cryo-nodal biopsies in children: A case series.

Bronchoalveolar lavage cytokine-based risk stratification of clinically-stable lung transplant recipients with undefined rejection: Further insights from a follow-up investigation.

Surveillance bronchoscopies with bronchoalveolar lavage (BAL) and transbronchial biopsies (TBB) are primarily used to detect acute cellular rejection (ACR) or infection in lung transplant (LTx) recipients. We previously identified a BAL protein signature associated with chronic lung allograft dysfunction (CLAD) or death/retransplant in patients with stable minimal (grade A1) ACR. This present study aimed to determine whether similar BAL biomarkers predict outcomes in stable patients when ACR grade is undetermined. The cohort included all adult, first bilateral LTx performed 2010-2017. Clinical status was categorized as unstable or stable based on the presence or absence of a ≥10% drop in FEV1. Clinically-stable patients with grade AX TBB (inadequate biopsies) during the first year post-transplant, not preceded by ACR (grade A≥1 or B≥1), were included. IL6, S100A8, IL10, TNF-receptor-1, IL1α, pentraxin3, and CXCL10 were measured in the BAL using a multiplex bead assay. Associations with subsequent CLAD or death/retransplant were assessed using multivariable Cox proportional hazards models, adjusted for relevant clinical covariates. Among 107 patients with stable AX biopsies at a median of 188 days post-transplant, the median times from biopsy to CLAD and death/retransplant were 972 and 1410 days, respectively. CXCL10 was significantly associated with CLAD, while IL6, S100A8, pentraxin3, TNF-receptor-1, and IL10 were associated with death/retransplant (p<0.05 for all). A focused BAL protein signature in stable patients with ungradable TBB early post-transplant may predict worse outcomes. Such select BAL biomarkers may identify patients who require more aggressive management strategies or closer monitoring.

Lymphocytic Interstitial Pneumonia with Varied Association: Case Series

Lymphocytic interstitial pneumonia (LIP) is an unusual variant of interstitial lung disease with unknown incidence and prevalence. It is often seen in patients with autoimmune diseases and in immune-compromised individuals, and is associated with specific infections; rarely, it is idiopathic. Idiopathic LIP has a male preponderance, while the secondary form is more common in females. It is characterized by dense infiltration of polyclonal lymphocytes, plasma cells, and histiocytes in the interstitial and alveolar spaces. Early diagnosis and treatment initiation are crucial for a favorable prognosis. Here, we present four cases of LIP with variable associations, emphasizing the importance of clinical examination, imaging, and, whenever needed, a transbronchial lung biopsy for accurate diagnosis.

Cone-beam computed tomography-guided transbronchial lung biopsies: Leading the way to precision.

Cone-beam computed tomography-guided transbronchial lung biopsies: Leading the way to precision.

Utility of Flexible Bronchoscopy as an Interventional Tool in Children: A Single-Center Cross-Sectional Study

AbstractThe aim of this study was to study the utility of pediatric flexible bronchoscopy as an interventional tool. This is a prospective study conducted in a tertiary care hospital. The studied patients underwent flexible bronchoscopy for various diagnostic and therapeutic reasons. The endpoint was to document the type of therapeutic procedure done in a patient, success rate, and any procedural complications encountered. During the 7-year period, a total of 824 different bronchoscopic procedures were conducted. The majority of procedures were for diagnostic reasons. A total of 68 therapeutic procedures were performed successfully, which included foreign body retrieval in 46 patients, bronchoscopic intubation in 5 patients, transbronchial needle aspiration (TBNA) in 4 patients, dilatation of tracheal stenosis in 4 patients, mucus plug removal in 3 patients for lung collapse, postoperative hydatid membrane removal in 3 patients, whole lung lavage in 2 patients, and transbronchial needle biopsy (TBNB) for suspected fibrosing mediastinitis in 1 patient. The 7-year audit of therapeutic role of flexible bronchoscopy (FB) in children revealed that the procedure is safe and can be utilized for many therapeutic procedures in children, including removal of aspirated foreign bodies, bronchoscopic intubation, dilatation of tracheal stenosis, treatment of atelectasis, and collection of biopsy specimens from the mediastinum. The procedure is safe and carried no major complication rate.