Cost Effectiveness of Transbronchial Needle Aspiration
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To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.Retrospective study.A university hospital.Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.Keywords:
Mediastinal lymphadenopathy
Flexible bronchoscopy
Medical record
Flexible bronchoscopy
GUNSHOT INJURY
Gunshot wound
Rigid bronchoscopy
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Tracheobronchomegaly is a rare disorder characterized by marked dilatation of trachea and major bronchi. We report a 10-year-old child with tracheobronchomegaly presenting with localized bronchiectasis and mimicking foreign body aspiration. The diagnosis was confirmed via flexible bronchoscopy. We believe that flexible bronchoscopy can provide useful information in children with a prolonged history of respiratory symptoms and a large trachea in whom the diagnosis of tracheobronchomegaly is considered.
Flexible bronchoscopy
Foreign body aspiration
Tracheobronchomalacia
Rigid bronchoscopy
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There are few reports comparing flexible and rigid bronchoscopy in adult foreign body (FB) aspiration. The aim of this retrospective study was to review the clinical characteristics, outcomes and factors associated with success in adult patients who underwent flexible or rigid bronchoscopy for airway FB removal.We retrospectively reviewed the records of 103 patients who underwent bronchoscopy to remove airway FB at Samsung Medical Center, South Korea from January 1999 to March 2017.The median patient age was 64 years, and 70% were males. Among the 54 patients who underwent flexible bronchoscopy as first-line treatment, 43 (80%) patients had their FB successfully removed. Previous attempts at other hospitals was significantly associated with failed flexible bronchoscopy [9/11 (82%) vs. 3/43 (7%), P<0.001]. Delayed diagnosis (median 29 vs. 5 days, P=0.074) and peripherally located airway FB [9/12 (75%) vs. 23/48 (48%), P=0.115] were factors that trended towards flexible bronchoscopy failure. All of the 59 patients who underwent rigid bronchoscopy had their FB successfully removed. Rigid bronchoscopy was preferred to flexible bronchoscopy in patients with no comorbidities [38/59 (64%) vs. 18/44 (41%), P=0.018], previous attempts at other hospitals [34/59 (58%) vs. 4/44 (9%), P<0.001], delayed diagnosis (median 162 vs. 5 days, P<0.001), and hard FBs [48/62 (77%) vs. 21/49 (43%), P<0.001].Our data suggest that previous failed attempts and delayed diagnosis are associated with flexible bronchoscopy failure. However, rigid bronchoscopy could be effective in removing an airway FB even in these cases. Further studies to identify factors to facilitate optimal patient selection will minimize failure rates and optimize resource utilization.
Flexible bronchoscopy
Rigid bronchoscopy
Foreign body aspiration
Medical record
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Flexible bronchoscopy
Rigid bronchoscopy
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Flexible bronchoscopy
Airway obstruction
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The flexible bronchoscopy has not yet been popular in the foreign body in the airway, especially in children. We performed the flexible bronchoscopy for 27 patients with foreign bodies in the airway including 22 patients who had not been removed foreign bodies by the rigid bronchoscopy. Nineteen of 27 patients were children. The success rate of flexible bronchoscopy was 81% (22/27 cases) in all patients, 77% (17/22 cases) in patients failed by the figid bronchoscopy, and 82% (9/11 cases) in young children of 2 years old or less. For the removal of foreign bodies under the flexible bronchoscope, a biopsy forceps and a Fogarty balloon catheter were effective. The flexible bronchoscope is useful for foreign bodies in the airway, even in young children.
Flexible bronchoscopy
Rigid bronchoscopy
Foreign Body Removal
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Background: Rigid bronchoscopy is the procedure of choice for removal of inhaled foreign bodies, with certain complication rate. Aim: to assess whether flexible bronchoscopy is an efficient and safe procedure in extraction of foreign bodies in children, compared to rigid bronchoscopy. Then, to further assess if it is associated with a shorter procedure time, and shorter length of stay in the hospital (LOS). Methods: a retrospective study including patients aged 0-18 years, that were hospitalized in Soroka University Medical Center throughout 2009-2019, and underwent flexible or rigid bronchoscopy for the removal of inhaled foreign body. The data were analyzed according to two time periods; 2009-2016 and 2017-2019. Results: from 2009-2019, 182 patients (median age of 24 months, 58% males) underwent an interventional bronchoscopy; 40 (22%) by flexible and 142 (78%) by rigid bronchoscopy. 88.73% of rigid and 95% of flexible bronchoscopies were successful in the removal of foreign bodies (p value=0.24). The rate of major complications was higher among rigid bronchoscopy (9.2 % vs. 0%, p =0.047). From 2017 onwards, after implementation of the flexible bronchoscopy for removal of foreign bodies, 64 procedures were performed; 33 (51.6%) flexible and 31 (48.4%) rigid. Procedure length was found to be shorter via flexible bronchoscopy (42 vs 58 minutes, p = 0.016). No significant difference was found in LOS. Conclusion: Flexible bronchoscopy is an efficient and safe method for removal of inhaled foreign bodies in children, with shorter procedure time. It may be the primary procedure for removal of inhaled foreign bodies.
Rigid bronchoscopy
Flexible bronchoscopy
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Nonasphyxiating foreign-body aspiration in adults can be difficult to diagnose because the symptoms are nonspecific and chest x-rays may be normal due to organic composition of the foreign bodies. The diagnosis is often made via flexible bronchoscopy; however, debate remains as to whether rigid or flexible bronchoscopy is the optimal method of extraction. The authors describe a patient who was initially referred for assessment of a calcified left mainstem bronchus mass identified only on computed tomography scan of the thorax. The patient underwent flexible bronchoscopy and was discovered to have a bone fragment wedged in the bronchus for a duration of 22 years, which was successfully removed via rigid bronchoscope.
Flexible bronchoscopy
Foreign body aspiration
Right Main Bronchus
Thorax (insect anatomy)
Presentation (obstetrics)
Rigid bronchoscopy
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Abstract Background: A flexible bronchoscopy is an essential tool that is globally used for the diagnosis and treatment of Broncho-pulmonary diseases. However the indication and outcome of flexible bronchoscopy has not been widely documented in majority of low resource settings. Objective: To determine the indications and outcome of flexible bronchoscopy (FB) at Muhimbili National Hospital (MNH). Methodology: A cross sectional analytical study was conducted for a period of 12months. Details involving indications and outcome of flexible bronchoscopy includes; bronchoscopy findings, therapeutic value, diagnostic yield, and early procedural related complications together with their demographic data were documented after each procedure followed by analysis using SPSS version 25. Results: Among 151 patients underwent flexible bronchoscopy 76(50.3%) were male and 75(49.7%) were female. The median age of 58 years with IQR (43, 65). Among the indications of flexible bronchoscopy, Cough and hemoptysis were the leading by 82.1% and 25.2% respectively. On the other hand hyperemic mucosa (31.1%) and endobronchial mass (21.2%) constituted the majority of the bronchoscopy findings. The overall diagnostic yield was 34.3% and procedural related complications was 18.54%. Among the indications for flexible bronchoscopy, the hemoptysis was associated with procedure related complications by 31.6% (p-value<0.020, OR 2.779). Among sampling technique of flexible bronchoscopy, the endobronchial biopsy and BAL sampling technique were associated with procedure related complications by 39.5 %( p-value<0.001, OR 4.393) and 14.7 %( p-value<0.005, OR 1.870) respectively Conclusion: We have demonstrated that flexible bronchoscopy is a safe and reliable procedure in diagnosis of respiratory maladies including MTB at Muhimbili National Hospital.
Flexible bronchoscopy
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BACKGROUND/HYPOTHESIS: Recommendations regarding management of foreign body (FB) aspiration in childhood have not substantially been modified since 1897 when Gustav Kilian first described the technique how to extract FBs by rigid bronchoscopy. Many paediatric pulmonology centers have adapted a two-step-procedure: First, to explore the airways by flexible bronchoscopy in case of suspicion of a FB aspiration, and then, if confirmed, to switch to rigid bronchoscopy for FB removal. In recent years, instruments have been developed especially for FB removal by flexible bronchoscopy. We hypothesize that it is no longer necessary to routinely pursue the two-step procedure. CASE: We present the case of a 2-year-old boy who aspirated a peanut. In order to exemplarily share our experiences regarding the modern technique, we display serial photographs from the video taken during the procedure of FB removal by specialized instruments for flexible bronchoscopy. In our center, this flexible technique has developed into the usual method of choice; only in rare cases it is necessary to switch to a rigid bronchoscopy procedure. DISCUSSION: There are only few reports on the novel flexible method for FB removal in children. A safe one-step procedure with flexible bronchoscopy offering both a diagnostic and a therapeutic potential appears to be an advantageous method for the management of our young patients. We suggest to compile and analyze paediatric pulmonologists9 experiences with the new technique, in order to finally formulate recommendations for the most advisable first-line procedure of bronchial FB removal in children.
Rigid bronchoscopy
Flexible bronchoscopy
Foreign body aspiration
Pulmonology
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