Open Bronchus Sign on CT: A Risk Factor for Hemoptysis after Percutaneous Transthoracic Biopsy
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Objective:We hypothesized that open bronchi within target pulmonary lesions are associated with percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis.We sought to analyze and compare patient characteristics and target features as well as biopsy-related factors between patients with and without PTNB-related hemoptysis.Materials and Methods: We retrospectively analyzed 1484 patients (870 males and 614 females; median age, 66 years) who had undergone 1569 cone-beam CT (CBCT)-guided PTNBs.Patient characteristics (sex, age, and pathologic diagnosis), nodule features (nodule type, size, location, and presence of an open bronchus in target nodules), and biopsy-related factors (biopsy needle size, pleura-to-target distance, blood test results, open bronchus unavoidability [OBU] index, etc.) were investigated.OBU index, which was assessed using the pre-procedural CBCT, was a subjective scoring system for the probability of needle penetration into the open bronchus.Univariate analysis and subsequent multivariate logistic regression analysis were conducted to reveal the independent risk factors for PTNB-related hemoptysis.For a subgroup of nodules with open bronchi, a trend analysis between the occurrence of hemoptysis and the OBU index was performed.Results: The independent risk factors for hemoptysis were sex (female; odds ratio [OR], 1.918; p < 0.001), nodule size (OR, 0.837; p < 0.001), open bronchus (OR, 2.101; p < 0.001), and pleura-to-target distance (OR, 1.135; p = 0.003).For the target nodules with open bronchi, a significant trend between hemoptysis and OBU index (p < 0.001) was observed. Conclusion:An open bronchus in a biopsy target is an independent predictor of hemoptysis, and careful imaging review may potentially reduce PTNB-related hemoptysis.Keywords:
Nodule (geology)
Right Main Bronchus
Foreign body (FB) aspiration remains a serious health problem, particularly in children. The complications due to occlusion by FB or related to procedures for removal can lead to morbidity and mortality. Most of the FBs are located in the unilateral bronchus, however, the organic FB can be multiple or bilaterally located when children chewed the FB. Here, we present a case of successful retrieval of bilateral bronchial FBs. Preoperatively, FB in the left main bronchus was diagnosed, however, FB of the right upper bronchus was not definitive on X-ray and CT scan. During the rigid bronchoscopy, occult FB in the right upper bronchus was detected and successfully removed.
Right Main Bronchus
Left main bronchus
Foreign body aspiration
Occult
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Abstract Background Therapeutic bronchoscopy is one of the effective methods in the treatment and management of malignant central airway stenosis (MCAS). However, restenosis after therapeutic bronchoscopy frequently occurs and severe restenosis (SR) can be life-threatening. Therefore, this study aimed at investigating the risk factors for SR after therapeutic bronchoscopy. Methods The data of 233 consecutive cases with MCAS who were subjected to therapeutic bronchoscopy between 2015 and 2020 at a tertiary hospital were collected. Patients were divided into SR group and non-SR during 6 months after therapeutic bronchoscopy. Multiple logistic regression analysis was performed to determine the risk factors for SR. Results SR during 6 months after therapeutic bronchoscopy occurred in 39.5% (92/233) of patients. The location and the initial degree of MCAS were associated with SR, as assessed by multiple logistic regression analysis ( P < 0.05). The risk of SR after therapeutic bronchoscopy in the left main bronchus, right main bronchus, and right intermediate bronchus increased, compared to the risk when of MCAS was located in the trachea (OR (95% CI) of 8.821 (1.850-25.148), 6.583 (1.791–24.189), and 3.350 (0.831–13.511), respectively). In addition, the initial degree of MCAS was positively associated with an increased risk of SR (OR 1.020; 95% CI 1.006–1.035). Conclusions MCAS located in the left main bronchus, right main bronchus and right intermediate bronchus, as well as the higher initial degree of MCAS were independent risk factors for SR during 6 months after therapeutic bronchoscopy.
Right Main Bronchus
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Objective To estimate the value of bronchoscopy in diagnosis of tracheobronchial tuberculosis. Methods 216 patients who had clinical presentations and examination of bronchoscopy findings diagnosed by using a standard or ultrathin bronchoscope were retrospectively investigated. Results Bronchoscopic findings: edematous-hyperemic type in 67 cases (31%); ulcerative type in 52 cases (24.1%); granular type in 78 (36.1%) and fiberostenotic type in 19 cases (8.8%). Localization of lesions: there were 242 lesions founded in 216 patients, trachea, 8 (3.3%); carina, 3 (1.2%); carina accompanied with left main bronchus, 4 (1.7%); left main bronchus, 65 (26.9%); left-upper lobar bronchus, 31 (12.8%); left lingual lobar bronchus, 18 (7.4%); left-lower lobar bronchus, 22 (9.1%); right main bronchus, 11 (4.5%); right-upper lobar bronchus, 28 (11.8%); right middle lobar bronchus, 36 (14.9%); right-lower lobar bronchus, 16 (6.6%). 21 patients (9.7%) contained two or more lesions simultaneously. Conclusion Tracheobronchial tuberculosis was lack of specific clinical features, and the bronchoscopic approach is necessary. Bronchial biopsy should be the most reliable and accurate step to get the definite diagnosis.
Right Main Bronchus
Left main bronchus
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Flexible airway bronchoscopy is an accepted and frequently performed procedure in the evaluation of children with known or suspected airway and lung parenchymal disorders. Between 2012 and 2015, retrospective analysis of 134 flexible bronchoscopies was done in Children’s Hospital, Cairo University, as regards demographic profile, clinical and radiological presentation and diagnostic indication. The results were analyzed on the basis of bronchoscopy inspection, conclusion and future recommendations. Patients indicated for flexible bronchoscopy presented clinically with unilateral diminished breath sounds in 24.6%, unilateral bronchial breathing in 17.9%, recurrent lower respiratory tract infection in 11.2%, persistent cough in 4.5% and stridor in 9.7%, others showed radiological findings in the form of unilateral hyperinflation in 9%, bronchiectasis in 3.7% and unilateral wheezes in 1.5%. Out of 134 patients undergoing bronchoscopy, 38% had foreign body (FB) in the airways although only 7.5% of patients had recalled a previous history of FB aspiration (15.6% in the trachea, 52% in the right side and 31.3% in the left side, among those patients 60.8% were males while 39.2% were females), 14.1% had tracheal abnormality, 26.8% had post inflammatory changes, 56.7% had right bronchus abnormality, 55.2% had left bronchus abnormality, bronchoalveolar lavage (BAL) was done in 30.6% of patients, FB was successfully removed in 15.6% of patients and further cardiothoracic intervention was needed in 29.8% of patients. The combination of history, physical examination, and chest X-ray findings are crucial when investigating a child with suspected foreign body aspiration. Flexible bronchoscopy is effective for diagnostic and sometimes therapeutic purpose of problems in the upper and lower respiratory airways in children, with a high success rate as it significantly reduces the rate of negative rigid bronchoscopies and ultimately saves the child from undergoing an unnecessary procedure.
Right Main Bronchus
Abnormality
Foreign body aspiration
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Objective To explore the clinical characteristics,diagnosis and treatment for airway foreign bodies with electron-bronchoscopy in children.Methods We retrospectively summarized the data about airway foreign bodies that diagnosed by electron-bronchoscopy.Results There were 60 airway foreign bodies diagnosed by electron-bronchoscopy.The ages was from 20 days to 17 years,and the course was from 6 hours to 7 years.38 airway foreign bodies were located underⅡ or Ⅲ grade bronchus.Alimentary foreign bodies were 52 cases.Conclusion Trachea and bronchus foreign bodies are one of the pathogeny in chronic reactive respiratory diseases and they are discovered by electron-bronchoscopy.Electron bronchoscope plays an important role in the diagnosis and treatment to children trachea and bronchus foreign bodies.
Left main bronchus
Rigid bronchoscopy
Right Main Bronchus
Flexible bronchoscopy
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An experimental study of tracheal reconstruction after lower tracheal resection using the inverted bronchus was performed in 8 dogs. After right upper lobectomy, the five cartilage rings of the lower trachea, ending three cartilage rings above the carina, was circumferentially resected; the right bronchus was transected just above the right second carina, the portion of the transected trachea above the carina was closed, and the right bronchus was inverted. The peripheral end of the upper trachea was anastomosed to the inverted right bronchus, and the intermediate bronchus was anastomosed to the lateral wall of the left bronchus. After completion of the airway reconstruction, the anastomotic site was wrapped with an omental flap. Although anastomotic complication were observed in two dogs, all the dogs survived the operation. Bronchoscopically and histopathologically, the findings for the inverted bronchus were almost normal three to four weeks after the operation. The clinical relevance of such a tracheal reconstruction is discussed.
Right Main Bronchus
Left main bronchus
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Right Main Bronchus
Foreign body aspiration
Main Bronchus
Demographics
Flexible bronchoscopy
Left main bronchus
Foreign Body Removal
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Objective:This article explored the value of CT expression and diagnosis of foreign body in the trachea and bronchus.Methods:The results of CT scanning of 50 cases of foreign body in the trachea and bronchus were retrospectively analysed,which were all verification by clinical and drawing out with fibrescope.Results:4 cases of foregign body in the trachea,31 cases of foreign body in the right major bronchus,15 cases of foreign body in the left major bronchus.CT expression:①the self of foreign body;②localized bronchus obstruction,the bronchus under it inflated air or slightly dilated;③mediastinal displacement andtwo margins;④thoraxtwo margins;⑤emphysema;①and ② are the most imporant of them.Conclusion:CT scanning not only makes differential diagnosis but also shows directly the self of foreign body,which is superior to ordinary x ray examination.
Right Main Bronchus
Left main bronchus
Foreign body aspiration
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A 40 year old female underwent successful pulmonary sparing resection of an adenoidcystic carcinoma (ACC) of the tracheal carina involving the right main bronchus with a size of 3 cm. The operative technique: A right thoracotomy was performed. The trachea and main bronchi were dissected. The left main bronchus was transected about 1 cm from the carina. The airway management was intermittent conventional ventilation via the operative field. The right bronchus was transected at the upper lobe and the intermediated bronchus 1.0 cm from the tumor margin. Finally the trachea was transected 1 cm above the tumor margin. The proximal end of the trachea was anastomosed end to end to the distal left main bronchus. The intermediate bronchus was incised vertically and 2/3 of the circumferential distal end of the upper lobe bronchus was anastomosed end to side to the incisional line of the intermediate bronchus. Then the neo-bronchial orifice of the right bronchus was anastomosed end to side to the lateral wall of the trachea 1 cm above the previous tracheal anastomosis. The patient recovered well from the operation and was discharged within 2 weeks after the operation. Early postoperative fiberoptic bronchoscopy revealed adequated anastomotic bronchial lumens and minimal granulation tissue at the left bronchial anastomosis.
Right Main Bronchus
Thoracotomy
Main Bronchus
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