Cerebral air embolism complicating transbronchial lung biopsy: A case report

BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Increases the Yield of Transbronchial Lung Biopsy for the Evaluation of Peribronchial Lesions

Background： Due to absence of visible endobronchial target, the diagnostic yield of flexible bronchoscopy for peribronchial lesions has been unsatisfactory. Convex probe endobronchial ultrasound （CP-EBUS） has allowed for performing real-time transbronchial needle aspiration （TBNA） of enlarged hilar and mediastinal lymph nodes and therefore could also be used as a means of diagnosing proximal peribronchial lesions. Methods： We retrospectively analyzed the results related to 72 patients who underwent CP-EBUS for peribronchial lesions without endobronchial involvement and adjacent to three-grade bronchi based on chest computed tomography （CT） scan. We recorded the images during EBUS as well as the diagnostic results of TBNA and conventional-transbronchial lung biopsy/brush （C-TBLB/b）, and final diagnoses were based on pathologic analysis and follow-up. Results： In all cases, the mass was able to be identified using EBUS in 97.2% patients （70/72） who were performed with EBUS-TBNA ＋ C-TBLB/b. Sixty-six patients had a final diagnosis, 80.0% patients （56/70） had malignancies, and 14.3% patients （10/70） had benign disease. In malignancies, the diagnostic yield of C-TBLB/b was 57.1% （32/56） and in EBUS-TBNA was 85.7% （48/56）, whereas pathologic diagnosis reached 94.6% when EBUS-TBNA was combined with C-TBLB/b. C-TBLB/b ＋ EBUS-TBNA also exhibited stronger potency of histolytic diagnosis for malignancies than either EBUS-TBNA or C-TBLB/b alone. Furthermore, there are data supporting the value of EBUS-TBNA for the diagnosis of benign lung disease. Conclusion： The combined endoscopic approach with EBUS-TBNA and C-TBLB/b is an accurate and effective method for the evaluation of peribronchial lesions, with better results than using each technique alone.

Diagnosis based on electromagnetic navigational bronchoscopyguided biopsied peripheral lung lesions in a 10-year-old girl:A case report

BACKGROUND Electromagnetic navigational bronchoscopy(ENB)is an emerging diagnostic tool that enables practitioners to biopsy peripheral lung tissues that were previously only accessible under computed tomography(CT)guidance.However,few studies have investigated ENB use in children.Here,we report a case of a 10-yearold girl with peripheral lung lesions who complained of a 7-d persistent fever.She was diagnosed with Streptococcus parasanguinis infection based on findings obtained using ENB-guided transbronchial lung biopsy(TBLB).CASE SUMMARY A 10-year-old girl presented with constitutional symptoms of cough and fever of 7 days’duration.Chest CT scans detected peripheral lung lesions and no endobronchial lesions.TBLB performed under the guidance of an ENB Lungpro navigation system was safe,well-tolerated,and effective for biopsying peripheral lung lesions.Examination of biopsied samples indicated the patient had a pulmonary Streptococcus parasanguinis infection,which was treated with antibiotics instead of more invasive treatment interventions.The patient’s symptoms resolved after she received a 3-wk course of oral linezolid.Comparisons of pretreatment and post-treatment CT scans revealed absorption of some lung lesions within 7 mo of hospital discharge.CONCLUSION ENB-guided TBLB biopsying of peripheral lung lesions in this child is a safe,well-tolerated,and effective alternative to conventional interventions.

Two methods of lung biopsy for histological confirmation of acute fibrinous and organizing pneumonia:A case report

BACKGROUND Acute fibrinous and organizing pneumonia(AFOP)is a rare,noninfective lung disease,histologically characterized by a patchy distribution of intra-alveolar fibrin“balls”and organizing pneumonia.The clinical manifestations of AFOP are nonspecific.Diagnosis depends on pathology.Surgical lung biopsy is optimal for tissue sampling to diagnose AFOP.However,many patients have no tolerance to the operation,including mentally and physically.There is still no standard therapy for AFOP and the methods remain controversial.Therefore,further clinical attention and discussion are warranted.CASE SUMMARY A 53-year-old woman presented with fever,cough and dyspnea for 15 d.Antiinfective therapy was ineffective.Chest computed tomography showed bilateral patchy consolidation,especially in the lower lobes.We performed both ultrasound-guided transbronchial lung biopsy and ultrasound-guided percutaneous fine needle puncture at different lung lesion locations.Both samples supported the diagnosis of AFOP.The patient had a good clinical course after treatment with methylprednisolone,and no side effects of steroids.CONCLUSION Percutaneous needle biopsy combined with transbronchial lung biopsies may be a good choice in the absence of surgical biopsy.Methylprednisolone alone is effective in the treatment of idiopathic AFOP.

Chronic eosinophilic pneumonia with mucous plugs:case report

Chronic eosinophilic pneumonia （CEP）, a rare eosinophilic lung disease of unknown etiology,is characterized by peripheral blood eosinophilia, chest radiograph infiltrates, and prompt response to corticosteroid therapy. The first detailed description of CEP was described by Carrington et al in 1969. The usual symptoms are cough, dyspnea, fever, and weight loss. It is most often seen in middle aged woman and has a subacute onset. We report a case of CEP presenting with right lower lung infiltrates and mucus plugging that causing bronchus obstruction.