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 bronchol...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.展开更多
Interstitial lung diseases (ILD’s) are a group of heterogenous chronic, ferociously progressive lung diseases. The aetiology of the aforementioned diseases is not always recognisable. The diagnosis of these dismal di...Interstitial lung diseases (ILD’s) are a group of heterogenous chronic, ferociously progressive lung diseases. The aetiology of the aforementioned diseases is not always recognisable. The diagnosis of these dismal diseases is a vivid challenge for the physicians. Through the intervening years different diagnostic algorithms have been implemented towards more accurate outcome. Different types of ILD’s demand diverse diagnostic approaches. In the latest years a novel diagnostic mini invasive approach seems to gain continuously terrain towards the diagnosis of ILD’s. Transbronchial cryobiopsy may be the Holy Grail in the diagnosis of these diseases or a misleading diagnostic tool in this challenging field.展开更多
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...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.展开更多
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)gu...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.展开更多
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 allow...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.展开更多
Pulmonary lymphangioleiomyomatosis(LAM)is a rare cystic lung disease that targets women during their reproductive years.A confident diagnosis can often be based on clinical grounds,but diagnostic certainty requires pa...Pulmonary lymphangioleiomyomatosis(LAM)is a rare cystic lung disease that targets women during their reproductive years.A confident diagnosis can often be based on clinical grounds,but diagnostic certainty requires pathological analysis.Although surgical lung biopsy is considered the gold standard for obtaining tissue in patients with diffuse lung disease,it is also associated with higher morbidity and mortality than alternative,less invasive techniques.The objective of our study was to examine the utility of transbronchial biopsy in the diagnosis of LAM.We conducted two online surveys of over 1000 LAM patients registered with the LAM Foundation who were accessible by email.Transbronchial biopsy specimens were subsequently collected and reviewed by an expert pathologist to validate the diagnosis.We found that transbronchial biopsy has a yield of approximately 60% in patients with LAM.We conclude that transbronchial biopsy may be a safe and effective method for establishing the diagnosis of LAM,obviating the need for surgical lung biopsy in more than half of LAM patients.展开更多
基金by The publication has been supported by Ministry of Health of the Czech Republic,No.MH CZ-DRO FNBr 65269705The Czech Pneumological and Phthisiological Society(open access publication fee grant).
文摘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.
文摘Interstitial lung diseases (ILD’s) are a group of heterogenous chronic, ferociously progressive lung diseases. The aetiology of the aforementioned diseases is not always recognisable. The diagnosis of these dismal diseases is a vivid challenge for the physicians. Through the intervening years different diagnostic algorithms have been implemented towards more accurate outcome. Different types of ILD’s demand diverse diagnostic approaches. In the latest years a novel diagnostic mini invasive approach seems to gain continuously terrain towards the diagnosis of ILD’s. Transbronchial cryobiopsy may be the Holy Grail in the diagnosis of these diseases or a misleading diagnostic tool in this challenging field.
基金Supported by Natural Science Foundation of Liaoning Province,No.2021-MS-287。
文摘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.
基金Supported by The Natural Science Foundation of Jilin Province,No.20200201475JC.
文摘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.
文摘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.
文摘Pulmonary lymphangioleiomyomatosis(LAM)is a rare cystic lung disease that targets women during their reproductive years.A confident diagnosis can often be based on clinical grounds,but diagnostic certainty requires pathological analysis.Although surgical lung biopsy is considered the gold standard for obtaining tissue in patients with diffuse lung disease,it is also associated with higher morbidity and mortality than alternative,less invasive techniques.The objective of our study was to examine the utility of transbronchial biopsy in the diagnosis of LAM.We conducted two online surveys of over 1000 LAM patients registered with the LAM Foundation who were accessible by email.Transbronchial biopsy specimens were subsequently collected and reviewed by an expert pathologist to validate the diagnosis.We found that transbronchial biopsy has a yield of approximately 60% in patients with LAM.We conclude that transbronchial biopsy may be a safe and effective method for establishing the diagnosis of LAM,obviating the need for surgical lung biopsy in more than half of LAM patients.
