RESUMEN
BACKGROUND AND OBJECTIVE: Many interventional tools for airway disorders can now be delivered via flexible bronchoscopy (FB), including neodymium-yttrium aluminium garnet laser, electrocautery, argon plasma coagulation, cryotherapy, balloon dilatation and metal or hybrid stents. Comparison of outcomes for patients undergoing rigid bronchoscopy (RB) with those treated using FB highlights the usefulness of the FB approach. METHODS: A retrospective medical record review of all interventional bronchoscopy procedures performed at Lahey Clinic over the past 8 years was conducted. Patients were categorized into two groups according to the procedure used, that is, RB (251 patients), and FB (161 patients) groups. Patients with malignancies were included as a separate subgroup, comprising 178 RB and 117 FB patients. For every procedure, the location of the lesion, patient survival from the first interventional procedure performed, and in patients with malignancy, additional treatments received such as chemotherapy and radiation were recorded. RESULTS: Ninety per cent of RB procedures were performed in patients with tracheal or main stem lesions, while over half the patients undergoing FB had more distal lesions. A trend towards increasing use of FB for interventional procedures in recent years was noted. CONCLUSIONS: FB is a valuable alternative to RB for treating less advanced malignant disease or distal airway lesions.
Asunto(s)
Enfermedades Bronquiales/terapia , Broncoscopios , Broncoscopía , Enfermedades de la Tráquea/terapia , Anciano , Enfermedades Bronquiales/mortalidad , Enfermedades Bronquiales/patología , Estudios de Cohortes , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents , Análisis de Supervivencia , Enfermedades de la Tráquea/mortalidad , Enfermedades de la Tráquea/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Severe post tracheostomy (PT) and post intubation (PI) tracheal stenosis is an uncommon clinical entity that often requires interventional bronchoscopy before surgery is considered. We present our experience with severe PI and PT stenosis in regards to patient characteristics, possible risk factors, and therapy. METHODS: We conducted a retrospective chart review of 31 patients with PI and PT stenosis treated at Lahey Clinic over the past 8 years. Demographic characteristics, body mass index, co-morbidities, stenosis type and site, procedures performed and local treatments applied were recorded. RESULTS: The most common profile of a patient with tracheal stenosis in our series was a female (75%), obese (66%) patient with a history of diabetes mellitus (35.4%), hypertension (51.6%), and cardiovascular disease (45.1%), who was a current smoker (38.7%). Eleven patients (PI group) had only oro-tracheal intubation (5.2 days of intubation) and developed web-like stenosis at the cuff site. Twenty patients (PT group) had undergone tracheostomy (54.5 days of intubation) and in 17 (85%) of them the stenosis appeared around the tracheal stoma. There was an average of 2.4 procedures performed per patient. Rigid bronchoscopy with Nd:YAG laser and dilatation (mechanical or balloon) were the preferred methods used. Only 1(3.2%) patient was sent to surgery for re-stenosis after multiple interventional bronchoscopy treatments. CONCLUSION: We have identified putative risk factors for the development of PI and PT stenosis. Differences in lesions characteristics and stenosis site were noted in our two patient groups. All patients underwent interventional bronchoscopy procedures as the first-line, and frequently the only treatment approach.
Asunto(s)
Intubación Intratraqueal/efectos adversos , Estenosis Traqueal/etiología , Traqueostomía/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Broncoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Estenosis Traqueal/epidemiología , Estenosis Traqueal/terapia , Resultado del TratamientoRESUMEN
Bronchial diseases alter the color and structural characteristics of the pulmonary mucosa through changes in blood flow, epithelial thickening, and abnormal cell growth. Current analysis of these subtle changes includes visual interpretation of the airway color and topography through bronchoscopy procedures, and quantitative multidetector-x-ray-computed-tomography (MDCT)-based structural analysis, each affording valuable insights to the health of the lungs. The fusion of the bronchoscopy and MDCT image data promises to provide a synergistic data set exhibiting both mucosal color and topography crucial to fostering an understanding of airway structure and function. A real-time airway color analysis imaging system is developed and utilized to perform pulmonary mucosal color assessment in healthy volunteers with subsequent comparative studies performed in example disease states. Our results indicate that macro-optical digital bronchoscopes with appropriate image analysis may have a significant impact on understanding bronchial diseases. To ensure the correct interpretation of scene content, which is critical in the assessment of airway topography, we are developing methods of extracting 3-D structure from 2-D bronchoscope images utilizing MDCT imaging techniques. The resulting 3-D true-color images of the pulmonary mucosa facilitate the combination of mucosal color and topography analysis as well as region of interest localization within the airway tree.
Asunto(s)
Broncoscopía/métodos , Colorimetría/métodos , Imagenología Tridimensional/métodos , Neoplasias Pulmonares/diagnóstico , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Técnica de Sustracción , Tomografía Computarizada por Rayos X/métodos , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/fisiopatología , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Integración de SistemasRESUMEN
We present the case of an 84-year-old man with nonmassive hemoptysis and an obstructing endobronchial mass who was referred for rigid bronchoscopy and biopsy of the lesion. We illustrate how the pulsatile movement of his endobronchial lesion could be differentiated by convex probe endobronchial ultrasound bronchoscopy to be a vascular lesion rather than an endobronchial mass or tumor. Although convex probe endobronchial ultrasonography has many mediastinal applications, it has yet to be used to characterize endobronchial masses. We describe the first case of using convex probe endobronchial ultrasonography in the diagnosis of a left upper lobe pulmonary artery aneurysm presenting as an endobronchial mass.
Asunto(s)
Aneurisma/diagnóstico por imagen , Neoplasias de los Bronquios/diagnóstico , Broncoscopía/métodos , Endosonografía/métodos , Arteria Pulmonar/diagnóstico por imagen , Anciano de 80 o más Años , Aneurisma/diagnóstico , Neoplasias de los Bronquios/diagnóstico por imagen , Diagnóstico Diferencial , Progresión de la Enfermedad , Resultado Fatal , Hemoptisis/diagnóstico , Hemoptisis/etiología , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Arteria Pulmonar/patología , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodosRESUMEN
The triad of pleural effusion, ascites, and benign ovarian fibroma is rare. Often, the ovarian mass is accompanied by elevated cancer antigen-125, both in serum and in pleural and peritoneal fluid. When benign ovarian fibroma is associated with ascites and/or pleural effusion it is termed Meigs syndrome. Meigs syndrome, however, is a diagnosis of exclusion only after ovarian carcinoma is ruled out. The presentation of symptoms and radiographic findings mimics that of metastatic ovarian cancer, creating a significant clinical challenge. We report a case of a patient with recurrent pleural effusions and an ovarian mass, with the outside hospital pleural fluid cytology report describing ovarian cancer. Although initially suspected to have metastatic ovarian cancer, subsequent workup of the patient's pleural and peritoneal fluid revealed no carcinoma. Surgical biopsy of the ovarian mass showed the presence of a benign tumor (fibroma). Postovarian mass resection, the patient showed resolution of pleural and peritoneal effusions. We describe our case in detail and review the literature on Meigs syndrome.
Asunto(s)
Ascitis/complicaciones , Fibroma/diagnóstico , Neoplasias Ováricas , Derrame Pleural/complicaciones , Ascitis/diagnóstico por imagen , Antígeno Ca-125/sangre , Diagnóstico Diferencial , Femenino , Humanos , Síndrome de Meigs/diagnóstico , Persona de Mediana Edad , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Malignant pleural effusion is a common cause of morbidity and mortality in patients suffering from end-stage metastatic cancer. Malignant pleural effusion is associated with a shortened survival of 3 to 12 months after diagnosis, with 1- and 6-month mortality rates of 54% and 85%, respectively. Nearly all medical management in these patients is directed toward palliation of symptoms caused by pleural fluid accumulation. Options for treatment are repeated thoracentesis, use of chronic indwelling catheters, pleurodesis, and pleuroperitoneal shunts. Associated procedure risks include infection, bleeding, pneumothorax, and respiratory failure. Transthoracic ultrasound use is advocated to minimize procedural risks for thoracentesis and indwelling pleural catheter (IPC) placement. Most patients with advanced metastatic cancer and pleural effusion are not suitable candidates for pleuroscopy-delivered pleurodesis. Therefore, IPC is more commonly chosen to palliate respiratory symptoms related to pleural fluid accumulation from pleural tumor burden. Although pleural catheter complications are low, malignant seeding of the pleural tract can occur. Transthoracic ultrasound use to determine the presence of pleural tract seeding in conjunction with guided percutaneous biopsy has not been described. We report the use of ultrasound-guided percutaneous biopsy to diagnose metastatic seeding of an IPC.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Siembra Neoplásica , Derrame Pleural Maligno/cirugía , Neoplasias Pleurales/secundario , Neoplasias del Recto , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Neoplasias Pleurales/patologíaRESUMEN
Pulmonary giant cell carcinoma is a rare subtype of sarcomatoid carcinoma. Pseudomyxoma peritonei (PMP) is a rare condition in which gelatinous material accumulates within the peritoneal cavity. It is believed PMP arises from a primary appendiceal mucinous neoplasm that perforates the gut, causing mucinous ascites. There are sporadic reports of PMP associated with neoplasms of other organs, rarely the lung. Here, we report on a 60-year-old woman with pulmonary giant cell carcinoma associated with PMP. She presented with progressive dyspnea and abdominal distention. Abdominal computed tomography revealed moderately dense ascites without an obvious mass. Chest computed tomography revealed a large, solitary right lower-lobe lung mass. She underwent transbronchial fine-needle aspiration of the mass, and was diagnosed with pulmonary giant cell carcinoma. The ascites showed scattered malignant cells in a background of mucin, confirming PMP. To our knowledge, this is the first report of pulmonary giant cell carcinoma associated with PMP.
Asunto(s)
Carcinoma de Células Gigantes/secundario , Neoplasias Pulmonares/patología , Pulmón/patología , Neoplasias Peritoneales/secundario , Seudomixoma Peritoneal/patología , Ascitis/diagnóstico por imagen , Biopsia con Aguja Fina , Líquido del Lavado Bronquioalveolar/citología , Broncoscopía , Carcinoma de Células Gigantes/diagnóstico por imagen , Disnea , Femenino , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/diagnóstico por imagen , Persona de Mediana Edad , Paracentesis/métodos , Neoplasias Peritoneales/diagnóstico por imagen , Neoplasias Peritoneales/patología , Seudomixoma Peritoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Pulmonary fistulas are associated with a high risk of morbidity and mortality. We report 2 cases of alveolopleural fistulas, 1 in a patient with chronic hydropneumothorax and the other after wedge biopsy. In both cases, Watanabe spigot (Novatech, Grasse, France) was placed for bronchial occlusion with short-term success.