[The contribution of widely used devices in the diagnosis of peripheral pulmonary lesions in patients presenting with respiratory distress].

PURPOSE: We retrospectively reviewed the contribution of widely used devices such as the standard fiberoptic bronchoscope in the diagnosis of peripheral pulmonary lesions (PPLs) in patients who presented with respiratory distress. SUBJECT: We performed bronchoscopy for 106 PPLs in January-December 2007, and diagnosed access to the lesions to be difficult. METHOD: For these lesions, we applied Sasada transbronchial angled forceps (STAF), transbronchial needle aspiration cytology (TBAC), thin bronchoscopy, and ultra-thin bronchoscopy, which are widely used devices, after routinely performing biopsy with standard forceps and saved each specimen separately, and finally compared the pathological diagnosis. RESULTS: The diagnostic yield obtained with specimens using standard forceps was 36.8%; however, the overall diagnosis was improved to 70.8% after we used these other devices and methods. We achieved diagnosis with STAF (10 lesions), followed by thin bronchoscopy (5 lesions), and ultra-thin bronchoscopy (14 lesions). No diagnosis was made by TBAC. CONCLUSION: We conclude that these widely employed devices can contribute to improvements in the diagnosis of cases of respiratory distress in which arrival to the lesions is difficult.

[A case of severe COPD associated with tracheo-bronchial stenosis, treated with non-invasive positive pressure ventilation].

A 76-year-old man was admitted with acute exacerbation of COPD. He was administered bronchodilators, antibiotics and oral corticosteroids. Although his cough, sputum, fever and the laboratory data improved. wheezing and dyspnea remained. The chest CT revealed severe stenosis of the trachea and both main bronchi, which was thought to be the cause of the symptoms, and similar to the condition of "excessive dynamic airway collapse (EDAC)". We treated him with NPPV and his symptoms improved and he returned home. "EDAC"-like tracheobronchial stenosis with COPD treated with NPPV is rare.