Distinguishing Bronchoscopic Changes of Mitral Stenosis From Carcinoma In Situ With Narrow Band Imaging.

A 75-year-old woman presented with minor hemoptysis. Past history included atrial fibrillation and rheumatic mitral stenosis. Bronchoscopy revealed a striking abnormality of widespread dilated mucosal and submucosal vessels. Initially the concern was whether there was widespread endobronchial malignancy; however, narrow band imaging (NBI) demonstrated the symmetrical uniform nature of the vessels. In addition, there was a focal area of in situ carcinoma with classic NBI features of malignancy. Following external-beam radiation therapy, NBI features had dramatically changed in the treated area which was now biopsy negative. The case highlights the utility of NBI in identifying endobronchial microvessel appearance even where there are widespread nonmalignant vessel changes in the bronchial mucosa.