Usefulness of endobronchial ultrasound (EBUS) in the diagnosis of peripheral pulmonary lesions in a general hospital.

AIM: To investigate the efficiency of guided bronchoscopy compared to blind techniques in the study of non-visible pulmonary lesions. MATERIALS AND METHODS: A one-year, retrospective, study was conducted comparing two populations: Biopsies were either performed conventionally (FB-B) with the help of static images and the second where biopsies were performed after guidance (FB-EBUS). A 20-MHz radial-type ultrasound probe was used to obtain images. Sampling techniques, like bronchial brushing and transbronchial biopsies, were conducted in both populations by two separate bronchoscopists. If diagnosis was not achieved a surgical biopsy or observation followed. RESULTS: Forty patients appeared with non-visible lesions and were included in this study. Twenty were examined with the use of FB-EBUS and in 20 cases FB-B was conducted. At the FB-EBUS population a pathologic lesion was visualized in 16 cases (80%) and in 15 cases (75%) a diagnosis was achieved. All lesions that weren't visualized had a diameter less than 30 mm. At the FB-B population a diagnosis was achieved in 11 cases (55%). In pulmonary lesions with a diameter more than 30 mm, the diagnostic yield was 87, 5% using guidance and 61, 5% using FB-B and in lesions less than 30 mm 66, 67% and 42, 85% respectively. Moreover, left lower lobe was the most promising to obtain a diagnosis. CONCLUSION: Our results suggest that in patients with a non-visible pulmonary lesion a diagnostic strategy involving the choice of EBUS-guided biopsy is a reasonable and effective choice.

The role of endobronchial ultrasound in lung cancer diagnosis and staging: a comprehensive review.

Endobronchial ultrasound (EBUS) technology is a relatively new bronchoscopic method of visualizing the tracheobronchial tree, the surrounding pulmonary parenchyma, and the mediastinal structures, with a particular role in lung cancer diagnosis, staging, and treatment. There are 2 types of probes used in EBUS: the peripheral or radial probe (RP) and the linear or convex probe (CP) EBUS, which have technical differences and distinct diagnostic abilities. Both are used for EBUS-guided biopsies and transbronchial needle aspirations (TBNA), which increases the diagnostic yield over conventional bronchoscopic techniques, thus providing advanced information on staging, diagnosis, and treatment. Complications of EBUS are rare, and they are usually related to the underlying biopsy procedure and the operator's experience. EBUS examination duration is usually short, and it can be performed as an outpatient procedure. Interestingly, EBUS combinations with other current and evolving techniques, eg, electromagnetic navigation, are feasible and have a role in therapeutic interventions and molecular diagnostics. In conclusion, EBUS is a safe and accurate technique that is comparable with current criterion standard procedures, eg, mediastinoscopy. More training is required for the vast majority of respiratory physicians, and precise diagnostic algorithms are needed so that more patients benefit from this development.

Fatal Hemoptysis due to Chronic Cavitary Pulmonary Aspergillosis Complicated by Nontuberculous Mycobacterial Tuberculosis.

A 51-year-old man, with a history of severe COPD and bilateral pneumothorax, who was under treatment for pulmonary tuberculosis due to mycobacterium avium, was admitted due to high-grade fever, weight loss, cough, and production of purulent sputum, for almost one month without any special improvement despite adequate antibiotics treatment in outpatient setting. A CT scan revealed multiple consolidations, fibrosis, scaring, and cavitary lesions in both upper lobes with newly shadows which were fungus balls inside them. Aspergillus flavius was isolated in three sputum samples, a diagnosis of chronic cavitary pulmonary aspergillosis was made, and treatment with intravenous amphotericin B was started. An initially clinical improvement was noted, and a first episode of minor hemoptysis was treated with conservative measures. Unfortunately a second major episode of hemoptysis occurred and he died almost immediately. Aspergilloma is defined as the presence of a fungus ball inside a preexisting pulmonary cavity or dilated airway and is one of the clinical conditions associated with the clinical spectrum of pulmonary colonization. Tuberculosis is the most common underling disease. Hemoptysis is the most common symptom. Antifungal antibiotics, surgical interventions, bronchial arteries embolization, and intracavity infusion of antibiotics have been proposed without always adequate sufficiency.

Potential interaction between telithromycin and warfarin.

OBJECTIVE: To report a case of warfarin-telithromycin interaction resulting in an elevated international normalized ratio (INR) and hemoptysis. CASE SUMMARY: A 73-year-old white man developed an elevated INR and mild hemoptysis as a result of an interaction between warfarin and telithromycin 800 mg/day. The INR increased from 3.1 before telithromycin was started to 11 after 5 days of telithromycin therapy. The INR returned to the therapeutic range 4 days after telithromycin was discontinued. DISCUSSION: Telithromycin is the first member of the macrolide subclass of ketolides and offers potential advantages over traditional macrolides/azalides for community-acquired respiratory tract infections caused by macrolide-resistant pathogens. As of July 16, 2004, bleeding complications and an increased INR as a result of an interaction between warfarin and telithromycin have not been described. Although the mechanism for this interaction remains unknown, it is suspected that it is a result of the inhibition of the metabolism of the R-isomer of warfarin, which is metabolized predominantly by CYP1A2 and less by CYP3A4. Further research is required to elucidate this issue. An objective causality assessment revealed that this adverse drug event as a result of the warfarin and telithromycin interaction was probable. CONCLUSIONS: We recommend close monitoring of INR levels in patients on warfarin who receive telithromycin therapy in an effort to control and prevent bleeding complications.