relationship between peak expiratory flow rate before bronchoscopy and arterial oxygen desaturation during bronchoscopy

A significant reduction in arterial blood oxygen saturation during fiberoptic bronchoscopy has been proved but it is not yet known whether all patients need supplemental oxygen during this procedure. The aim of study is to examine the relationship between peak expiratory flow rate [PEFR] before bronchoscopy and oxygen desaturation during bronchoscopy. Measurement of PEFR [% predicted] performed before bronchoscopy and arterial O2 desaturation was assessed with a pulse oximeter during bronchoscopy. Study performed in 66 patients with a median age 53 years, who had been referred to our bronchoscopy unit. None of the patients received supplemental oxygen before the procedure. Thirty nine cases [59%] had an episode of O2 desaturation during bronchoscopy. Of them 25 cases [38%] had sustained O2 desaturation, requiring oxygen therapy while 14 cases [21%] had momentary desaturation [< 20s] not requiring O2 therapy. Oxygen therapy was administered in 58% of cases with PEFR% < 60 and in 83% of cases with PEFR% less than 45 [P, 0.008 and 0.001, respectively]. We also observed a significant fall in mean O2 saturation during bronchoscopy [88 +/- 4%] compared to prebronchoscopy levels [95 +/- 2%] [P < 0.0001]. It is concluded that PEFR < 60% and especially < 45% is a reliable predictor of hypoxemia and the need to O2 therapy during bronchoscopy

[ value of endobronchial biopsy in diagnosis of pulmonary sarcoidosis]

Sarcoidosis is a multiorgan granulomatous disorder of undetermined etiology with 90% of patients exhibiting some degree of pulmonary involvement. Transbronchial Lung biopsies [TBLB] with fiberoptic bronchoscopy which demonstrate granuloma formation have been established as standard method for histological confirmation of sarcoidosis. In this study endobronchial biopsy [EBB] was used to assess the frequency of positive EBB findings in patients with pulmonary sarcoidosis. The study included 28 patients [Mean +/- SD age 41.8 +/- 11.64 and 55% female]. Transbronchial and endobronchial biopsy were done for all patients. Results of EBB were analyzed. EBB was positive in 53.5% of subjects and TBLB showed granuloma in 71.5% of cases. In 8 cases [28.5%] diagnosis was established only by EBB. Normal appearing endobronchial mucosa in 73.5% of cases was associated with positive EBB findings. Endobronchial involvement is common in sarcoidosis and EBB can safely increase the diagnostic value of fiberoptic bronchoscopy

Mucormycosis of the lung, a rare cause for lung cavitations. case report

Cavitary lung lesion is caused by serious lung pathology. Among rare causes is mucormycosis that should not be overlooked. High index of suspicion is necessary to avoid missed diagnosis especially in diabetic and immunosuppressed patients. We present two cases with lung mucormycosis diagnosis. Case 1: A 58 year old male with history of diabetes, presented with hemoptysis. Chest X ray [CXR] showed cavitation. Bronchial lavage revealed mucor hypha that was proved again with lobectomy. Case 2: A 39 year old female with history of chronic renal failure and lung cavitary lesion due to previous necrotizing pneumonia. She suffered from cough, dyspnea and hemoptysis. Comparison of old and new CT scan showed increasing of cavity thickness. Lobectomy was performed and mucor was proved in histopathology. We present two cases of pulmonary mucormycosis who referred with hemoptysis and other respiratory tract symptoms and lung cavitations. Surgical resection and amphotericin was very successful in their management. We recommend investigation of fungus in BAL fluid or tissue material of patients with cavitary lesion

Sulfur mustard induced bronchiectasis 15-20 years after exposure, review of 34 cases

Sulfur mustard is a chemical warfare agent that was widely used against Iranian veterans. The most prevalent effect of this agent on the respiratory system was chronic obstructive pulmonary disease. The aim of this study was evaluation of bronchiectasis as a late complication of chemical gas injury. One hundred fifty two patients who had been exposed to chemical weapons were selected. Complete history, physical examination, chest x-ray, HRCT of chest, and spirometry were performed. Among one hundred fifty two patients with pulmonary complications of chemical gas inhalation thirty four patients with bronchiectasis were diagnosed. Others were mostly asthma, chronic bronchitis and, rarely, large airway stenosis and interstitial fibrosis. Bronchiectatic lesions were mostly identified as bilateral 67.6%, and 33.4% of cases were unilateral. The most common sites were RLL, LLL, RML, Lingual and LUL in order. Abnormality of spirometric parameters were found in all of them. The most common finding was obstructive pattern [58%]. No significant difference was seen between Spiro metric values and age in the patients with bronchiectasis and patients with asthma and chronic bronchitis. Bronchiectasis is a late pulmonary complication of sulfur mustard gas inhalation and should be considered in chemical gas victims with pulmonary problems

Endotracheal-endobronchial metastases: report of 14 cases

Endotracheal-Endobronchial Metastases [EEM] secondary to extrapulmonary neoplasm are rare. Since 1989 we have encountered 14 patients with EEM. EEM were defined as documented extra pulmonary neoplasm metastatic to subsegmental or more proximal central bronchi in a bronchoscopically visible range. The developmental modes were described on the basis of classifying categories of Kiryu. The primary tumors included breast cancer [4 cases including 3 women, 1 man], colorectal carcinoma 1, renal cell carcinoma 1, embryonal cell carcinoma of testis1, uterine cervix carcinoma 2, melanoma 1, osteogenic sarcoma 2, papillary thyroid carcinoma 1 and prostatic sarcoma 1. The chest roentgenographic findings were: collapse 5, parenchyma mass 5, multiple nodule 2 and hilar enlargement 2. Median interval from diagnosis of primary tumor was 39.5 months. Endobronchial lesions were detected by bronchoscopy and their metastatic nature was confirmed histopathologically in all patients. Six patients were treated with external radiotherapy, while 6 patients had chemotherapy and 2 patients underwent surgical resection of metastasis. The cases we have reported are similar to those found in the literature, regarding their clinical and roentgenographic presentation. Local treatment is effective for palliating symptoms. All patients with extra pulmonary malignant tumor who are suspected to have pulmonary metastasis should undergo bronchoscopy to diagnose end bronchial metastasis and to differentiate it from primary lung cancer

Tracheobronchopathia Osteochondroplastica [case report]

Tracheobronchopathia Osteochondroplastica [TO] or Tracheopathia Osteoplastica is a rare disorder of large airways with unknown etiology. The diagnosis is usually made on bronchoscopy and confirmed on histology. Generally it is benign and asymptomatic but it may lead to serious complication like airway obstruction requiring surgical treatment. We describe two cases of TO with characteristic bronchoscopic and histological findings. The first one had squamous cell carcinoma of the lung, and the second one had chronic rheumatoid arthritis associated with interstitial fibrosis

[Use of pleural fluid to serum bilirubin concentration ratio for the separation of exudates from transudates]

Differentiation between exudates and transudates is the first diagnostic approach of a patient with pleural effusion. The aim of this study was to evaluate usefulness of pleural fluid to serum total bilirubin ratio for distinguishing exudates from transudates and to compare accuracy of this parameter with three other criteria: pleural protein, lactic dehydrogenase [LDH], cholesterol and in relation to established etiology for differentiating exudates from transudates. We prospectively studied 50 patients with pleural effusion, 34 had exudates and 16 had transudates. Correlation of pleural fluid to serum bilirubin concentration ratio of 0.6 or more with the presence of an exudates as determined by other established criteria was statistically significant. Its sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and efficiency were 76%, 87.5%, 93%, 63% and 87%, respectively. Therefore pleural fluid to serum bilirubin ratio can be effective for separation of exudates from transudates. In addition the bilirubin ratio is more cost effective in terms of laboratory processing and is more readily available

Roentgenographic and bronchoscopic findings in sputum smear negative pulmonary tuberculosis

During 1991-1992, 124 patients who were clinically suspected as having tuberculosis but their sputum smear was negative on three or more occasions or had no sputum underwent fiberoptic bronchoscopy [FOB] and bronchoalveolar lavage [BAL]. 26 patients [15 male and 11 female] with mean age of 53 years were diagnosed as having pulmonary tuberculosis. Diagnosis was based on positive BAL culture and/or smear for acid-fast bacilli [AFB] and or biopsy showing caseating or non-caseating granuloma. Chest radiography showed predominant involvement of lower lobes [LL] 24/52 [46%], versus upper lobe [UL] 16/52 [31%], [P=0.1]. Bronchoscopically 15/26 had an inflammatory process. 10/15 [66.7%] were in the LL bronchi and 4/15 [26.7%] in the UL bronchi with P=0.028. 18 of the 26 patients had more than two lobes involved. 3/8 [36%] required biopsy [P=.3]. These findings show: [1] patients who might require FOB for diagnosis of T.B. are elderly patients with lower lobe involvement; and [2] patients with multifocal disease are more likely to require biopsy for diagnosis

Rapid diagnosis of suspected pulmonary tuberculosis by flexible fiberoptic bronchoscopy and transbronchial biopsy

The records of 44 patients who underwent flexible fiberoptic bronchoscopy for suspected active pulmonary tuberculosis over a nine year period were examined. All patients had either negative sputum smear [40] or could not produce sputum [4]. Bronchial washings were smear positive in 31 patients [70.4%]. Endobronchial biopsy performed on 32 patients revealed specific granulomas in 26, and non-specific chronic inflammation with positive AFB in 6 patients, while transbroncial biopsy showed specific granulomas in all 4 patients examined