Computed tomography versus fiberoptic bronchoscopy in the evaluation of bronchial disease

CT was compared to fiberoptic bronchoscopy [FOB] in 41 cases in which local airway disease was identified with FOB and in 30 patients in whom the airway appeared normal at bronchoscopy. CT was positive in 38 of 41 cases in which lesions were detected at FOB and in 60 [90%] of 67 lesions in the results are analyzed according to the extent of the involvement of the individual bronchi. CT excluded disease if 27 [90%] of 30 cases that were verified to be normal by FOB. The diagnosis of malignancy was not missed in any case by CT. While extremely accurate in detecting focal lesions CT was inaccurate in predicting whether a given abnormality was endobronchial, submucosal or peribronchial. In conclusion CT is helpful when bronchoscopy is contraindicated or refused. CT may also be used in cases with low clinical suspicion of endobronchial disease and as an adjuvant procedure to FOB for outlining the exact location of major mediastinal and hilar vessels, lymph nodes and tumour in relation to adjacent airways

Value of computed tomography in the evaluation of pleural diseases

48 cases of localised and diffuse pleural diseases were evaluated with computerized tomography [CT] after perforimg plain X-ray chest [both P.A. and Lat. Views]. History of asbestos exposure was obtained in 12% of the cases, while past history of radiotherapy was found in 27% of the cases. Plain X-ray chest revealed unilateral opacification in 41 cases and bilateral opacification in 7 cases. The opacity was homogenous in 20 cases, heterogenous in 27 cases and nodular in 5 cases. Ipsilateral mediastinal shift was seen in 41 cases. CT revealed 25 cases with solid masses [17 cases associated with pleural effusion] and 23 cases with pleural effusion [free effusion in 20 cases and encysted in 3 cases]. Mediastinal lymphadenopathy was found in 5 cases [3 cases of proven lymphoma and 2 cases of pleural metastasis from cancer breast]. Diaphragmatic invasion and retroperitoneal extension of mesothelioma were found in 2 cases. Liver metastasis was detected in 2 cases. CT guided fine-needle aspiration biopsy [FNAB] was done in 25 cases, thoracotomy and wide resection of pleural mass was performed in 4 cases. CT could differentiate solid lesion from pleural effusion, clearly demonstrate extension of the lesion, associated lymphadenopathy, rib destruction, distant liver metastasis in addition to taking CT guided FNAB