Virtual versus fiberoptic bronchoscopy in the evaluation of tracheobronchial neoplasms

Lung tumours represent a true epidemic of the twentieth century. Patients with suspected tracheobronchial lesions typically undergo diagnostic evaluation consisting of CT scanning and fiberoptic bronchoscopy. Multislice CT is more than upgrade of single detector CT. Virtual bronchoscopy is the descriptive term given to representations of the bronchial tree and surrounding structures created from spatial information derived from imaging sources other than the bronchoscope itself. The present work aimed to assess accuracy of virtual bronchoscopy compared to fiberoptic bronchoscopy in evaluating tracheobronchial neoplasms. The studied group included 20 patients who were subjected to full history taking, clinical examination, routine laboratory investigations, radiologic evaluation using plain X-ray chest and Multidetector CT virtual bronchoscopy then fiberoptic bronchoscopy examination under local anesthesia. The mean age of the patients was 54.6 +/- 15.79 years. There were 14 male and 6 female patients. All patients were symptomatic at the time of presentation. Thirty-four airways were found by endoscopy to be obstructed. The mucosal descriptions of these lesions were described only by fiberoptic bronchoscopy. There were no significant differences between both bronchoscopes regarding the type of the lesion [endoluminal or extrinsic compression], the degree of obstruction [partial, near total or total], the origin of the masses and its extent. Exploration distal to the obstructing mass was possible in 61.8% of the airways by virtual bronchoscopy and only in 32.4% by fiberoptic bronchoscopy. Virtual bronchoscopy reported sensitivity of 82% and specificity of 87% in detecting extrinsic compression while in endoluminal masses, it reported sensitivity of 86% and specificity of 79%. However, regarding the degree of obstruction, virtual bronchoscopy reported in partial obstruction sensitivity of 85% and specificity of 75.9%. The sensitivity of virtual bronchoscopy in near-total obstruction was 80.5% and specificity was 78.9%, and for total obstruction, the sensitivity was 82.3% and the specificity was 80.2%. Virtual bronchoscopy using multislice CT is an accurate mean of estimating airway lesions. It is an easy complementary tool to fibroptic bronchoscopy

Haemodynamic and ventilatory responses to thoracocentesis in patients with massive pleural effusion

This work aimed to evaluate the effect of thoracocentesis on the haemodynamic and ventilatory functions in patients with massive pleural effusion [PE]. The study entailed 20 patients with massive pleural effusion divided into two equal groups, each of 10 cases. Group I: patients with right PE, Group II: patients with left PE. All patients underwent basal assessment protocol including plain X-ray chest, computed tomography when needed, chest ultrasonography, pulmonary function tests, arterial blood gases and echocardiography. Thoracocentesis was carried out repeatedly until nearly complete evacuation of pleural effusion was reached, this was followed up and guided by X-ray chest and chest ultrasonography. The previously mentioned assessment protocol was repeated after PE evacuation. Patients with massive pleural effusions in both groups I and II demonstrated restrictive pattern of pulmonary function tests [PFTs] together with evidence of small airway obstruction FEF[25-75%] [51.2 +/- 13.2], arterial hypoxemia PaO[2] [65.2 +/- 11.3 mmHg], echocardiographic study demonstrated high mean values of pulmonary artery pressure [mPAP] 47.3 +/- 5.7 mmHg together with evidence of both right and left ventricular diastolic dysfunctions of relaxation pattern [E/A<1]. No significant difference was found between patients with right and left effusions. Thoracocentesis produced significant improvement in PFTs, arterial PaO[2] and biventricular diastolic dysfunction [E/A >1], as well as decrease in mPAP. Correlation study revealed significant relationship between total volume of aspirated pleural fluid and% change in PFTs, PaO[2] and mPAP. Our data provide circumstantial evidence that massive pleural effusion produce detrimental effects on the ventilatory function, gas exchange as well as on cardiac function. This occur irrespective to the side affected. Thoracocentesis induced significant improvement in cardiac and pulmonary functions that is proportional to the volume aspirated. Thoracocentesis can lead to rapid improvement of the haemodynamic profile