Bronchoscopic Evaluation in Clinically and Radiologically Suspected Lung Carcinoma.

Lung cancer is generally diagnosed during late stage of the disease; so, early diagnosis of lung cancer is very important to reduce lung cancer death rate. Flexible fibreoptic bronchoscopy (FOB) is an important diagnostic technique performed in patients with suspected malignant lung lesion as it provides sufficient cytologic and histologic specimens in the form of bronchial washing, bronchial brushing and bronchial forceps biopsy.METHODSThe present descriptive study analysed cytology of bronchial washing, bronchial brushing and histology of bronchial biopsy in 100 patients with suspected lung cancer. Patients in whom clinical and radiological findings suggested lung carcinoma, were included in the study. Patients with coagulopathy, refractory hypoxemia, cardiac instability, poor ability to cooperate with the procedure were excluded from this study. Age, gender, smoking habits, clinical and radiological findings, various histological types of malignancies, and yield of various bronchoscopic diagnostic techniques in the diagnosis of lung cancer were evaluated.RESULTSOf the 100 cases, 86 (86%) were males and 14 (14%) were females with male to female ratio of 6.14:1. The mean age in this study group was 58 years. Overall diagnostic yield by means of all techniques during bronchoscopy was 90% (90/100 patients). Squamous cell carcinoma was the most common primary bronchogenic tumour 36.67% (33/90 patients) followed by Adenocarcinoma 25.56% (23/90 patients), small cell carcinoma 24.44% (22/90 patients), Undifferentiated Non-Small Cell Carcinoma (NSCLC) 12.22% (11/90 patients), poorly differentiated carcinoma 1 patient. No evidence of malignancy was found in 10 patients by all techniques during bronchoscopy.CONCLUSIONSLung cancer is a common malignancy with male preponderance. Bronchial washing and brushing cytology in combination with bronchial biopsy has a very high diagnostic yield. Therefore, all these techniques may be used concurrently to diagnose lung malignancy.

Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients.

Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy. Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure. Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB. Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.

A Clinical Study of Post-tubercular Bronchiectasis

Pulmonary tuberculosis (PT) Tuberculosis (TB) is one of the most important communicable diseases in the world. India is the highest PT TB burden country accounting for one-fifth (21%) of the global incidence (9.4 million cases). This problem is further magnified by the after-effects of the disease—post-tubercular bronchiectasis (PTBX). As a result, the sufferers run from pillar to post with sinister symptomatology. Some of them are retreated with antituberculous treatment, although there is no definite indication. Katuri Medical College is situated in the rural Guntur surrounded by number of dusty industries like granite, quarrying, cotton crop and mills, tobacco, capsicum crop, spices besides being an agricultural area on the brink of mighty Krishna River flowing at a length of more than 700 km through three states of Karnataka, Maharashtra and Andhra Pradesh. As a result the flora and fauna is complex. Workers in this area report with variegated granulomatous lung diseases to the faculty of Pulmonology. Over and above the incidence of smoking in both sexes is rampant. The final outcome in all these morbidities is bronchiectasis. Quite a few of them have had treatment for pulmonary TB in the past. With this background the present study was undertaken to find out the vagary of post-tubercular bronchiectasis ruling out the extrinsic atmospheric factors.

Transbronchial lung biopsy via the fibreoptic bronchoscope \r\n', u'in diagnosis of the lung diseases \r\n', u'

Background: Bronchoscopy is an essential technique for diagnosis of some lung diseases by taking samples for histological and cytological tests. Objective: To assess the role of transbronchial lung biopsy procedure in diagnosis some parenchymal pulmonary diseases. Subjects and method: A retrospective study conducted in 50 patients with diffuse and localized lung diseases, who were admitted to the Department of Respiratory in Bach Mai Hospital, from January 2003 to December 2005. Results: Transbronchial lung biopsy confirmed the diagnosis in 30 of 50 (60%) cases; with localized malignant lesions (12%), diffuse lung disease (16%), tuberculosis (28%), and cystic fibrosis (4%). Following transbronchial lung biopsy, two patients had pneumothorax (1 patient had chest tube drainage) and five patients had hemoptysis but no of them required further treatment. Conclusions: Transbronchial lung biopsy offer good diagnostic accuracy and low complication rate.

Middle lobe syndrome due to Tuberculous etiology A series of 12 cases.

The term right middle lobe syndrome (RMLS) is often used in clinical practice though it has no consistent definition. Inflammatory lesion, malignant tumors followed by bronchiectasis are considered as the most common etiological factors for RMLS. Here we describe 12 cases of RMLS due to tuberculous etiology diagnosed over a period of 6.5 years at our Institute. They were diagnosed using conventional methods and responded to anti-tubercular treatment with favourable outcome. The cases are being presented here to highlight the fact that tuberculosis, though not frequently reported in published literature, is an important etiological factor and must be considered for differential diagnosis when RMLS is evaluated particularly in regions where the prevalence of tuberculosis is high as it responds to anti-tubercular chemotherapy remarkably.

Bilateral lower zone shadows on chest radiograph - A clinicopathological profile.

Background: The initial suspected diagnosis in bilateral lower zone lung involvement made clinically can be compared and correlated with the final diagnosis obtained after percutaneous FNA cytology, BAL fluid examination and transbronchial biopsy. Aim: To study diseases presenting with bilateral lower zone shadow on chest radiograph and compare the initial clinical diagnosis to the final diagnosis. Methods: Fifty six patients were studied by routine hematological, sputum and pleural fluid examination along with PCNA and TBNA cytology, bronchial aspirate/ BAL fluid examination and transbronchial biopsy after a detailed clinical history and thorough physical examination. Results: Initially suspected diagnosis included tuberculosis in 32.1% cases, pneumonia in 30.4%, malignancy in 10.7%, pulmonary oedema in 5.4%, bronchiectasis in 8.9%, ILD in 7.1%, TPE in 3.6% and bilateral hydatid disease of lung in 1.7% of cases. The final diagnosis revealed tuberculosis in 25.0% cases, pneumonia in 23.2%, malignancy in 16.1%, bronchiectasis in 8.9%, pulmonary oedema and ILD in 7.1% each, sarcoidosis and TPE in 3.6% each, while pulmonary candidiasis, pulmonary alveolar proteinosis and bilateral hydatid disease of the lung in 1.7% case each respectively. Conclusion: Majority of cases can be diagnosed by a detailed clinical profile along with a chest radiograph. However, FNAC and fibreoptic bronchoscopy are of high value for pathological and microbiological confirmation of the diagnosis and provides a significant yield.