Dieulafoy's disease of the bronchial tree: a case report / Doença de Dieulafoy da árvore brônquica: relato de caso

ABSTRACT CONTEXT: Dieulafoy's disease of the bronchial tree is a very rare condition. Few cases have been reported in the literature. It can be asymptomatic or manifest with massive hemoptysis. This disease should be considered among heavy smokers when recurrent massive hemoptysis is present amid otherwise normal findings. The treatment can be arterial embolization or surgical intervention. CASE REPORT: A 16-year-old girl was admitted to the emergency department due to hemoptysis with an unknown lesion in the bronchi. She had suffered massive hemoptysis and respiratory failure one week before admission. Fiberoptic bronchoscopy revealed a lesion in the bronchus of the right lower lobe, which was suspected to be a Dieulafoy lesion. Segmentectomy of the right lower lobe and excision of the lesion was carried out. The outcome for this patient was excellent. CONCLUSION: Dieulafoy's disease is a rare vascular anomaly and it is extremely rare in the bronchial tree. In bronchial Dieulafoy's disease, selective embolization has been suggested as a method for cessation of bleeding. Nevertheless, standard anatomical lung resection is a safe and curative alternative.

RESUMO CONTEXTO: A doença de Dieulafoy da árvore brônquica é uma condição muito rara, poucos casos foram descritos na literatura. Pode ser assintomática ou manifestar-se com hemoptise maciça. Esta doença deve ser considerada em fumadores pesados quando eles têm recorrentes hemoptises maciças sem outros achados anormais. O tratamento pode ser tanto embolização arterial como intervenção cirúrgica. RELATO DE CASO: Uma menina de 16 anos foi admitida no Serviço de Urgências devido a hemoptise com uma lesão nos brônquios de origem desconhecida. Havia sofrido hemoptise maciça e insuficiência respiratória uma semana antes da admissão. A broncoscopia de fibra óptica relevou lesão no brônquio do lobo inferior direito, com suspeita de ser lesão de Dieulafoy. Foi realizada uma segmentectomia do lobo inferior direito com excisão da lesão. O resultado da paciente foi excelente. CONCLUSÃO: A doença de Dieulafoy é uma anomalia vascular rara, sendo extremamente rara na árvore brônquica. Na doença de Dieulafoy bronquial, embolização seletiva tem sido sugerida como método para cessação do sangramento; no entanto, a habitual resseção anatômica do pulmão é uma alternativa segura e curativa.

Tracheobronchopathia osteochondroplastica / Traqueobroncopatia osteocondroplástica

ABSTRACT Tracheobronchopathia osteochondroplastica is a rare benign disease, of unknown cause, characterized by numerous sessile, cartilaginous, or bony submucosal nodules distributed throughout the anterolateral walls, projecting into the laryngotracheobronchial lumen. In general, tracheobronchopathia osteochondroplastica is diagnosed incidentally during bronchoscopy or autopsy and is not associated with a specific disease. We report the case of a male patient who was diagnosed with tracheobronchopathia osteochondroplastica via bronchoscopy and biopsy.

RESUMO A traqueobroncopatia osteocondroplástica é uma doença benigna rara, de causa desconhecida, caracterizada por numerosos nódulos submucosos sésseis, cartilaginosos e/ou ósseos, distribuídos pelas paredes anterolaterais da traqueia, projetando-se no lúmen laringotraqueobrônquico. Em geral, a traqueobroncopatia osteocondroplástica é descoberta acidentalmente durante broncoscopias ou em necropsias e não é associada a uma doença específica. Relatamos o caso de um paciente que foi diagnosticado com traqueobroncopatia osteocondroplástica por broncoscopia e biópsia.

Collateral Ventilation Quantification Using Xenon-Enhanced Dynamic Dual-Energy CT: Differences between Canine and Swine Models of Bronchial Occlusion

OBJECTIVE: The aim of this study was to evaluate whether the difference in the degree of collateral ventilation between canine and swine models of bronchial obstruction could be detected by using xenon-enhanced dynamic dual-energy CT. MATERIALS AND METHODS: Eight mongrel dogs and six pigs underwent dynamic dual-energy scanning of 64-slice dual-source CT at 12-second interval for 2-minute wash-in period (60% xenon) and at 24-second interval for 3-minute wash-out period with segmental bronchus occluded. Ventilation parameters of magnitude (A value), maximal slope, velocity (K value), and time-to-peak (TTP) enhancement were calculated from dynamic xenon maps using exponential function of Kety model. RESULTS: A larger difference in A value between parenchyma was observed in pigs than in dogs (absolute difference, -33.0 +/- 5.0 Hounsfield units [HU] vs. -2.8 +/- 7.1 HU, p = 0.001; normalized percentage difference, -79.8 +/- 1.8% vs. -5.4 +/- 16.4%, p = 0.0007). Mean maximal slopes in both periods in the occluded parenchyma only decreased in pigs (all p < 0.05). K values of both periods were not different (p = 0.892) in dogs. However, a significant (p = 0.027) difference was found in pigs in the wash-in period. TTP was delayed in the occluded parenchyma in pigs (p = 0.013) but not in dogs (p = 0.892). CONCLUSION: Xenon-ventilation CT allows the quantification of collateral ventilation and detection of differences between canine and swine models of bronchial obstruction.

Benign superior mediastinal syndrome due to intrathoracic tuberculosis in a child-association with endobronchial tuberculosis.

A 5-year-old boy presented with fever, cough, breathlessness and facial swelling. He was pale with distended veins over neck and chest, cervical and axillary lymphadenopathy and bilateral expiratory wheeze. Chest radiographs showed superior mediastinal widening. A computed tomography scan of the chest revealed mediastinal lymph nodes compressing superior vena cava and trachea. Bronchoscopy revealed nodular lesions in trachea and bronchi and compression of trachea. Broncho-alveolar lavage revealed acid fast bacilli. Diagnosis of superior mediastinal syndrome (SMS) secondary to tuberculosis was made and child was treated with antitubercular treatment along with oral prednisolone with good response.

Evaluation of Tracheobronchial Diseases: Comparison of Different Imaging Techniques

OBJECTIVE: To compare the clinical utility of the different imaging techniques used for the evaluation of tracheobronchial diseases. MATERIALS AND METHODS: Forty-one patients with tracheobronchial diseases [tuberculosis (n = 18), bronchogenic carcinoma (n = 10), congenital abnormality (n = 3), post-operative stenosis (n = 2), and others (n = 8)] underwent chest radi-ography and spiral CT. Two sets of scan data were obtained: one from routine thick-section axial images and the other from thin-section axial images. Multiplanar reconstruction (MPR) and shaded surface display (SSD) images were obtained from thin-section data. Applying a 5-point scale, two observers compared chest radiography, routine CT, thin-section spiral CT, MPR and SSD imaging with regard to the detection, localization, extent, and characterization of a lesion, information on its relationship with adjacent structures, and overall information. RESULTS: SSD images were the most informative with regard to the detection (3.95 +/-0.31), localization (3.95 +/-0.22) and extent of a lesion (3.85 +/-0.42), and overall information (3.83 +/-0.44), while thin-section spiral CT scans provided most information regarding its relationship with adjacent structures (3.56 +/-0.50) and characterization of the lesion (3.51 +/-0.61). CONCLUSION: SSD images and thin-section spiral CT scans can provide valuable information for the evaluation of tracheobronchial disease.

Comparative study between FOB and CT in the evaluation of bronchial diseases

Thirty-nine patients with clinical problems of bronchial or suspected bronchial abnormalities were examined with plain radiography, CT scan of the chest and fiberoptic bronchoscopy [FOB] in order to compare the diagnostic yield of CT with that of FOB. The study revealed a good overall correlation between CT and FOB in identification of focal bronchial abnormalities. It was found that CT was inaccurate in predicting whether a given focal abnormality documented at FOB will be endobronchial, submucosal or extrinsic on CT. Only bronchial irregularity or the presence of intraluminal mass are specific indicators of endobronchial disease. CT was superior to FOB in delineating the extent of lesions in two patients having complete bronchial occlusion with inability to visualize the distal airways by FOB. It was concluded that CT should be complementary to bronchoscopy especially in detecting extra-luminal lesions, parenchymal and mediastinal involvements