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Fulltext Endobronchial metastasis from resected renal cell carcinoma causing total lung collapse

Poh ME, Liam CK, Pang YK, Chua KT

Respirol Case Rep, 2013 Dec;1(2):26-7.
PMID: 25473534 DOI: 10.1002/rcr2.16

We report a man presenting with dyspnea, cough, and hemoptysis due to left lung collapse from an endobronchial tumor obstructing the left main bronchus. Endobronchial biopsy of the tumor showed renal cell carcinoma, identical to a previous specimen of renal cell carcinoma removed by a radical left nephrectomy five years ago. The endobronchial tumor was removed by snare diathermy through a flexible bronchoscope, following which his symptoms resolved and the left lung re-expanded. Endobronchial metastasis from renal cell carcinoma is rare and can mimic obstruction from other endobronchial etiologies, such as bronchogenic carcinoma. Total lung collapse as a result is even more uncommon, although atelectasis is well described. Endobronchial techniques, such as snare diathermy, can relieve obstruction, providing symptom palliation even in advanced disease.

Matched MeSH terms: Bronchoscopy
Fulltext Anesthesia for massive retrosternal goiter with severe intrathoracic tracheal narrowing: the challenges imposed -A case report-

Tan PC, Esa N

Korean J Anesthesiol, 2012 May;62(5):474-8.
PMID: 22679546 DOI: 10.4097/kjae.2012.62.5.474

Anesthetic management of patients with mediastinal masses remains challenging as acute cardiorespiratory decompensation may follow induction of anesthesia. We describe a 57 year old lady with massive retrosternal goiter and severe intrathoracic tracheal compression who had a total thyroidectomy. Comprehensive contingency plans were an essential prerequisite for successful management of difficult airway, including multidisciplinary involvement of otorhinolaryngologic and cardiothoracic surgeons preparing for rigid bronchoscopy and cardiopulmonary bypass. Awake oral fiberoptic intubation was performed under dexmedetomidine sedation. Severe tracheal narrowing necessitated usage of a 5.0 mm uncuffed flexometallic endotracheal tube. Anesthesia was maintained with sevoflurane and dexmedetomidine infusion with target controlled infusion of remifentanil as analgesia. No muscle relaxant was given. Surgical manipulation led to intermittent total tracheal compression and inadequate ventilation. The tumor was successfully removed via the cervical approach. A close working relationship between anesthesiologists and surgeons was the key to the safe use of anesthesia and uneventful recovery of this patient.

Matched MeSH terms: Bronchoscopy
Fulltext Pulmonary tuberculosis--a review of clinical features and diagnosis in 232 cases

Ismail Y

Med J Malaysia, 2004 Mar;59(1):56-64.
PMID: 15535337

The diagnosis of pulmonary tuberculosis is often delayed due to atypical clinical features and difficulty in obtaining positive bacteriology. We reviewed 232 cases of pulmonary tuberculosis diagnosed in Kedah Medical Centre, Alor Setar from January 1998 to December 2002. All age groups were affected with a male predominance (Male:Female ratio = 60:40). Risk factors include underlying diabetes mellitus (17.7%), positive family history (16.8%) and previous tuberculosis (5.2%). Nearly half (45.3%) of patients had symptoms for more than one year. Only 22% of patients had typical symptoms of tuberculosis (prolonged recurrent fever, cough, anorexia and weight loss), whilst others presented with haemoptysis, chronic cough, COPD, bronchiectasis, general ill-health, pyrexia of unknown origin or pleural effusion without other systemic symptoms. Fifteen percent of the patients presented with extrapulmonary diagnosis. Ninety percent of the patients had previous medical consultations but 40% had no chest radiograph or sputum examination done. The chest radiographs showed 'typical' changes of tuberculosis in 62% while in the other 38% the radiological features were 'not typical'. Sputum direct smear was positive for acid-fast bacilli in only 22.8% of patients and 11.2% were diagnosed base on positive sputum culture. Sputum may be negative even in patients with typical clinical presentations and chest radiograph changes. Bronchial washing improved the diagnosis rate being positive in 49.1% of cases (24.1% by direct smear and the other 25.0% by culture). In 16.8% of cases, the diagnosis was based on a good response to empirical anti-tuberculosis therapy in patients with clinical and radiological features characteristic of tuberculosis. In conclusions, the clinical and radiological manifestations of pulmonary tuberculosis may be atypical. Sputum is often negative and bronchoscopy with washings for Mycobacterium culture gives a higher yield for diagnosis. In highly probable cases, empirical therapy with antituberculosis drugs should be considered because it is safe and beneficial.

Matched MeSH terms: Bronchoscopy
Fulltext Foreign bodies in the larynx and tracheo-bronchial tree

Yip CH, Wong TJ, Somasundaram K

Med J Malaysia, 1988 Jun;43(2):150-4.
PMID: 3237130

From 1973 to 1982,40 children with respiratory distress was bronchoscoped for suspected foreign body in the trachea-bronchial tree. In 31 children, foreign bodies were found and were successfully removed. The condition appeared to be confined to the early toddler group. Six children had pulmonary complications post-operatively. There was no death. A plea is made for early diagnosis and referral to lessen the likelihood of residual pulmonary damage.
Study site: University Hospital, Kuala Lumpur, Malaysia (current name: University Malaya Medical Centre)

Matched MeSH terms: Bronchoscopy
Fulltext Dental technician pneumoconiosis mimicking pulmonary tuberculosis: a case report

Tan HL, Faisal M, Soo CI, Ban AY, Manap RA, Hassan TM

BMC Pulm Med, 2016 09 07;16(1):131.
PMID: 27604085 DOI: 10.1186/s12890-016-0293-2

BACKGROUND: Dental laboratory technicians are at risk of developing occupational respiratory diseases due to exposure to various potentially toxic substances in their working environment. Since 1939, few cases of silicosis among dental technician have been reported.

CASE PRESENTATION: We illustrate a 38 year-old female, who worked in a dental laboratory for 20 years, initially treated as pulmonary tuberculosis and chronic necrotising aspergillosis without much improvement. Computed tomography guided lung biopsy and bronchoscopic transbronchial lung biopsy were performed. Lung tissue biopsies showed presence of refractile dental materials within the areas of histiocyte proliferation. The diagnosis of dental technician pneumoconiosis was obtained and our patient underwent pulmonary rehabilitation.

CONCLUSIONS: This case highlights the importance of obtaining a detailed occupational history in tuberculosis endemic area, as pulmonary tuberculosis is a great mimicker of other respiratory diseases.

Matched MeSH terms: Bronchoscopy
Fulltext A case report of airway stenting in tracheal compression secondary to right subclavian artery pseudo-aneurysm

Muhammad Naimmuddin Abdul Azih, Aishah Ibrahim, How, Soon Hin, Kuan, Yeh Chunn

International Medical Journal Malaysia, 2018;17(1):141-144.
MyJurnal

We report a 55-year old lady with the presentation of stridor and type II respiratory failure requiring tracheal intubation. She had right Horner’s syndrome associated with pleural effusion. Her chest radiograph revealed right upper zone lobulated opacities and therefore right Pancoast tumor was the initial diagnosis. However, her CECT thorax revealed a huge right subclavian artery pseudoaneurysm with severe tracheal compression. This rare condition imposed a significant diagnostic as well as therapeutic challenge. Vascular surgery is the definitive treatment but it is associated with high risks. The exact role of rigid bronchoscopy for airway stenting is unknown due to limited evidence available. Indeed, this form of central airway obstruction may benefit from temporary tracheal stenting whilst the surgical repair of the lesion is planned. It may facilitate early weaning and allows less complicated airway control.

Matched MeSH terms: Bronchoscopy
Fulltext Metallic hair pin aspiration into the left tertiary bronchus

Noh, K.B., Salim, R., Abdullah, M.S., Mohamad, I.

Malaysian Family Physician, 2018;13(2):36-38.
MyJurnal

Foreign body aspiration is commonly described in infants and children. However, recently, a new
high-risk group was identified among young women, especially those from the Muslim population
who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the
lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the
scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a
case of scarf pin inhalation and the challenges encountered in managing this patient during the
successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular
case was technically challenging for us as the sharp tip of the needle was pointing upward and
piercing the bronchial mucosa.

Matched MeSH terms: Bronchoscopy
Fulltext Central airway obstruction tumour debulking using rigid bronchoscopy and cryotherapy: a case report

Wai Heng Chew, Abdul Aziz Marwan, Ummi Nadira Daut, Rosmadi Ismail, Mona Zaria Nasaruddin, Jamalul Azizi Abdul Rahman

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):75-77.
MyJurnal

Sarcomas usually frequented in the head and neck region of young adults. Trachea is a rare site, and due to scarce clinical data, its clinical outcome is unclear. We reported a case of 60-year old patient presented with progressive worsening shortness of breath, cough, and progressive worsening dysphagia. Computer tomography scan revealed extensive 2 lobulated soft tissue lesions within and surrounding the trachea at the T4 level. Rigid bronchoscopy with mass cryo-debulking was performed and ultimately synovial sarcoma was diagnosed. Shortness of breath was com- pletely relieved post-procedure.

Matched MeSH terms: Bronchoscopy
Manual work and lung cancer risk in high-risk populations

Fauziah Nordin, Lewis, SJ., O’Donnell, PNS., Crosbie, PAJ., Richard Booton, Agius, RM., et al.

Journal of Occupational Safety and Health, 2014;11(1):5-14.
MyJurnal

Manual work is associated with increased lung cancer risk possibly because of increased exposure to occupational and other carcinogens, reduced use of health care services and/or a less healthy lifestyle. The aim of this study was to examine whether the association between manual work and lung cancer risk has changed over time. Three separate retrospective studies were carried out over a 10-year period (1996-1997, 1998-2000 and 2003-2005) in patients attending a bronchoscopy clinic to investigate lung cancer risk in an area of Manchester characterised by high deprivation and unemployment. Cases (n=321) were patients newly diagnosed with a tumour of the lung, trachea or bronchus and controls (n=542) were patients free of tumours at the time of, and prior to, examination. Patients were interviewed using the same structured questionnaire for associations between risk factors and lung cancer examined. The study population in all three studies was similar with little difference in smoking history. In each study smoking was associated with lung cancer risk. Lung cancer risk was higher in manual workers (compared to managers and other professionals) in the first (OR 2.50, 95% CI 1.20 – 5.05) and second study (OR 2.73, 95% CI 0.97 – 7.70) but not the third (OR 0.97, 95% CI 0.58 – 1.61). However, the summary odds ratio (meta-OR) for lung cancer in manual worker was 1.81 (95% 1.75 – 1.87) after controlling for sex, age and smoking. This study suggested that even after taking into account known occupational and environmental causes of cancer, there was a residual cancer risk associated with manual work, high risk working populations of lung cancer. However this appears to have attenuated recently for as yet unknown reasons.

Matched MeSH terms: Bronchoscopy
Fulltext Masquerade syndrome: an ocular involvement of lung cancer

Umi Kalthum, M. N., Wan Haslina Wah

Medicine & Health, 2013;8(1):47-51.
MyJurnal

We report a case of a 37-year-old smoker who presented with painless and sudden onset of loss of upper field vision of the right eye, associated with one month history of dry cough which was unresponsive to antibiotic and subsequent anti- tuberculosis therapy. Visual acuity at presentation was counting finger. There was bullous retinal detachment on examination. Radiological imaging revealed multiple lung opacities, involving the brain and the right orbit. Bronchoscopy and biopsy confirmed the diagnosis of adenocarcinoma of the lung. This case illustrates masquerade syndrome of which a lung carcinoma harbours behind a seemingly innocent retinal detachment. It also highlights the importance of entertaining lung carcinoma as a differential diagnosis in suspected tuberculosis among heavy smokers.

Matched MeSH terms: Bronchoscopy
Fulltext Pediatric laryngotracheal cases in Hospital Universiti Sains Malaysia

Irfan, M., Izani S.M., Adil, S.A.R., Suzina, S.A.H.

Malaysian Journal of Medicine and Health Sciences, 2012;8(1):55-59.
MyJurnal

There are many inherent challenges in the evaluation and management of children with laryngotracheal disorders, and it differs widely from one institution to another. The main challenges include access to suitable equipment, fully trained surgeon and, cooperation with the anesthetist and pediatrician. Material & Methods: The aim of the study was to analyze the pediatric laryngotracheal cases undergoing endoscopic examination in Hospital Universiti Sains Malaysia. A retrospective review of 73 cases undergoing microlaryngoscopy and bronchoscopy from 2004 to 2008 was done. Results: Laryngomalacia was the commonest diagnosis. The majority of the cases (45.2 %) were referred because of noisy respiration. Other reasons for referral were foreign body inhalation, unresolved lung disease, failed extubation, examination prior to decannulation and hoarseness. Conclusion: Management of pediatric laryngotracheal cases were varied and tailored to each problem. The endoscopic examination must be meticulous. The management include observation, medical treatment, closed (endoscopic)
techniques and open surgery.

Matched MeSH terms: Bronchoscopy
Bronchography and selective bronchoscopy in diagnosis of lung malignancy: a case report

Galanti A, Wong Wai Kwan, Choy T

Med J Malaya, 1970 Dec;25(2):152-4.
PMID: 4251136
Matched MeSH terms: Bronchoscopy
Fulltext Metallic hair pin aspiration into the left tertiary bronchus

Noh KB, Salim R, Abdullah MS, Mohamad I

Malays Fam Physician, 2018;13(2):36-38.
PMID: 30302183

Foreign body aspiration is commonly described in infants and children. However, recently, a new high-risk group was identified among young women, especially those from the Muslim population who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a case of scarf pin inhalation and the challenges encountered in managing this patient during the successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular case was technically challenging for us as the sharp tip of the needle was pointing upward and piercing the bronchial mucosa.

Matched MeSH terms: Bronchoscopy
Fulltext Cervical Aerocele: A Rare Delayed Complication of Tracheostomy

Arepen SAM, Mohamad H, Nik Hassan NFH

Oman Med J, 2018 Nov;33(6):520-522.
PMID: 30410695 DOI: 10.5001/omj.2018.94

Acquired cervical aerocele in adults is a rare condition and its delay development after tracheostomy decannulation is reported rarely. Our patient presented eight years after tracheostomy decannulation with a compressible anterior neck mass that only appeared when she coughed and could be deflated using manual compression. The mass was situated suprasternal at the previous tracheostomy scar. Computed tomography scan showed a paratracheal air sac without significant defect at the tracheal wall. Surgical intervention is the best treatment for symptomatic patients. As in this patient, we advise direct laryngoscopy and bronchoscopy for diagnostic and therapeutic purposes in such cases. However, our patient refused any surgical intervention.

Matched MeSH terms: Bronchoscopy
Tissue-clot-coagulum cell block in EBUS/TBNA specimen adequacy: A real world experience

Kho SS, Chan SK, Ismail AM, Tie ST

Diagn Cytopathol, 2022 Dec;50(12):583-585.
PMID: 36135808 DOI: 10.1002/dc.25056
Matched MeSH terms: Bronchoscopy
Predictive risk factors for pneumothorax following fluoroscopic-guided transbronchial lung biopsy

Ng BH, Low HJ, Nuratiqah NA, Soo CI, Imree A, Mas FMJ, et al.

Med J Malaysia, 2023 Dec;78(7):897-900.
PMID: 38159925

INTRODUCTION: Fluoroscopic-guided transbronchial lung biopsy (FG-TBLB) is routinely performed via bronchoscopy to diagnose focal peripheral lesions and diffuse lung disease. Identifying the risk factors of FG-TBLB-related pneumothorax can assist the operator in taking pre-emptive measures to prepare for this potential complication.
MATERIALS AND METHODS: We retrospectively analysed data from 157 patients who underwent FG-TBLB, with the primary outcome being procedure-related pneumothorax. We assessed several risk factors for pneumothorax following FG-TBLB: patient characteristics, location of biopsy, number of biopsies and computed tomography pattern. Univariate and multivariate logistic regression analyses were performed.
RESULTS: One-hundred fifty-seven patients were included [mean (SD) age 57.9 (16.2) years; 60.5% male]. The most common location for FG-TBLB was the right upper lobe (n=45, 28.7%). The mean (SD) number of biopsy samples was 6.7 (2.1). Radiographic evidence of pneumothorax was reported in 12 (7.6%) patients, with 11 of those requiring intercostal chest tube intervention (mean air leak time: 5.7 days and 1 had persistent air leak requiring autologous blood patch pleurodesis. None experienced pneumothorax recurrence. Female gender and upper lobe location of the biopsy were identified as predisposing factors for pneumothorax. In the multivariable analysis, upper lobe biopsies were associated with a higher risk of pneumothorax (OR 0.120; 95% CI 0.015-0.963; p = 0.046).
CONCLUSION: The overall rate of pneumothorax is low. We recognise the increased risk of pneumothorax associated with upper lobe biopsy. These findings suggest that clinicians should exercise caution when performing FGTBLB in this region and consider alternative biopsy locations whenever feasible. We suggest adequate planning and preparation should be implemented to minimise the risk of pneumothorax following FG-TBLB.

Matched MeSH terms: Bronchoscopy
Fulltext Fibreoptic bronchoscopy--a Malaysian experience

Yaacob I, Harun Z, Ahmad Z

Singapore Med J, 1991 Feb;32(1):26-8.
PMID: 2017700

Two hundred and ninety-three bronchoscopies were done for 285 patients (78% males, 22% females) at Hospital University Sains Malaysia between 1984 and 1988. The mean age was 56.4 years (range 13 to 90 years). 70.2% of patients underwent bronchoscopies to confirm or exclude the diagnosis of carcinoma of the bronchus, out of which 58% were confirmed to have bronchial carcinoma. 77% of the 98 patients with visible endobronchial tumours had biopsy specimens diagnostic of malignancy. Brushing and washing cytology increased the positive yield to 92%. The commonest histological type of bronchial carcinoma identified was squamous cell carcinoma (48.1%), followed by small cell carcinoma (27.1%), anaplastic/undifferentiated carcinoma (12.9%), adenocarcinoma (9.4%) and large cell carcinoma (2.4%). Bronchoscopy for the investigation of haemoptysis identified the commonest cause as 'bronchitis'. There were no complications noted in our series. Notable differences of our experience compared to that of the western series were the high percentage of bronchoscopy done for infective respiratory disorders and the younger age of our patients.

Matched MeSH terms: Bronchoscopy/methods*
Fulltext Feasibility, safety and outcomes of stereotactic radiotherapy for ultra-central thoracic oligometastatic disease guided by linear endobronchial ultrasound-inserted fiducials

Sidhu C, Tang C, Scott A, Yamini Ramamurty H, Yagnik L, Morey S, et al.

Radiother Oncol, 2024 Dec;201:110547.
PMID: 39332638 DOI: 10.1016/j.radonc.2024.110547

BACKGROUND & PURPOSE: Local treatment of oligometastases has been found to improve survival and prognosis. Stereotactic body radiotherapy (SBRT) has emerged as a treatment option for oligometastases but its use in ultra-central (UC) areas can cause significant toxicity and mortality. Fiducial markers (FM) can be used to improve SBRT accuracy, and can be inserted in the central thorax using linear endobronchial ultrasound (EBUS) bronchoscopy. Outcomes of FM-guided SBRT for UC thoracic oligometastases is unknown.
METHODS: A single-centre retrospective study investigating the feasibility, safety and outcomes of both linear EBUS-inserted FMs and subsequent FM-guided SBRT for UC-oligometastatic disease. Motion analyses of FMs were also performed.
RESULTS: Thirty outpatients underwent 32 EBUS-FM insertion procedures with 100 % success, and no major procedural mortality or morbidity. Minor complications were 4.8 % incidence of delayed FM-displacement. UC FM-guided SBRT was completed in 20 patients with 99.9 % fractions delivered. Median SBRT dose delivered was 40 Gy over a median of 8 fractions. Majority of adverse events were Grade 1 and there was no SBRT-related mortality. Local control with SBRT was 95 %, with overall survival at 1-year and 3-years of 90 % and 56.3 % respectively. Median overall survival after SBRT was 43.6 months. FM movements in UC areas were recorded being greatest in the superior-inferior axis.
CONCLUSION: Combined linear EBUS sampling and FM-insertion in UC thoracic oligometastatic disease is feasible and safe. UC-SBRT to oligometastases using FM guidance was found to have minimal complications and associated with moderate survival up to 3 years post-treatment.

Matched MeSH terms: Bronchoscopy/methods
Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy

Woodhull S, Bush A, Tang AL, Padley S

Paediatr Respir Rev, 2020 Nov;36:100-105.
PMID: 32680823 DOI: 10.1016/j.prrv.2020.06.001

Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.

Matched MeSH terms: Bronchoscopy*
Fulltext Diagnostic yield of flexible bronchoscopic procedures in lung cancer patients according to tumour location

Liam CK, Pang YK, Poosparajah S

Singapore Med J, 2007 Jul;48(7):625-31.
PMID: 17609823

This study aims to determine whether the diagnostic yield of flexible bronchoscopy sampling procedures in patients with lung cancer was dependent on tumour location.

Matched MeSH terms: Bronchoscopy/methods*

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