Journal of Bronchology & Interventional Pulmonology最新文献

{"title":"Mycobacterium avium Complex-associated Pleural Effusion in an Immunocompetent Host : A Rare Case Report and Literature Review.","authors":"Muhammad Perwaiz, Reiichiro Obata, Ellen C Bradley","doi":"10.1097/LBR.0000000000000858","DOIUrl":"10.1097/LBR.0000000000000858","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Bilateral Whole Lung Lavage for Pulmonary Alveolar Proteinosis: Experiences in a Multicenter Cohort.","authors":"Max T Wayne, Muhammad S Ali, Lance Roller, Steven E Gay, Fabien Maldonado, Jose De Cardenas","doi":"10.1097/LBR.0000000000000897","DOIUrl":"10.1097/LBR.0000000000000897","url":null,"abstract":"P ulmonary alveolar proteinosis (PAP) is a rare lung disease in which surfactant accumulates in alveolar macrophages and the distal airways, resulting in impaired gas exchange.1,2 For symptomatic patients, standard treatment is whole lung lavage to restore gas exchange.1,3 This procedure is performed under general anesthesia using a double-lumen endotracheal tube with single lung-ventilation.3,4 Warmed saline is instilled in the target lung in serial aliquots until the fluid return resembles normal lavage fluid.3 Consequently, this can take hours to perform, may be associated with hypoxemia during the procedure, and has therefore traditionally been performed as a staged procedure over multiple days (ie, 1 lung per procedure).3,4 However, some institutions have adopted techniques that allow for bilateral whole lung lavage to be performed sequentially in a single procedure, although this practice remains controversial. We describe a multicenter cohort of patients with PAP treated with bilateral whole lung lavag in a single procedural setting.","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9327320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19-Associated Tracheal Stenosis (COATS): A New Entity?","authors":"Rahul Tyagi, Meenakshisundaram Arunachalam, Saurabh Mittal, Vijay Hadda, Anant Mohan, Randeep Guleria, Karan Madan","doi":"10.1097/LBR.0000000000000863","DOIUrl":"10.1097/LBR.0000000000000863","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Transbronchial Lung Cryobiopsy in the Diagnosis of Interstitial Lung Disease: A Meta-analysis of 68 Studies and 6300 Patients.","authors":"Yazan Zayed, Bashar N Alzghoul, Ryan Hyde, Zerka Wadood, Momen Banifadel, Majd Khasawneh, Phillip Brandon Maharrey, Haneen Saker, Christopher Harden, Gabrielle Barnes, Diana Gomez-Manjarres, Divya Patel, Ibrahim Faruqi, Borna Mehrad, Hiren J Mehta","doi":"10.1097/LBR.0000000000000865","DOIUrl":"10.1097/LBR.0000000000000865","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of interstitial lung disease (ILD) is based on multidisciplinary team discussion (MDD) with the incorporation of clinical, radiographical, and histopathologic information if available. We aim to evaluate the diagnostic yield and safety outcomes of transbronchial lung cryobiopsy (TBLC) in the diagnosis of ILD.</p><p><strong>Methods: </strong>We conducted a meta-analysis by comprehensive literature search to include all studies that evaluated the diagnostic yields and/or adverse events with TBLC in patients with ILD. We calculated the pooled event rates and their 95% confidence intervals (CIs) for the diagnostic yield by MDD, histopathologic diagnostic yield, and various clinical adverse events.</p><p><strong>Results: </strong>We included 68 articles (44 full texts and 24 abstracts) totaling 6386 patients with a mean age of 60.7±14.1 years and 56% men. The overall diagnostic yield of TBLC to achieve a definite or high-confidence diagnosis based on MDD was 82.3% (95% CI: 78.9%-85.2%) and histopathologic diagnosis of 72.5% (95% CI: 67.7%-76.9%). The overall rate of pneumothorax was 9.6% (95% CI: 7.9%-11%), while the rate of pneumothorax requiring drainage by a thoracostomy tube was 5.3% (95% CI: 4.1%-6.9%). The rate of moderate bleeding was 11.7% (95% CI: 9.1%-14.9%), while the rate of severe bleeding was 1.9% (95% CI: 1.4%-2.6%). The risk of mortality attributed to the procedure was 0.9% (95% CI: 0.7%-1.3%).</p><p><strong>Conclusion: </strong>Among patients with undiagnosed or unclassified ILD requiring tissue biopsy for diagnosis, transbronchial cryobiopsy represents a reliable alternative to surgical lung biopsy with decreased incidence of various clinical adverse events.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10448786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a Dedicated Pleural Clinic on Indwelling Pleural Catheter Related Outcomes: A Retrospective Single Center Experience.","authors":"Katherine B Malcolm,&nbsp;Eric J Seeley,&nbsp;Yaron B Gesthalter","doi":"10.1097/LBR.0000000000000901","DOIUrl":"10.1097/LBR.0000000000000901","url":null,"abstract":"<p><strong>Background: </strong>Recurrent pleural effusions are a major cause of morbidity and frequently lead to hospitalization. Indwelling pleural catheters (IPCs) are tunneled catheters that allow ambulatory intermittent drainage of pleural fluid without repeated thoracentesis. Despite the efficacy and safety of IPCs, data supporting postplacement follow-up is limited and variable. Our study aims to characterize the impact of a dedicated pleural clinic (PC) on patient outcomes as they relate to IPCs.</p><p><strong>Methods: </strong>Patients who underwent IPC placement between 2015 and 2021 were included in this retrospective study. Differences in outcomes were analyzed between patients with an IPC placed and managed by Interventional Pulmonology (IP) through the PC and those placed by non-IP services (non-PC providers) before and after the PC implementation.</p><p><strong>Results: </strong>In total, 371 patients received IPCs. Since the implementation of the PC, there was an increase in ambulatory IPC placement (31/133 pre-PC vs. 96/238 post-PC; P =0.001). There were fewer admissions before IPC placement (18/103 vs. 43/133; P =0.01), and fewer thoracenteses per patient (2.7±2.5 in PC cohort vs. 4±5.1 in non-PC cohort; P <0.01). The frequency of pleurodesis was higher in the PC cohort (40/103 vs. 41/268; P <0.001). A Fine and Gray competing risks model indicated higher likelihood of pleurodesis in the PC cohort (adjusted subhazard ratio 3.8, 95% CI: 2.5-5.87).</p><p><strong>Conclusion: </strong>Our experience suggests that the implementation of a dedicated PC can lead to improved patient outcomes including fewer procedures and admissions before IPC placement, and increased rates of pleurodesis with IPC removal.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9698257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"O-arm CT for Confirmation of Successful Navigation During Robotic Assisted Bronchoscopy.","authors":"Jefferson Chambers,&nbsp;Daniel Knox,&nbsp;Timothy Leclair","doi":"10.1097/LBR.0000000000000894","DOIUrl":"10.1097/LBR.0000000000000894","url":null,"abstract":"<p><strong>Background: </strong>Robotic assisted bronchoscopy (RAB) is designed to increase bronchoscopic accessibility for difficult to reach pulmonary lesions. One limitation to success of RAB is computed tomography (CT) to body divergence. Real time imaging with cone beam CT is increasingly utilized for confirmation of correct navigation and tool-in-lesion during RAB. O-arm CT is a 3-dimensional imaging modality, which has not previously been described for use with RAB. Our purpose is to display the feasibility, ease of use, and high rate of confirmation of tool-in-lesion when using O-arm CT during RAB.</p><p><strong>Methods: </strong>Single center, retrospective review of 75 patients undergoing RAB with intraprocedural use of O-arm CT.</p><p><strong>Results: </strong>Median patient age was 65 years. Forty-nine percent of cases involved nodules ≤2 cm. Bronchus sign was absent in 44% of cases. Median procedure time was 80 minutes. Median number of O-arm CT runs per case was 2. The median effective dose of radiation was 7.2 millisieverts. Tool-in-lesion was confirmed in 97% (77 of 79) of cases. Definitive diagnosis was reached in 61 to 68 of 79 cases (77% to 86%). There were 2 cases of pneumothorax (2.5%), one of which needed intervention with tube thoracostomy.</p><p><strong>Conclusions: </strong>O-arm CT is an effective, and convenient alternative to other 3-dimensional imaging modalities for intraprocedural confirmation of tool-in-lesion during RAB.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2b/16/lbr-30-155.PMC10063183.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9229852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Feasibility of Photodynamic Therapy for Ablation of Peripheral Lung Tumors.","authors":"Sandeep Bansal,&nbsp;Rabih I Bechara,&nbsp;Jiten D Patel,&nbsp;Hiren J Mehta,&nbsp;J Scott Ferguson,&nbsp;Benjamin L Witt,&nbsp;Septimiu D Murgu,&nbsp;Kazuhiro Yasufuku,&nbsp;Roberto F Casal","doi":"10.1097/LBR.0000000000000889","DOIUrl":"10.1097/LBR.0000000000000889","url":null,"abstract":"<p><strong>Background: </strong>Newer navigational bronchoscopy technologies render peripheral lung lesions accessible for biopsy and potential treatment. We investigated whether photodynamic therapy (PDT) delivered via navigational bronchoscopy is feasible and safe for ablation of peripheral lung tumors.</p><p><strong>Methods: </strong>Two studies evaluated PDT in patients with solid peripheral lung tumors followed by clinical follow-up (nonresection study, N=5) or lobectomy (resection study, N=10). Porfimer sodium injection was administered 40 to 50 hours before navigational bronchoscopy. Lesion location was confirmed by radial probe endobronchial ultrasonography. An optical fiber diffuser was placed within or adjacent to the tumor under fluoroscopic guidance; laser light (630 nm wavelength) was applied at 200 J/cm of diffuser length for 500 seconds. Tumor response was assessed by modified Response Evaluation Criteria in Solid Tumors at 3 and 6 months postprocedure (nonresection study) and pathologically (resection study).</p><p><strong>Results: </strong>There were no deaths, discontinuations for adverse events, or serious or grade ≥3 adverse events related to study treatments. Photosensitivity reactions occurred in 8 of 15 patients: 6 mild, 1 moderate, 1 severe (elevated porphyrins noted in blood after treatment). Among 5 patients with clinical follow-up, 1 had complete response, 3 had stable disease, and 1 had progressive disease at 6 months follow-up. Among 10 patients who underwent lobectomy, 1 had no evidence of tumor at resection (complete response), 3 had 40% to 50% tumor cell necrosis, 2 had 20% to 35%, and 4 had 5% to 10%.</p><p><strong>Conclusion: </strong>PDT for nonthermal ablation of peripheral lung tumors was feasible and safe in this small study. Further study is warranted to evaluate efficacy and corroborate the safety profile.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/eb/lbr-30-135.PMC10063184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9241924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Regression of Metastatic Lung Adenocarcinoma Following a Core Biopsy.","authors":"Bilal F Samhouri,&nbsp;Anastasios Dimou,&nbsp;Jennifer M Boland,&nbsp;Eric S Edell","doi":"10.1097/LBR.0000000000000867","DOIUrl":"10.1097/LBR.0000000000000867","url":null,"abstract":"of PPM was reported in 1982 and since then about 60 cases have been reported in the English literature.3,4 The histologic origin of PPM is unclear. It is hypothesized that they either arise from ectopic arachnoid cells, the small meningeal epithelial nodules or subpleural pluripotent cells.5 The disease generally affects patients in fourth to seventh decade of life and is more common in females. Most cases are asymptomatic at presentation, with lesions being found incidentally on chest imaging. In symptomatic cases, chest pain, cough, hemoptysis, and breathlessness are the common presenting features.4 PPM usually presents as a single, peripheral, round or lobulated, noncalcified parenchymal nodule with well circumscribed margins. Few cases of multiple lung nodules mimicking metastatic lung disease have been reported.6 In most cases the bronchi or pleura are not involved. Endobronchial presentation of meningioma is uncommon, and to the best of our knowledge, only one case of endobronchial PPM has been previously reported.7 Our patient had a single large lobulated endobronchial mass which was well circumscribed and appeared to arise from the right upper lobe bronchus. Most cases of PPM are benign, slow growing tumors which have an excellent prognosis with very few cases of metastases or recurrence. Only 3 cases of malignant transformation of PPM have been reported thus far.8 Microscopically, these tumors are composed of spindle-shaped or ovoid cells arranged in lobules or a whorl pattern with psammoma bodies commonly being seen. In our case histopathological examination showed sheets and papillae of uniform cuboidal cells with round nuclei with mild nuclear atypia. Immunohistochemistry staining was positive for vimentin and EMA, characteristic of meningioma. The treatment of choice for pulmonary meningioma has historically been surgical resection. While wedge resection is ideal for benign peripheral lesions, lobectomy is preferred for malignant or central lesions. In view of the benign nature of the disease and low recurrence, we attempted to do a minimally invasive, endobronchial resection. Complete patency of bronchial tree was achieved with complete reexpansion of the collapsed lung postendobronchial resection. To the best of our knowledge this is the first case of endobronchial PPM where bronchoscopic resection was attempted. However, the patient eventually required thoracoscopic bilobectomy as there was a recurrence after 3 months. In conclusion, PPM is a rare disease with endobronchial presentation being reported only 1 case earlier. It should be considered in the differential diagnosis of endobronchial mass lesions and peripheral lung nodules.","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9327304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endobronchial Primary Pulmonary Meningioma: A Rare Cause of Right Main Bronchus Obstruction.","authors":"Virender P Prasad,&nbsp;Naseer Mohammed Abdul,&nbsp;Srikanth Peddi,&nbsp;Chetan R Vaddepally,&nbsp;Dommata Raghotham Reddy,&nbsp;Venkata N Maturu","doi":"10.1097/LBR.0000000000000866","DOIUrl":"10.1097/LBR.0000000000000866","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9327309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of Thoracic Ultrasonography in a Case of Tension Hydrothorax.","authors":"Maxwell Diddams,&nbsp;Shalini Mehta,&nbsp;Christina R MacRosty","doi":"10.1097/LBR.0000000000000856","DOIUrl":"10.1097/LBR.0000000000000856","url":null,"abstract":"CASE We present a 79-year-old female with history of hypertension, stage III chronic kidney disease, and supraventricular tachycardia managed with metoprolol succinate, who presented to the emergency department through ambulance after a fall when standing from a seated position. Triage vital signs were notable for blood pressure 81/49, heart rate 93, oxygen saturation 95% on 3L nasal cannula. Blood pressure did not improve after 3L of intravenous crystalloid. Physical exam revealed a cachectic woman in moderate respiratory distress with absent breath sounds on the right. Electrocardiography revealed sinus tachycardia at a rate of 108, premature atrial contractions, and no atrioventricular blocks. Labs notable for white blood cells of 13.8×103/μL, hemoglobin 10.9 g/dL. Chemistries notable for sodium 134mEq/L, creatinine 1.89mg/dL, blood urea nitrogen 62mg/dL. Troponin was elevated to 0.053 ng/ mL. Lactate was 3.5mmol/L and improved after intravenous fluids. Chest radiography revealed complete opacification of the right hemithorax with tracheal deviation to the left (Fig. 1, panel A) and noncontrasted computed tomography (CT) scan of the chest revealed a large right upper lobe mass and a heterogeneous cystic mass-like lesion occupying the right hemithorax with small pleural effusion (Fig. 1, panel C). Bedside thoracic ultrasonography showed a large heterogenous, loculated pleural effusion with solid structures and an inverted right hemidiaphragm (Fig. 1, Panel E and F). Bedside echocardiography showed a leftward-deviated heart without evidence of pericardial effusion. The inferior vena cava was >2.1 cm in diameter without respiratory variation. A 14 French pigtail chest tube was placed with a forceful gush of fluid on entering the pleural space and immediate drainage of 2000mL serosanguinous fluid. The patient’s blood pressure improved to 122/65 within 3 minutes of chest tube placement. Pleural fluid studies were consistent with a neutrophilic exudate with 79% neutrophils, lactate dehydrogenase 14,892U/L, protein 7.9 g/dL, glucose 23mg/dL, albumin 4.4 g/dL, and hematocrit 7 (Table 1). Cytology was negative for malignant cells. Postprocedure contrasted CT scan demonstrated persistent effusion, multiple masses involving the hilum, persistently collapsed right lung, and improvement in mediastinal shift (Panel D). Positron emission tomography 5 days later revealed a hypermetabolic right upper lobe paramediastinal mass with invasion into the right medial pericardium and the right parietal pleura, likely a primary lung cancer. Because of her advanced disease at presentation and comorbidities, the patient declined biopsy for diagnosis and elected to pursue comfort measures only. She did not want any further procedures so the chest tube remained in place until death. DISCUSSION Tension hydrothorax is a lifethreatening extreme of pleural effusion that threatens cardiopulmonary collapse.1–8 Because of its rarity, the exact physiology is imperfectly described","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9328624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}