Interventional Bronchoscopy and Pleuroscopy

A Book of Case Studies with Videos

Anne Ann Ling Hsu, Pyng Lee;;;

• Publisher: WSPC
• Year: 2017
• ISBN:
  9789813229020
• Topic: Medicina
• Subtopic: Cirugía y medicina quirúrgica

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This is a book of case series on interventional bronchoscopy and pleuroscopy based on decades of clinical experience of the authors. The purpose of this publication is not to provide the principles, theory or evidence of clinical practice of these procedures but to illustrate actual case scenarios. Each case is presented with the history, including clinical, radiological, endoscopic findings and final outcome; and procedural details in the form of video illustration. Learning points of these cases are highlighted either at the end of the case presentation and/or in a separate chapter. Physicians accessing the immense resource of videos will acquire the knowledge and expertise necessary to manage their patients.

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Sample Chapter(s)
Introduction - Interventional Bronchoscopy (540 KB)
Non-malignant airway obstruction: Intraluminal lesions (1.24 MB)

--> Contents:

• Non-Malignant Airway Obstruction:
  • Foreign Body
  • Mucus Plug and Blood Clot
  • Tumors
  • Tuberculosis
  • Fibrosing Mediastinitis
  • Trauma
  • Excessive Dynamic Airway Collapse (EDAC)
  • Mediastinal Mass
• Malignant Airway Obstruction:
  • Primary Respiratory Malignancy
  • Esophageal Carcinoma
  • Thyroid Carcinoma
  • Mediastinal Lymphadenopathy
  • Lower Respiratory Tract Metastases
• Challenging Conditions:
  • Fistulation
  • Bleeding
  • Copious Secretions
  • Critical Airway Obstruction
  • Rigid Tube Coring and Dilatation
  • Flexible Forceps Dilatation
  • Stenting
  • Pulmonary Alveolar Proteinosis
• Rigid Bronchoscope Intubation
• Critiques

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--> Readership: Specialists and trainees in Pulmonary Medicine, Oncology, Thoracic Surgery, Pathology; endoscopists and researchers with interest in tracheobronchial pathologies will most likely find this book educational and informative that will have impact on their field of work and training. -->
Keywords:Rigid Bronchoscopy;Tracheobronchial Ablative Therapies and Stentings;Pleural Disorders;Pleural Biopsy and Talc PleurodesisReview:

"This collection contains lessons learnt, pearls and pitfalls alike, in almost 150 cases of interventional bronchoscopy and pleuroscopy. Concise and readable, it brings the reader into the intervention suite, intensive care unit and clinic and seeks to help others in the comprehensive approach to each case. In contrast to other books and publications, both good and adverse outcomes and lessons from cases collected over 20 years are presented. "

Mariko Siyue Koh, MBBS, MRCP (UK), FCCP (USA)
Senior Consultant, Department of Respiratory and Critical Care Medicine
Singapore General Hospital
Adjunct Associate Professor, Duke-NUS Medical School, Singapore
Senior Clinical Lecturer, NUS Yong Loo Lin School of Medicine, Singapore
Key Features:

• Worldwide there are only few books published on interventional bronchoscopy and pleuroscopy. The book is unique as it combines both subjects, presented in the form of case-video illustrations
• Specific unique topics covered were endobronchial lesions due to tuberculosis and esophageal carcinoma
• Case series with full video recordings of therapeutic bronchoscopy and pleuroscopy performed over a span of 20 years by two highly experienced interventional pulmonologists

1. Foreign body

Fishbone

Foreign Body in Lower Trachea

Rigid forceps removal of fishbone

Presentation: A couple of episodes of hemoptysis for 1.5 years after an episode of choking on fishbone. Had nasoendoscopy and neck computed tomography (CT) scan done at presentation which revealed no foreign body. Had curative surgery for colonic carcinoma (Ca) 4 years prior.

Chest imaging: Foreign body incidentally found in lower trachea on cancer surveillance chest CT scan.

Risks or comorbidities: Age (octogenarian), colon Ca status post (s/p) resection.

Airway intervention: Rigid forceps removal of fishbone. In view of remote history of foreign body aspiration, rigid bronchoscopy and intervention was recommended after CT scan findings.

Complications: Nil

Post-intervention: Successful (bronchoscopic and symptoms)

Proximal tip of the fishbone in the mid trachea seen on CT thorax scan & rigid bronchoscopy.

Distal tip of the fishbone resting on the carina.

Jaw fragment

Foreign Body in RMB

Laser coagulation & resection of bleeding granuloma, removal of jaw fragment

Ref: AAL Hsu, A Takano, A Chan. Beyond Removal of Foreign Body. AJRCCM 2014;189(8):996–7 doi: 10.1164/rccm.201311-2039IM.

Presentation: Referred for right main bronchus (RMB) mass on CT scan. Had recurrent pneumonia and cough over the past 20 years after a vehicular accident.

Chest imaging and bronchoscopy: A bony lesion with granulation tissue almost completely obliterating the RMB.

Comorbidities: Nil

Airway intervention: Laser coagulation and resection of bleeding granuloma. Rigid forceps removal by grasping on the free left border of the bone and mobilising it with rotational and pulling force. The foreign body (FB) was a maxillary or mandibular fragment measuring 4 cm by 3 cm. Residual granulomas in RMB and right bronchus intermedius (RBI) were not resected as spontaneous regression was expected following removal of the inciting factor.

Complications: Nil

Post-intervention: Had hemoptysis 2 years later. Bronchoscopy showed nodular lesions in RBI. Thorax CT revealed right lower lobe (RLL) ‘abscess’ and lobectomy was performed. The resected lung showed bronchiectasis evident by massively dilated bronchial wall close to the pleural, broncholith and actinomycosis. The patient had 6 weeks of amoxicillin/clavulanate and remained well for the next 10 years.

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