Improved Bronchial Tree Image Reconstruction from the Lateral Decubitus Position of Computed Tomography Images for Virtual Navigation: A Case Report

Abstract

Appropriate endobronchial path selection is important for the bronchoscopic diagnosis of peripheral pulmonary lesions (PPLs). Herein, we report a case of a successful ultrathin bronchoscopic biopsy of a small PPL using computed tomography (CT) in the lateral decubitus position. CT imaging and bronchoscopy were performed on a patient in the supine and lateral decubitus positions. CT images in the supine position showed a pseudo-obstruction of the left B¹⁰ in three-dimensional (3D) images of the bronchial tree and virtual bronchoscopic navigation (VBN). Conversely, CT images in the lateral decubitus position with "examination side up" showed the 3D bronchial tree image of the lower lobe, delineating the B¹⁰ bronchus along with the further subsegmental bronchi. In conclusion, using VBN and CT imaging can improve the optimal bronchial pathway determination for the transbronchial biopsy of a target lesion.