Introduction. Flexible bronchoscopy is a safe, widely applied procedure for the diagnosis of airway diseases or lung abnormalities. In cases of the elderly, however, we should take account of uncommon adverse events such as Takotsubo cardiomyopathy. Takotsubo cardiomyopathy is recognized as stress-induced cardiomyopathy preceded by emotional or physical stress, which is typically associated with transient dyskinesia or akinesia of the left ventricular apical wall with normal findings or hyperkinesis of the basal wall. Flexible bronchoscopy can give elderly patients so much stress that it is at risk for developing Takotsubo cardiomyopathy. Case Reports. We report a series of cases diagnosed as Takotsubo cardiomyopathy during or after flexible bronchoscopy as follows. Case 1: A woman aged 85 developed Takotsubo cardiomyopathy one day after flexible bronchoscopy. She was associated with arrhythmias, and died partly because of heart failure and progression of lung cancer. Case 2: A woman aged 85 developed Takotsubo cardiomyopathy 6 days after the procedure. Her case was associated with intraventricular thrombus and was treated with anticoagulant. Case 3: A man aged 85 developed Takotsubo cardiomyopathy 6 days after the procedure. His condition was associated with acute heart failure and was treated with non-invasive positive-pressure ventilation. He was also treated with anticoagulant, but developed cerebral embolism and led to right hemiplegia. Case 4: A man aged 78 developed Takotsubo cardiomyopathy during the procedure. He had no complications and was treated for lung cancer with irradiation. Conclusion. Takotsubo cardiomyopathy is an uncommon, but an important adverse event of flexible bronchoscopy on the elderly, partly because it can lead to severe events such as pump failure, arrhythmia, or thromboembolism. Once Takotsubo cardiomyopathy develops, activities of daily living and cognitive functions may decline before recovering from it and it can be attributed to their poor prognosis, especially in the frail elderly. To prevent Takotsubo cardiomyopathy during bronchoscopy, we should prevent emotional and physical stress with administration of the appropriate sedative or anti-anxiety medicine.
背景．成人T細胞白血病（adult T cell leukemia：ATL）の肺浸潤の診断には経気管支肺生検が推奨され，気管支肺胞洗浄液（bronchoalveolar lavage fluid：BALF）中細胞のフローサイトメトリー分析の有用性は不明である．症例．63歳女性．慢性咳嗽を訴え胸部CT画像で両肺野に浸潤影を認めた．抗菌薬に反応せず末梢血異型リンパ球の出現を認め，抗HTLV（human T cell leukemia virus）-1抗体値が高値であった．BALF中に異型リンパ球様の細胞増加を認め，フローサイトメトリー分析ではCD4＋CD7－CD25＋であった．ATLの肺浸潤と診断した．結論．BALF中細胞のフローサイトメトリー分析によってATLの肺浸潤と診断した．