Five normal bronchi were removed from five different cadavers, fixed in formalin, and subsequently observed utilizing bronchoscopic ultrasonography. A direct comparison between ultrasonography and histology verified the former to effectively identify three bronchial layers. Isoechoic, hyperechoic, and isoechoic levels corresponded respectively to the submucosal, chondral, and extrachondral layer, however, the mucosal layer could not be identified. The clinical relevance of bronchoscopic ultrasonography was demonstrated in a patient with squamous cell carcinoma of the lung which had slightly invaded the internal bronchial surface. At the time of diagnosis, ultrasonographic analysis revealed thickening of the bronchial submucoal layers prior to chemotherapy and a reversal to normal thickness following chemotherapy. These findings suggest bronchoscopic ultrasonography to be an effective means for evaluating specific therapies for bronchogenic carcinoma.

View full abstract

We reported a case of 48-year-old woman with tracheal stenosis. She had been treated for bronchial asthma from 1991. In March 1997, she was admitted to a certain hospital with status asthmaticus. She was intubated and treated with mechanical ventilation for 8 days. Then she was extubated and discharged. Two weeks later, she complained of dyspnea and was admitted to our hospital. The chest radiograph and flow-volume curve suggested tracheal stenosis. Bronchoscopy revealed circumferential stenotic change. Three-dimensional computed tomography showed that the length of stenosis was 21 mm and the narrowest portion was 6 mm in diameter. The method was useful in determining the location, length and width of the stenosis. Segmental resection and tracheoplasty were performed. After the operation, dyspnea disappeared and the pulmonary function improved.

View full abstract

A 60-year-old woman with metastatic lung cancer in her right lung field developed a large tracheoesophageal fistula in the lower trachea after repeated radiotherapy and bronchial artery-infusion therapy. We first inserted a Dumon stent (16mm) into the trachea, but it failed to occlude the fistula completely, because it was not large enough to fit the comparatively long diameter (18mm) of the fistula. Our own hand-made silicone stent (18mm) replaced the Dumon one, but a portion of the fistula at the tracheal bifurcation was still not covered by the stent. We therefore prepared a covered expandable metallic stent (EMS) with spreading edge to adjust to the carina, but it caused reactive granulation leading to stenosis at the carina. Finally, we withdrew the EMS and inserted a Dumon Y-shaped stent and a hand-made silicone stent (18mm) covering the former.

View full abstract

A 62-year-old man was operated for esophageal cancer in 1983. In 1996 he was treated by Linac and brachytherapy for tumor reccurence at the carina. In 1997, he was admitted to our hospital for tracheal stenosis at the carina. Bronchoscopic findings showed tumor invasion from the carina into both main bronchi. At first, we prepared a Dumon Y-shaped stent, but the stent could not cover the tumor extent in the bronchial lumen, because it had grown to near the bifurcation of the left upper and lower lobe bronchi. So we proposed a 3-piece silicone stent, because it is easier to perform laser vaporization at the carina than in more peripheral bronchi. The portion for the left bronchus was 4.5cm in length and 12mm in diameter, that for the right main bronchus had a cut-down tip for preservation of the right upper lobe orifice was 4cm in total length and 14mm in diameter, while the portion for the tracheal lumen was 5cm in length and 16mm in diameter. Four months later, tumor grew out from the gap between portion at the carina, so it was vaporized by contact Nd-YAG laser safely and easily.

View full abstract

A foreign body lodged in the bronchial tree was detected by bronchoscopy in two patients with persistent inflammatory disease of the respiratory tract. Case one was a 60-year-old man. He had had an one-month-history of persistent cough. Bronchoscopic examination showed a dental crown, about 1cm in size, lodged immediately below the segmental bronchus B^6 of the right lower lobar bronchus. Case two was a 70-year-old man. He had had an approximately 6-month history of cough as case one. Bronchoscopic examination showed a false tooth, about 1cm in size, lodged distally in the right truncus intermedius. The foreign body could be removed by bronchoscopy without any serious complications in both patients. Foreign bodies in the bronchial tree are commonly associated with a known history of aspiration in adult patients. To detect foreign bodies in the respiratory tract, chest X-ray films are generally useful. However, foreign bodies are difficult to identify on chest X-ray films if blood vessels or the heart are superimposed over them as occurred in the present two cases. Careful history taking may also assist in the diagnosis.

View full abstract

A 79-year-old woman was admitted to our hospital for further examination of a tracheal tumor shadow on chest computed tomograpy. Fiberoptic bronchoscopy revealed a tracheal tumor and a metallic foreign body in the trachea and right main bronchus. We removed the foreign body successfully by conventional forceps under fiberoptic bronchoscopy. The foreign body was an obturator of lidocaine spray nozzle, and was considered to have been caused by pharyngeal analgesia using a lidocaine spray before upper gastrointestinal endoscopy.

View full abstract

Unilateral total atelectasis, due to metastatic malignant melanoma in the left main bronchus, was treated by topically injecting β-interferon and using an Nd-YAG laser. A 57-year-old man, who had received a wide excision of the right plantar and who had his inguinal lymph nodes removed 7 years prior, was admitted due to bloody sputum and atelectasis. Fiberoptic bronchoscopy revealed a red-brown colored tumor that nearly occluded the left main bronchus and brushing cytology showed malignant melanoma cells. Additional systemic metastases were observed during the restaging procedure. At first, the tumor was unsuccessfully treated with Nd-YAG laser alone, and recurred shortly thereafter. However, when the tumor was treated with Nd-YAG laser in conjunction with topically injected β-interferon, the occlusion in the left main bronchus improved significantly and remained patent. When the patient died four months later of brain metastasis, the autopsy demonstrated the wellmaintained opening of the bronchus. Topical injection of β-interferon in association with Nd-YAG laser was most effective in treating an endobronchial metastasis of malignant melanoma.

View full abstract

We report a case of squamous cell carcinoma of the lung producing human chorionic gonadotropin (HCG). A 67-year-old male was admitted to our hospital with a chief complaint of back pain and gynecomastia on December 5, 1996. The chest X-ray film revealed a mass in the left upper lung field. The laboratory tests demonstrated elevated level of CYFRA and HCG. The chest CT scan showed multiple metastases in both lung fields. The biopsy of the mass lesion showed poorly differentiated squamous cell carcinoma. In the immunohistochemical staining tumor cells were focally positive for HCG. In his testis, no nodule was palpated, and ultrasonography revealed no space occupying lesion. No extrathoracic lesion was found. Based on these results was made a diagnosis of squamous cell carcinoma of the lung producing human chorionic gonadotropin (HCG). He was treated with chemotherapy, but the tumor progressed and he died. There are only a few reports about HCG secreting lung cancer with gynecomastia, and HCG has not been expected to be a sensitive marker of lung cancer. However, recently urinary HCG β-core fragment is reported to be positive in many patients with lung cancer, and we expect it to be a valuable tumor marker for the early diagnosis of lung cancer.

View full abstract

A 56-year-old man was admitted for examination of a mediastinal mass on chest radiograph. He had no complaint related to intrathoracic lesions and no remarkable previous diseases. Since neurogenic tumor was suspected from chest CT findings, video-assisted thoracoscopic surgery was performed. It was confirmed that two different and separate lesions were attached to the right side of thoracic vertebrae, one a cystic tumor and the other a triangular mass resembling lung tissue. The former was diagnosed as bronchogenic cyst and the latter as extralobar pulmonary sequestration. They were safely resected without complications.

View full abstract

A 55-year-old man was admitted to the hospital with chief complaints of productive cough and left chest pain. A chest X-ray revealed consolidation with an air-fluid level in the left lingular division. Lung abscess was diagnosed and antibiotic therapy was started. In spite of successful treatment the shadow remained, so bronchoscopy was performed. A mucosal bridge was observed at the orifice of left B^5. He had no past history of pulmonary disease, therefore this formation may be associated with lung abscess.

View full abstract