Many approaches to bronchial embolization using a wide variety of materials have been developed. However, those used for conventional bronchial embolization were not necessarily sufficient in terms of reliability and durability. We employed a new bronchial embolization material using solid silicone(BEUS) in 9 patients, including 4 cases of intractable pneumothorax, 2 pyothorax with bronchial fistula, 1 post-operative bronchial fistula, 1 traumatic pneumothorax with consistent bronchial bleeding and 1 perinephric abscess with pyelobronchial fistula. Successful outcome was obtained in 7 of the 9 patients. The result was unsuccessful in the case of post-operative bronchial fistula, and one case of pyothorax. It is thought that BEUS has the possibility to provide more effective and longer bronchial embolization than other conventional methods.

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Anthracosis around bronchioles is one of the macroscopic findings commonly found in smoker's lungs and may possibly be related for pre-emphysematous lesions. High-resolution CT(HRCT) and pathologic findings were compared using inflated and fixed lungs to clarify the findings of smoker's lungs. Fifteen cases, which had anthracosis macroscopically without obvious emphysematous lesions in postmortem or operated lungs, were investigated for correlative study. The macroscopic anthracosis on the surface of the sliced specimens corresponded to pigmented fibrosis around bronchioles and arteries pathologically, accompanied with slight dilatation of bronchioles in the most cases. These lesions on radiographs showed ill-defined micronodular opacities in the central portion of secondary lobules and HRCT images of the specimens showed centrilobular micronodular opacities and ground-glass opacities (n=13) and centrilobular branching opacity (n=4). We also demonstrated these findings on HRCT images of the smokers. HRCT may have the potential to detect fibrosis with anthracosis around bronchioles which may be pre-emphysematous lesions in the smoker's lungs.

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Anesthesia of the respiratory tract for fiberoptic bronchoscopy usually is performed with injection of 2-3 ml air into the respiratory tract together with 1-2 ml lidocaine through a sheathed catheter. This usually requires an assistant. If the bronchoscopist could perform the procedure alone, the time required for examination would be shortened and the examination would be more efficient. To overcome the problems inherent in the conventional method, we developed an improved sheath catheter equipped with a T-shaped connector with 2 one-way valves allowing oxygen pressure to be used for injection of lidocaine. This procedure was used in 20 cases. The time required for examination was markedly shortened, because lidocaine could be injected without using a syringe. The use of this method of anesthesia for bronchoscopy is strongly advocated.

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A 93-year-old woman was admitted to our hospital because of hemoptysis. Bronchoscopy revealed a broncholith at the truncus intermedius. After removal of the broncholith using the bronchoscope, she had no symptoms for several months. However, she was readmitted after suffering repeatedly from refractory pneumonia and hemoptysis. Repeat bronchoscopic examination revealed a broncholith obstructing the truncus intermedius. Three stones, which were removed by bronchoscopy, were analyzed and were shown to be 65% calcium phosphate and 35% calcium carbonate. Bronchoscopy is very useful for the diagnosis of broncholithiasis and bronchoscopic removal of broncholith should be indicated regardless of the age of the patient when it is directly visible endoscopically and mobile.

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A 44-year-old man was admitted to our hospital because of cough and low grade fever. The chest X-ray taken on admission showed consolidation in the right middle lung field. The chest CT demonstrated a dilated bronchus-like structure with surrounding hyperlucency and scattered infiltration in the right S^1. Bronchoscopic findings of the right upper lobe bronchus showed complete obstruction of the orifice of the right B^1. We diagnosed congenital bronchial atresia of right B^1. Since he suffered repeated respiratory infections, he underwent a right upper lobectomy. The chest CT findings was useful in diagnosing congenital bronchial atresia in this patient.

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A 28-year-old man was admitted with acute respiratory failure. Chest CT scan and bronchofibercscopy revealed a polypoid tumor, which had originated from the anterior tracheal mucosa and occluded 90% of the tracheal lumen. Endoscopic electrosurgery was performed using an electric snare and forceps to open the airway. The tumor was completely resected safely and quickly. The histologic diagnosis revealed leiomyoma. Endoscopic electrosurged treatment can be a valuable modality for patients with tracheal tumors, especially benign polypoid tumors.

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We report a case of endobronchial leiomyoma in a 48-year-old woman complaining of dyspnea and wheezing cough. Chest X-ray showed no abnormal findings. She was treated for bronchial asthma. Three months later, chest computed tomography suggested an endbronchial tumor in the left main bronchus. Bronchoscopy revealed a smooth, round, whitish polypoid tumor protruding into the left lower lobe bronchus. Bronchoscopic biopsy specimens suggested endobronchial leiomyoma. Bronchofiberscopic polypectomy was performed by electrosurgery using a gastro-intestinal polypectomy snare. Her symptoms improved immediately after the resection of the tumor, and bronchoscopy 11 months after the resection revealed no evidence of recurrence.

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We report a case of bronchial foreign body removed by a balloon catheter. A 74-year-old man was admitted to our hospital for further evaluation and treatment of a foreign body in the lung. Chest CT showed that the foreign body was impacted in the peripheral bronchus of left B^<10>c. We could not observe the foreign body bronchoscopically. However we were able to remove the foreign body with a balloon catheter easily and safely. Long-term impacted bronchial foreign bodies cause various complications. They should be removed as repidly as possible. Balloon catheters can be useful for removal of peripheral bronchial foreign bodies even if they cannot be observed by the bronchoscope.

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A 45-year-old asymptomatic man with an abnormal shadow on his chest X-ray film detected in a mass survey visited our outpatient clinic for more detailed investigations. The chest X-ray showed a 3.0×4.0cm tumor overlapping the heart in the left lower lung field. CT revealed spicular shadow around the tumor. A tumor with a pearl-like appearance and a predisposition to bleeding was observed in left B^9 by bronchoscopy. Although transbronchial biopsy revealed diffuse chronic inflammation in the bronchial mucosa, we performed lobectomy because malignancy could not be completely ruled out. The pathological diagnosis of the resected specimen was organizing pneumonia with invasion of lymphocytes and plasma cells. It is interesting that an inflammatory polyp of the bronchus was caused by organizing pneumonia.

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A 31-year-old woman who had a history of bronchial asthma was admitted to our hospital with cough and purulent sputum. A chest X-ray examination showed pulmonary infiltrations in the left middle and lower lung fields accompanied by central bronchiectasis. The patient had eosinophilia and immediate skin reactivity to aspergillus, candida and penicillium. Serum precipitating antibodies against any fungi and elevated serum IgE, however, were absent. Bronchoscopic examination revealed bronchial inflammatory change with infiltration of eosinophils and mucous plugs containing numerous eosinophils and penicillium. Corticosteroid therapy ameliorated the symptoms and X-ray findings. We here present an unusual and informative case of allergic bronchopulmonary fungosis due to penicillium, which was successfully diagnosed by bronchoscopic examination.

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A 44-year-old man consulted our clinic because of cough with bloody sputum. Chest X-ray and computed tomography revealed a nodular shadow in the left lingular lobe. On suspicion of lung cancer, he underwent bronchoscopic examination. The transbronchial biopsy demonstrated several parasite eggs surrounded by granulomatous tissue. Bronchial lavage also revealed an egg. The dot-ELISA test yielded positive results for IgG antibody against both Paragonimus westermani and Paragonimus miyazakii antigens. A diagnosis of infection by P.westemanii was made because the test showed stronger reaction against the antigen of this parasite than against P.miyazakii antigen. Detailed history taking failed to disclose the route of infection. The treatment with praziquantel was considered effective because of roentgenological improvement and decrease in the titer of the specivic antibody.

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