Purpose. The purpose of this study was to evaluate the diagnostic value of bronchial arteriography for determination of the bleeding sites in patients with hemoptysis. Methods. Forty-nine patients (30 men and 19 women) with hemoptysis were examined by bronchofiberscopy and bronchial arteriography. All patients underwent bronchofiberscopy within 48 hr of active bleeding to determine the bleeding sites. Bronchial arteriography was also done in all patients. Bronchiectasis, tuberculosis, aspergillosis and lung cancer caused hemoptysis in these patients. The correlation between those findings and the bleeding sites was evaluated. Results. The angiographic signs were extravasation (11.1%), hypervascularization (97.7%), broncho-pulmonary shunts (51.1%), and aneurysms (11.1%), which tended to occur in the upper lobe bronchi. The sites of these signs were similar to the bleeding sites determined by bronchofiberscopy. Conclusion. We suggested that bronchial arteriography is valuable for the determination of the bleeding sites of patients with hemoptysis.

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Purpose. In peripheral pulmonary lesions that could not be diagnosed by standard transbronchial biopsy, computed tomography (CT)-guided examinations were performed using an ultrathin bronchoscope. We present patients in whom this procedure was considered effective. Subjects. This study included 7 patients (8 peripheral pulmonary lesions) that could not be diagnosed by X-ray fluoroscopic examinations with a standard bronchoscope (outer diameter: 5.3-6.0 mm). The mean age was 60 years. The subjects consisted of 3 men and 4 women. The lesion size was 10 mm or less in 1 lesion, 11 to 15 mm in 2 lesions, 16 to 20 mm in 3 lesions, and 21 mm or more in 2 lesions, with a mean size of 19 × 14 mm. Sites consisted of the right lung in 6 lesions (upper lobe: 1 lesion, middle lobe: 1 lesion, lower lobe: 4 lesions) and the left lung in 2 lesions (both upper lobe). One of 8 lesions was unclear on X-ray fluoroscopy. Three lesions were located immediately below the pleura. Methods. Using an ultrathin bronchoscope (Olympus XP-40, outer diameter: 2.8 mm, forceps channel: 1.2 mm), biopsy instruments were inserted to lesions with a combination of CT and X-ray fluoroscopy. After confirming that the instruments had reached the lesion site by thin section CT (TSCT) , a biopsy was performed. Results. Using an ultrathin bronchoscope, the 5th to 8th order bronchi (mean: 6.9) were observed. In 1 patient, a tumor was detected under direct endoscopic vision. In 7 of 8 lesions, the advancement of biopsy instruments to the lesion site was confirmed by TSCT. Five lesions were diagnosed as lung cancer, 1 as metastatic lung tumor, and I as pneumonia. Lesions immediately below the pleura, a lesion in left S^<1+2> close to the mediastinum, and a lesion that was unclear on X-ray fluoroscopy, were diagnosed. Conclusion. CT-guided ultrathin bronchoscopy facilitated introduction of biopsy instruments to the lesion site and confirmation of successful biopsy harvesting by CT. Therefore, this procedure may be useful for diagnosing lesions in which transbronchial diagnosis using the standard method is impossible.

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This report concerns a case of tracheobronchial stenosis which had progressed to the terminal phase of thyroid cancer. A 69-year-old woman complaining of dyspnea was found to have tracheobronchial stenosis accompanied by an irregular mucosa and a tendency to bleed of the mucosa from the trachea 5 cm below the vocal cord to the right upper bronchus. The bronchus was cleared as quickly as possible in order to preserve the pulmonary airway of the left lung. However, the patient did not recuperate satisfactorily, so we decided to insert a Spiral Z stent from the trachea to the right main bronchus. The stent was placed successfully without obstructing the left main bronchus. On day 14 after the stent placement, the patient again complained of dyspnea with bronchial stenosis because of a growth in the stent. Placement of an Ultraflex stent to clear most of the stenotic trachea resulted in elimination of complaints, but the patient' s bronchial stenosis progressed slowly as a result of repeated aspiration and difficulty with sputum expectoration. Although bronchoscopic examination before discharge showed fibrin-like materials covering the stent, the woman was followed as an outpatient. On day 56 after placement of the stent within the stent, she suffocated at home. Our attempt to place bilateral stents over the stenotic bronchus to make the most of the characteristics of the Spiral Z and Ultraflex stents was successful. In the future, many cases can be expected to select placement of a stent in order to relieve bronchial stenosis. We consider our case important because it illustrates not only the usefulness but also the risk associated with stent-in-stent placement.

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A 70-year-old man was hospitalized with productive cough since one month previously. Multiple squamous cell carcinomas were found in right S^1 the orifice of the right upper lobe bronchus, right basal lobe bronchus and left upper lobe bronchus. The orifice of the right upper bronchus, the right basal lobe bronchus and the left upper lobe bronchus contained carcinoma in situ. Tumors of the right S^1 and the orifice of the right upper lobe bronchus were removed by sleeve lobectomy. Metastatic mediastinal lymph nodes were not found. The lesions of the orifice of the right basal bronchus and in the left upper bronchus were treated by stereotactic radiotherapy (SRT). There was no severe complication, and the effect obtained was complete response (CR). SRT is considered to be effective therapy for multiple carcinomas, especially, early lung cancer lesions such as carcinoma in situ.

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A 54-year-old man presented with high-grade fever and cough and was referred to our hospital. On admission, chest X-ray films showed a mass shadow with infiltration in the left upper lung field. Chest computed tomography showed a mass shadow in S^<1+2> of the left lung. Bronchoscopy revealed a polypoid tumor obstructing B^<1+2> b. A preoperative diagnosis was not obtained, but lung cancer was suspected and surgery was performed. Semisegmentectomy of S^<1+2> of the left lung was performed. The cut surface of B^<1+2> b revealed an endobronchial hamartoma. Intraoperative findings showed an elastic hard mass in S^<1+2> of the left lung, which was diagnosed as organizing pneumonia, so surgery was performed. Histopathological examination of the resected specimen showed organizing pneumonia and an endobronchial hamartoma. We conclude that the endobronchial hamartoma occluded the bronchus, causing obstructive pneumonia.

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We report a case of bronchomalacia with atelectasis. A 69-year-old woman complaining of wet cough and right chest pain was found to have partial atelectasis of the right upper lobe on chest X-ray film and CT scans. Bronchofiberscopy showed reversible stenosis at the right upper lobe orifice on the expiratory phase. We diagnosed this case as bronchomalacia at the right upper lobe orifice accompanied by partial atelectasis of the right upper lobe. Bronchodilation and expectorants were administrated and the atelectasis disappeared in a week.

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Cough appeared in a 63-year-old woman on December 15, 2000, and she was hospitalized in another hospital after producing about 200 ml hemoptysis on December 22. On admission, her chest X-ray film showed an infiltrative shadow in the right upper and lower lung fields. Hemoptysis disappeared and the patient was treated based on a tentative diagnosis of pneumonia. However, atelectasis of the right lung field was recognized, whereupon she was transfered to our hosptal on January 11, 2001. Fiberoptic bronchoscopy demonstrated coagulated blood in the right main bronchus, which was removed through the fiberoptic bronchoscopy. Since no pathological change related to the extensive hemoptysis was found by fiberoptic bronchoscopy and chest CT scanning, idiopathic bronchial hemorrhage was diagnosed. The literature contains few reports on patients with massive atelectasis due to idiopathic bronchial hemorrhage.

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A case of intralobar pulmonary sequestration associated with fungal infection was reported. A 37-year-old woman with intralobar pulmonary sequestration was admitted to our hospital because of worsening of chest X-ray and CT findings. Video-assisted thoracoscopic surgery was done. Postoperative diagnosis was intralobar pulmonary sequestration associated with fungal infection. A review of Medline indicated that this case is the 10th reported case.

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A 70-year-old asymptomatic man was admitted to Chikugo City Hospital because of an abnormal shadow on chest X-ray. We found decreased PaO_2 and a diffuse reticular shadow and ground-glass attenuation on chest X-ray. Chest computed tomography also revealed bilateral diffuse reticular shadows and ground-glass attenuation, but did not show fibrosis, or honeycombing. The number of lymphocytes in the bronchoalveoler lavage fluid was erevated. Transbronchial lung biopsy demonstrated alveolitis with lymphocyte infiltration and slight fibrosis. After admission, the findings on chest X-ray and chest computed tomography and low PaO_2 improved without therapy. Furthermore, based on the abscence of symptoms and the presence of slight fibrosis in the lung biopsy, we diagnosed chronic hypersensitivity peumonitis without acute exacerbation.

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