Purpose and Objects. In order to evaluate the usefulness of bronchial washing, we analyzed the clinical outcome of patients with mycobacterium avium complex (MAC) according to the diagnostic procedure. Twenty-three patients who were diagnosed by bronchial washing (BF group) were compared to 42 patients who were diagnosed by sputum (Sp group). Results and Conclusion. Albumin levels in sera were higher in the BF group whereas the WBC count, population of neutrophils and IgG levels were higher in the Sp group. The extent of lesions was significantly larger in the Sp group. We analyzed the sputum status trend in the 58 patients treated with rifampicin, ethambutol and clarithromycin for a year or more showing favorable outcome in the BF group. To assess the correlation between radiographic images and therapy, we defined a "degree of improvement" (DI) that is calculated according to the CT findings. There was no difference in DI between the two groups, however, the patients with small lesions showed good responses. These results indicate that bronchial washing can predict response in MAC pulmonary disease.

View full abstract

Background. Tracheo-bronchial leiomyoma is comparatively rare and only 4 cases in children under 15 have been reported in the Japanese literature. Case. The patient was a 12-year-old boy with a chief complaint of wheezing and dyspnea. Treatment for bronchial asthma was ineffectual. Chest X-ray and CT scan demonstrated a tracheal tumor. Bronchofiberscopy under general anesthesia revealed a polypoid tumor in the trachea. The tumor originated from the membranous portion of the trachea. We resected the tumor bronchoscopically using electric forceps. Pathologically, the tumor was leiomyoma. Conclusion. Bronchoscopic electric treatment for tracheal leiomyoma is thought to be safe and effective.

View full abstract

Background. Laryngeal and tracheal cancers are likely to develop double primary cancers in patients with a heavy smoking history. The clinical course, imaging findings and risk factor (heavy smoking history) suggested that this case had metachronous double primary cancers of the larynx and trachea. We report a primary tracheal cancer growing rapidly in the tracheal lumen. Case. A 78-year-old man was referred to our hospital because of bloody sputum and expectoration of a part of a tumor. He had received 70 Gy irradiation for squamous cell carcinoma of the larynx two years previously. Histologic examination of the specimen of the expectorated tumor revealed squamous cell carcinoma. Bronchoscopic examination showed an intratracheal polypoid tumor (tracheal cancer) growing aggressively. The tumor, which incompletely obstructed the trachea, was vaporized with an Nd-YAG laser. After two sessions of Nd-YAG laser therapy, the tracheal lumen was maintained. He received radiation therapy (51 Gy) concurrently. He was discharged in good condition. Conclusion. Clinicians should be aware that tracheal cancer may grow aggressively and cause obstruction of the trachea.

View full abstract

Background. We report a case of widespread bronchogenic carcinoma in situ originating in trachea and bilateral bronchi. Case. A 65-year-old man was admitted because of class D sputum cytology, in October 2000. Although chest X-ray and CT findings showed no abnormalities, bronchofiberscopy revealed reddened and irregular mucosa in the trachea and bilateral bronchi. Multiple biopsies disclosed carcinoma in situ (squamous cell carcinoma). The lesions of the trachea and bronchi were treated by chemotherapy and external radiotherapy because of difficulties with both conventional surgical treatment and endoscopic laser surgery. After treatment, biopsies showed no malignancy. It has been reported that early stage hilar lung cancer often presents with multiple carcinomas, both synchronous carcinomas and metachronous carcinomas. Conclusion. We considered that this was a case of multiple bronchogenic carcinoma in situ, synchronous and widespread, originating in the trachea and bilateral bronchi, and that multi-combination therapy based on surgical resection would be suitable for regional carcinoma in situ, due to the multiplicity and the need to preserve respiratory function.

View full abstract

Background. Broncholithiasis is a well-known but rare condition. The incidence is 0.1〜0.2% of all lung diseases and about 0.8% of patients with hemoptysis or bloody sputum. Cases. From 1978 to 1997, we encounterd five patients with broncholithiasis. Two patients were men and three were women. The median age was 57 years (range:48-73). Chief complaints were hemoptysis and/or bloody sputum (2), dyspnea (1) and two patients were asymptomatic. Two patients also had bronchiectasis. The methods for definition and diagnosis of broncholithiasis were bronchofiberscopy (60%), operation (20%) and autopsy (20%). The most frequent site of broncholithiasis was the right lung (60%). Chemical analysis was performed on two cases, and the main components of the stones were CaCO_3 and protein. Pathological analysis suggested that one seemed to be caused by calcification of a lymph node (case 1) and another appeared to be due to calcification of mucus in the bronchus (case 2). Conclusion. It was difficult to estimate the origin by chemical analysis of broncholith.

View full abstract

Background. Most pulmonary hamartomas are generally seen subpleurally in the peripheral lung parenchyma. There are few cases originating from the endobronchial wall causing bronchial stenosis. Case. A 67-year-old man was referred to our hospital for further examination of an abnormal shadow on chest X-ray film during observation of another disease. He had no symptoms in relation to that, however, chest CT revealed that tumors on the membranous portion of the truncus intermedius caused a crescent-shaped stenosis. Although a biopsy was done at the bulging lesion several times via bronchofiberscope, a pathological diagnosis could not be obtained, thus an operation was performed. At operation, two walnut-like tumors were easily enucleated during ablation around the bronchus. The resected tumors were diagnosed as chondromatous hamartoma by a frozen section examination. Visceral pleura at the portion of exfoliation was not injured and no alr leakage was observed from that. Conclusion. Extrabronchial hamartomas present between the lung and bronchus compressing the proximal airway are rare.

View full abstract

Background. Aspergillus infection is well known to induce various types of lung diseases. We report a case of bronchopulmonary aspergillosis appearing as eosinophilic pneumonia. Methods and Results. A 52-year-old woman was admitted to our hospital because of dry cough and pulmonary infiltrates on chest X-ray. The percentages of eosinophils were high in peripheral blood and bronchoalveolar lavage fluid. IgE levels were within normal limits. Histological sections obtained by transbronchial lung biopsy revealed eosinophilic infiltration. Bronchofiberscopic findings showed a mucus plug occluding the orifice of left B^9. Plasma β-D glucan level was high, and precipitating antibody to Aspergillus antigen was positive. However, she had neither asthmatic symptoms nor proximal bronchiectasis on her chest CT scan. After initiating treatment with itraconazole, the respiratory symptoms improved and pulmonary infiltrates disappeared without requiring corticosteroids. Therefore, we diagnosed bronchopulmonary aspergillosis appearing as eosinophilic pneumonia. Conclusion. We considered our case is important because it has both the characteristics of infectious disease and allergic disease induced by Aspergillus.

View full abstract

Background. We have performed extended segmentectomy for small, peripheral, node-negative, non-small cell lung cancers less than 2cm in diameter. Case. A 56-year-old woman was admitted to our hospital for further examination of an abnormal shadow on chest X-ray. Chest computed tomography showed a mass 11mm in diameter in the right S^3b. Bronchoscopic brushing cytology failed to yield a diagnosis. Operation was performed because of the possibility of malignancy. A 55×64mm access thoracotomy was carried out with the aid of a thoracoscope. After dissection and transection of V^3 and then A^3, B^3 was dissected free. The upper lobe was selectively inflated by jet ventilation and B^3 was ligated to keep S^3 inflated. B^3 was severed at a point proximal to the tie. While closing the bronchus the preserved segments were deflated and a line between the deflated and the inflated area clearly appeared. Dissection of the intersegmental plane was performed along the line using electrocautery alone. Pathologic diagnosis was well differentiated adenocarcinoma, T1N0M0, stage IA. Her pulmonary function was well preserved. Conclusion. Segmentectomy under a video-assisted thoracic surgery is a procedure which has both less invasiveness and better functional preservation.

View full abstract

Background. We report a rare case of hemoptysis from a ruptured bronchial arterial aneurysm without lung disease. Case. A 54-year-old man was admitted to our hospital because of hemoptysis. Chest X-ray showed consolidation in the right upper lung field. Chest CT also revealed consolidation and ground glass opacity in the right S^1 and S^2. Since bronchoscopic therapy was not effective, we performed bronchial arteriography. Bronchial arteriography demonstrated a small aneurysm of the right bronchial artery. Flow into the bronchus from the aneurysm was observed. We performed bronchial arteial embolization. After successful embolization, the patient had no hemoptysis. Conclusion. Bronchial arteriography and embolization were very useful for the diagnosis and the treatment of bronchial arterial aneurysm.

View full abstract

Case. The patient was a 23-year-old man who was referred on an emergency basis to our department due to continuing hemoptysis. The chest roentgenogram and the chest computed tomogram showed infiltrative shadows in the left lower lobe. Bronchoscopic examination showed a blood clot from the left main bronchus to the left lower lobe bronchus, however neither the source of bleeding nor tumor was detected. Bloody sputum recurred three days after. Bronchoscopy was again performed, and bleeding from the left B^8 was detected. A bronchial arteriogram revealed a convoluted and dilated hemangioma connected with three bronchial arteries bilaterally and the thoracic artery, and bronchial-to-pulmonary arterial shunt was also observed. From these findings, we diagnosed racemose hemangioma of the bronchial artery. We performed bronchial artery embolization (BAE) on the left upper bronchial artery and the left internal thoracic artery using metallic coils. Results. There was no recurrence of hemoptysis after the BAE procedure. Conclusion. Bronchial artery embolization using metallic coils seems to be effective for hemoptysis due to racemose hemangioma.

View full abstract