Background. Bronchial foreign bodies are quite common among children and also adults with brain disorders. In addition to careful history taking, detailed examination is needed for early diagnosis. It is important to remove bronchial foreign body as early as possible . Purpose. We investigated the features, examination findings and treatment of patients with bronchial foreign body. Method. We reviewed 13 cases of bronchial foreign bodies treated at our hospital between June 1992 and February 2004. Results. The age ranged from I to 86 years of age with biphasic age distribution, i.e. under 12 years (5 cases) and over 60 years (7 cases) . Most cases were in males ( 12 males and I female) . Clinical symptoms varied such as cough, wheezing and dyspnea except for 2 asymptomatic cases. Foreign bodies were found in the right bronchus in 7 cases and in the left bronchus in 6. The foreign bodies consisted of radiolucent material in 9 cases and radiopaque material in 5 cases. On chest X-ray films we recognized foreign bodies in 5 cases, pneumonia in 1, atelectasis in 2 and unilateral hyperlucent lung in 2. We removed foreign bodies by basket type forceps in 4 cases, alligator type forceps in 3, laryngeal mask airway + Fogarty catheter in 2 and conventional forceps in 2, all through flexible bronchofiberscopes. Conclusion. For diagnosis of foreign bodies, careful history taking is most important. Detailed examination, including bronchoscopy, must be kept in mind when unilateral hyperlucent lung, atelectasis, or obstructive pneumonia is found on chest X-ray with clinical symptoms of cough or dyspnea. (JJSRE. 2004;26:505-510)

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Background. Cases of lymphocylic interstitial pneumonia associated with Sjogren's syndrome are often be encountered. Case. A 66-year-old woman was referred to our hospital because of dyspnea and cough. This case was given a diagnosis of rheumatoid arthritis and Sjogren's syndrome based on classical clinical features including immunoserological findings. Chest CT showed consolidations in both lower lobes. Because pathological findings in the video-assisted thoracoscopic surgery revealed severe lymphocytic and plasmacytic infiltrates in alveolar septa and lymphoid follicles, the diagnosis was changed to lymphocyiic interstitial pneumonia associated with secondary Sjogren's syndrome. Following corticosteroid therapy, clinical symptoms and radiologic abnorrnalities remitted. Conclusion. We reported a case of lymphocyiic interstitial pneumonia associated with rheumatoid arthritis and secondary Sjogren's syndrome. (JJSRE. 2004;26:517-521)

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Background. We report a case of foreign body aspiration of corn in a healthy adult. Case. A 38year-old woman who had never suffered from serious illness, and with no underlying disease, came to our hospital because of a history of a few days of cough and sputum. Her chest X-ray showed atelectasis of the right upper lobe. Her chest CT showed a small nodule with soft tissue density in the right upper bronchus. We strongly suspected foreign body aspiration of corn based on her present illness and the chest images, and performed a bronchoscopic examination. A piece of aspirated corn was impacted in the right upper bronchus. This was removed successfully using a wire-basket forceps. Her symptoms and chest X-ray findings improved promptly within a few days. Conclusion. It is suggested that foreign body aspiration should always be considered as a cause of atelectasis in the lung even in a healthy adult. Careful history-taking and prompt bronchoscopic examination are essential for the diagnosis and successful treatment of this disease. (JJSRE. 2004;26:522-525)

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Background. Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease. In most reported cases, the condition was recognized as an incidental finding at autopsy. However, recently many cases have been reported due to the increased number of bronchoscopy procedures. We identified three cases (0.16%) among 1840 bronchoscopies performed during a 5-year period. In one case the diagnosis was established from the HRCT finding. Cases. The chief complaints were fever and cough in one case and hoarseness in the other. Two cases had no symptoms. Two of the 4 cases had associated malignancies, of which primary lung cancer was diagnosed in one case and laryngeal cancer was diagnosed in the other. There was luminal stenosis of the trachea in all cases. And the main-stem bronchi were affected in two cases. No treatment for TO was performed in all cases. Conclusion. TO is concluded to be a rare disease. But in treating cases with symptoms related to upper airway obstruction, it is important to consider TO as one candidate for differential diagnosis. (JJSRE. 2004;26:526-530)

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Background. Tracheal schwannoma, a rare tracheal tumor, is usually treated with tracheal resection. We report a case of tracheal schwannoma successfully removed by bronchoscopic high-frequency electrosurgical snaring under general anesthesia. Case. A 35-year-old woman, who had been treated under a diagnosis of bronchial asthma, was referred to our hospital with chief complaints of persistent wheezing and severe dyspnea. Stridor was audible at the anterior chest, and chest radiograph showed a nodular opacity in the trachea. Chest computed tomography (CT) scans on admission showed a well defined round mass in the trachea. Three dimensional (3D) and multiplanar reconstruction images (MPR-CT) revealed intraluminal tumor originating from the membranous portion of the tracheal wall, without extension of the tumor into the paratracheal soft tissues or peripheral respiratory airway. Bronchoscopic examination revealed a mobile, round, and smooth surface mass with its stalk arising from the membranous portion of the trachea wall. Because CT examination and bronchoscopic observation showed no evidence of bronchial invasion, endoscopic resection of the tumor was performed with a high-frequency electrosurgical snare under general anesthesia. Pathologic examination showed schwannoma of the trachea and tumor cells were detected at the surgical margins. The resection of the tumor led to dramatic improvement without any complication during or after the procedure. Conclusion. We successfully resected tracheal schwannoma by bronchoscopic high-frequency electrosurgical snaring under general anesthesia. The minimally invasive nature of this method allows repeated performance if revealed recurrence occur at the site of resection. (JJSRE. 2004;26:531-535)

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Background. Primary malignant lymphomas of the lung are rare and most of them are MALToma. Case. A 78-year-old woman was admitted with a dry cough and an abnormal shadow in her chest X-ray film. Chest Xray examination revealed an infiltrative shadow in the right middle lobe. Chest CT showed an infiltrative shadow in the right middle lobe and a mass in the lower trachea and both main bronchi. With administration of antibiotics, her persistent cough and infiltrative shadows disappeared. Bronchoscopy revealed a polypoid mass in the lower trachea and both main bronchi. Microscopic examination of biopsy specimens of the tracheal mass showed infiltration of centrocyle-like cells. These cells were observed to have infiltrated the epithelium to form lymphoepithelial lesions. B-cell origin was demonstrated by the positive CD20 stain. Monoclonarity of tumor cells was shown immunohistochemically. After admission, her serum anti-Mycoplasma antibody titer was very high, so her infiltrative shadows were determined to indicate Mycoplasma pneumoniae . Considering these facts, endobronchial mucosa-associated lymphoid tissue lymphoma with Mycoplasma pneumoniae was diagnosed. Conclusion. This is a very rare case of endobronchial MALToma with Mycoplasma pneumoniae. (JJSRE. 2004;26:536-540)

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Background. Aspirated food is the most common foreign body of the trachea and bronchi. After an adequate medical interview and physical examination bronchoscopy is necessary for diagnosis. Case. A 53-year-old man, who underwent left upper lobectomy for squamous cell carcinoma of the left upper lung lobe at age 45, had been suffering from coughing and wheezing for two years. Bronchoscopy was performed on the basis of a tentative diagnosis of the local relapse of lung cancer at the lobectomy margin suggested by his chest CT films. Repeated bronchoscopic examination revealed no malignant findings, but a foreign body of the left main bronchus and concomitant inflammatory polyps. Arter the removal of the foreign body that revealed an aspirated fish bone, all symptoms disappeared and the bronchoscopic findings improved. Conclusion. For patients like this with chronic respiratory symptoms, basic medical interview and physical examination are most important. (JJSRE. 2004;26:541-544)

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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