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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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Idiopathic eosinophilic pneumonia is basically divided two clinical entities, which are chronic eosinophilic pneumonia(CEP) and acute eosinophilic pneumonia(AEP). Although thorough history about medication, smoking and travel and high resolution CT are needed for the diagnosis of CEP and AEP, bronchoscopy is one diagnostic procedure. Because analysis of bronchoalveolar lavage fluid(BALF) often shows a very high percentage (greater than 25 percent) and total number of eosinophils in CEP and AEP, BAL is useful for the diagonosis of CEP and AEP. AEP should be considered as a differential diagonosis of ARDS because response to corticosteroid therapy is good. Most patients with AEP present initially without peripheral blood eosinophilia. However, findnig prominent BAL eosinophilia with a typical acute onset of fever and respiratory failure can provide a reliable diagnosis of AEP without lung biopsy. Some authors consider that lung biopsy is unnecessary in most cases of CEP. Because the clinical course of CEP is always prolonged, I believe we should obtain histopathologic conhirmation of the diagnosis.(JJSRE. 2005;27:32-36)

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Background. We previously reported the usefulness of endobronchial ultrasonography with a guide-sheath (EBUS-GS) as a guide for transbronchial biopsy (TBB) for diagnosing peripheral pulmonary lesions using an ultrasound probe with a diameter of 1.4 mm (XUM-S20-17R, Olympus). In a total of 24 peripheral pulmonary lesions of 30 nun or less undergoing EBUS-GS-guided TBB and bronchial brushing, 19 Iesions (79%) were visualized by EBUS and 14 lesions (58%) were diagnosed cyiopathologically. However, several problems were found: the curette was hard to manipulate and only small insufficient specimens were obtained in some cases. Purpose. In order to alleviate these problems we attempted to re-evaluate the usefulness of EBUS-GS-guided TBB for diagnosing peripheral pulmonary lesions using an improved curette or a probe with a diameter of 1.7 mm (UM-S20-20R, Olympus) . Subjects.

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Backgrounds and Objective. Patients with malignant central airway stenosis require rapid palliation. Although the standard therapy is surgical treatment, endoscopic laser treatment and airway stent implantation have recently been performed to obtain clinical improvement in patients with inoperable lesions. We evaluated the efficacy of endoscopic laser treatment and airway stent implantation for malignant central airway stenosis. Subjects. Fifty-two patients (39 men, 13 women) who had undergone endoscopic laser treatment and airway stent implantation between November 1996 and September 2003 were examined retrospectively. Results. Endoscopic laser treatment was performed in 21 patients, consisting of 9 with lung cancer, 7 with thyroid cancer, 4 with endotracheal metastasis from renal cancer, and I with lung cancer endobronchial metastasis.

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Background. Microscopic polyangiitis with pulmonary lesions causing interstitial pneumonia and diffuse alveolar hemorrhage, has been reported frequently in recent years. Case. A 56-year-old man presented with a chief complaint of general fatigue in January, 2003. Chest radiographs revealed linear shadows and slight ground-glass opacities in both lower lobe in July, 2000, and ground-glass opacities in both middle lung fields. We performed bronchoscopy, obtained bloody bronchoalveolar lavage fluid and made a diagnosis of diffuse alveolar hemorrhage. In bronchoscopic lung biopsy specimens, inflammatory cells around small vessels were detected and a high titer of MPO-ANCA Ied to a diagnosis of microscopic polyangiitis. Conclusion. We encountered a case of microscopic polyangiitis with preceding interstitial pneumonia and diffuse alveolar hemorrhage. (JJSRE. 2005;27:55-59)

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Background. Loss of consciousness predisposes patients to the aspiration of food fragments. Case. A 69-year-old man was brought to the emergency room of our hospital because of loss of consciousness (Japan Coma Scale III-300) and multiple injuries caused by a traffic accident. He had a subarachnoid hemorrhage, a 6th cervical vertebral fracture, a cervical spinal injury, a right humerus fracture, a left pulmonary contusion, and a left hemothorax. Although artificial respiration with endobronchial intubation was performed, respiratory failure persistened. Atelectasis was recognized in the left lower lobe on his chest X-ray film on the third day of admission. A highly dense object was detected at the end of the left main bronchus by chest CT and a bronchial foreign body was suspected. Upon bronchoscopy, a seed-like foreign body was found at the end of the left main bronchus, and was extracted. The foreign body was the seed of a pickled plum. After extracting it, the patient recovered from atelectasis and respiratory failure, and he could be weaned from the ventilator. Conclusion. When unconscious victims of traffic accidents reveal persistent atelectasis and respiratory failure, bronchial foreign bodies consisting of food should be suspected and thorough examinations using chest CT and bronchoscopy should be carried out. (JJSRE. 2005;27:60-64)

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Background. Elevated serum carcinoembryonic antigen (CEA) occurs in various non-neoplastic lung diseases, but rarely in eosinophilic lung diseases. Case. A 62-year-old man was admitted due to an abnormal shadow on his chest X-ray and cough lasting over several months. He was diagnosed as having chronic eosinophilic pneumonia, because of eosinophilia in peripheral blood and bronchoalveolar lavage (BAL) fluid, and transbronchial lung biopsy (TBLB) specimens revealing thickened alveolar septa wlth infiiltration of inflammatory cells, mainly eosinophilic. Elevated serum CEA (15.6 ng/ml) was reduced to a normal level (3.1 ng/ml), along with improvement of respiratory symptoms and laboratory data by administration of corticosteroid . Immunohistochemical analysis demonstrated the presence of CEA in bronchial epithelial cells and bronchial secretions. Conclusion. Elevated serum CEA in this case of chronic eosinophilic pneumonia is attributable to abnormal production of CEA by bronchial epithelium in the diseased lung. (JJSRE. 2005;27:65-69)

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Background. Foreign body aspiration is rare in healthy young adult. Case. A 33-year-old man consulted our hospital because of cough and fever. He had choked when drinking miso soup containing the small prawns. After that, he had a cough and fever, and expectorated a prawn leg with a hard cough. Bronchoscopy revealed the head of a prawn in the truncus intermedius, and we extirpated that with straight grasping forceps. After extirpation, his symptoms resolved with antibiotic therapy. Conclusion. We should consider a bronchial foreign body as a possible diagnosis in a patient with a possibility of aspiration, regardless of the stated health. (JJSRE. 2005;27:70-72)

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[in Japanese]

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