Background. In an effort to understand the clinical situation of bronchoscopy in Japan, the Japan Society for Respiratory Endoscopy (JSRE) conducted a postal survey. Methods. A questionnaire was sent to 526 JSRE authorized institutes. The subject was bronchoscopy performed during 2006. Results. A 71.3% response was obtained. The total number of bronchoscopies performed was 74,770. Of these, 74,412 were flexible bronchoscopies and 358 were rigid bronchoscopies. At least one JSRE-authorized specialist worked in 97% of responding institution. Eighty-five percent of respondents performed bronchoscopy under local anesthesia in almost all patients. Seventy-five percent of respondents routinely used the oral route. The reported number of diagnostic bronchoscopies was 12,509 for simple bronchoscopy, 25,971 for forceps biopsy, 26,289 for brushing biopsy, 25,659 for bronchial washing, 1,387 for transbronchial needle aspiration, and 6,716 for bronchoalveolar lavage. Three deaths were caused by forceps biopsy (0.012%). The morbidity rates of each diagnostic procedure ranged from 0.14% to 2.5%. The reported number of therapeutic bronchoscopies was 476 for tracheobronchial stents, 164 for YAG laser photoresection (Nd: LPR), 40 for photodynamic therapy, 81 for balloon dilatation, 145 for endobronchial electrocautery, 120 for argon plasma coagulation, 109 for microwave coagulation, 116 for ethanol injection, 110 for foreign body removal, and 89 for bronchial occlusion. One fatality due to therapeutic bronchoscopy was caused by Nd: LPR (0.61%). The morbidity rates of each therapeutic procedure ranged from 0% to 5%. Conclusion. The preparation and practice of bronchoscopy varied greatly for each responding institution. Diagnostic bronchoscopy is well tolerated and safe. Therapeutic procedures appear to be relatively infrequent.

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Background. Among benign tumors originating in the trachea, the incidence of schwannoma is very low. We report a man with primary tracheal schwannoma who underwent tracheal sleeve resection. Case. An asymptomatic 55-year-old man underwent a health checkup in our hospital, and his chest CT showed a mass shadow (about 15mm) with a regular margin protruding into the tracheal lumen at the level of the 3rd thoracic vertebra. MDCT (multidetector-row CT) and MRI showed no extramural spread, suggesting no lesion in the peripheral bronchi. Bronchoscopy confirmed a submucosal tumor with a smooth surface originating from the posterior tracheal wall. To enable resection, tracheal sleeve resection was performed. The lesion was approached from the neck, and the portion from the 3rd to 5th tracheal rings was resected. Pathological examination demonstrated primary tracheal schwannoma and a negative resection margin. He showed a good postoperative course and was discharged on Day 10. Results. Tracheal sleeve resection was performed for primary tracheal schwannoma. Though tumor resection using a high frequency snare has also been performed, complete resection is difficult. For complete resection of the tumor, we selected this method.

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Background. Lung hamartoma is a benign tumor that generally occurs in lung parenchyma. They rarely occur as endobronchial lesions. Case. A 60-year old man with complaints of difficulty in walking and diplopia was referred to our department because he was suspected to have lung cancer and Lambert-Eaton syndrome. Bronchoscopy revealed a tumor at the orifice of the left lingular bronchus and a pedunculated polypoid tumor with a stalk at the orifice of the right B^6. The polypoid tumor was totally removed using conventional biopsy forceps. Histological examination showed this removed polypoid tumor was hamartoma. The tumor in the lingular bronchus was revealed to be small cell carcinoma. Conclusion. We report a case of endobronchial hamartoma discovered during evaluation of small cell carcinoma.

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Background. Primary racemose hemangioma of bronchial artery has been considered to be a congenital abnormality, and characterized by enlarged and convoluted bronchial arteries with shunt to the pulmonary arteries or veins. Case. A 61-year-old woman visited her local hospital with a complaint of abnormal shadow on chest X-ray. On referral to our department, she was admitted for abnormal opacity of right lower lobe and right hilar swelling on chest CT. Selective bronchial arteriography revealed tortuous and dilated right bronchial arteries with shunt formation between the bronchial artery and right pulmonary artery. Endoscopic finding was unpulsated submucosal tumor of right middle, and lower lobe bronchus. Racemose hemangioma of bronchial artery was suspected, and thoracoscopic segmentectomy was performed for avoiding massive hemoptysis in future and the risk of systemic embolism through bronchial-pulmonary shunt in this case. Pathological findings showed remarkable dilated and convoluted vessels with thickened media and no inflammatory cells or malignant cells, and confirmed a diagnosis of primary racemose hemangioma of the bronchial artery. Conclusion. In cases of primary racemose hemangioma of the bronchial artery connecting pulmonary artery or vein, surgical segmentectomy is very important as a therapeutic option.

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Background. Actinomycosis is often seen in the peripheral lung, and impossible to diagnose. We report a case of bronchial actinomycosis that formed a mycobacterial druse in the right middle lobe bronchus with an endobronchial inflammatory polyp, and that removed the druse under rigid bronchoscopy. Case. A 59-year-old woman complaining of productive cough was given a diagnosis of pneumonia at another hospital. Because chest CT demonstrated a mass shadow in the right middle lobe, bronchoscopy was performed. Bronchoscopy showed a mucosal polyp which obstructed the orifice of the right middle lobe bronchus, and she was admitted to our hospital. The patient underwent rigid bronchoscopy to resect the polyp which was diagnosed as an endobronchial inflammatory polyp. Moreover, at the distal end of the polyp, yellow-white granular tissue was also removed. Pathological examination revealed the granular tissue to be a druse, so we diagnosed bronchial actinomycosis. We administered penicillin intravenously followed by oral administration of amoxicillin for 6 months. After treatment the mass shadow improved on chest CT, and the right middle lobe bronchus was narrow, but open and there was no recurrence. Conclusion. We resected the endobronchial inflammatory polyp and removed the nodule by rigid bronchoscopy procedure, in a case of bronchial actinomycosis.

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Background. Tumor embolism is one of the manifestations of pulmonary metastasis, but is difficult to diagnose before death because the imaging features are nonspecific and biopsy is necessary to confirm diagnosis. Most lung tumor embolisms are confirmed at autopsy. Case. A 51-year-old man with advanced bladder cancer who was treated with chemotherapy developed dyspnea on effort. Chest CT image demonstrated linear, reticular and ground-glass opacity and dilation of pulmonary arteries. Pulmonary tumor embolism was suspected, however, drug-induced interstitial lung disease also had to be considered in the differential diagnosis. A transbronchial lung biopsy (TBLB) revealed tumor cells in small lung blood vessels, indicating pulmonary tumor emboli. The clinical presentation of this patient made it difficult to distinguish his condition from interstitial lung disease, and TBLB was useful in diagnosis. Conclusion. Microscopic pulmonary tumor embolism should be considered in the differential diagnosis of a patient with cancer who presents with worsening dyspnea or with abnormal shadows emerging on chest radiographs. The present case showed that when an abnormal interstitial shadow is identified on a chest radiograph and on a CT scan of a patient undergoing chemotherapy for malignancy, TBLB can prove useful in differentiating drug-induced pulmonary disease from tumor progression, such as tumor embolism.

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