Background/Objective. As a treatment for hemoptysis, methods of embolizing arteries communicating with the lungs, such as bronchial artery embolization (BAE), have been established. The short- and long-term efficacy and safety of embolization using platinum coils in our hospital were individually evaluated for each artery involved in hemoptysis. Patients and Methods. A total of 179 patients who received BAE for hemoptysis from January 1998 to December 2012 were included in this study. A platinum coil was used as the embolic material. In addition, the arteries involved in hemoptysis were divided into the bronchial artery (BA) and thoracic wall artery (TA), and cases were classified into groups of diseases related to these arteries (the BA and TA disease groups) to evaluate their short- and long-term results. Results. Short-term outcomes were successful in 56 and failure in 4 in the BA and successful in 111 and failure in 8 in the TA. Long-term outcomes were successful in 54 and failure in 2 in the BA, and successful in 99 and failure in 12 in the TA. The proportion of embolized TA in addition to BAE was significantly higher in the TA group (40.8%) than in the BA group (1.6%). The proportion of patients with long-term failure tended to be higher in the TA (10.8%) than in the BA (3.6%). No patients died or experienced serious complications. Conclusions. Arterial embolization for hemoptysis resulted in a significantly larger number of long-term failures in the group of diseases in which the TAs were considered to be largely involved in hemoptysis than in those involving the BAs. Platinum coils, however, showed high short-term success rates with relatively few complications. Therefore, this approach was considered a recommendable therapy for hemoptysis. Patients with diseases in which BAs were mainly involved in hemoptysis had satisfactory long-term outcomes.

Background. In Japan, only 37% of facilities regularly use sedatives during bronchoalveolar lavage (BAL). The effects of sedative use on the bronchoalveolar lavage fluid (BALF) recovery rate and complications are not clear. We conducted this study to determine whether the use of sedatives, particularly fentanyl (FNT), in BAL increases the recovery of BALF. Subjects and Methods. A total of 180 patients received BAL at our hospital from July 1, 2019 to June 30, 2021. Patients were divided into the non-sedative-use, midazolam (MDZ), and MDZ+FNT groups. The BALF recovery rate, sedative use, and complications were retrospectively examined using medical records. Results. The eligible patients were classified into the three groups as follows: non-sedative-use (n=19), MDZ (n=101), and MDZ+FNT (n=60). There were no significant differences in patient backgrounds, and no complications were observed in any of the groups. There were no significant differences in the BALF recovery rates among the three groups; however, the BALF recovery rate in the MDZ+FNT group tended to be higher in comparison to the non-sedative-use group and the MDZ group. The MDZ+FNT group received significantly less MDZ than the MDZ group. Conclusion. The use of sedatives, especially MDZ+FNT, during BAL may improve the BALF recovery rate without increasing complications.

Background. Bronchial foreign bodies can cause suffocation, which can lead to complications, such as obstructive pneumonia and atelectasis. Therefore, their accurate diagnosis and expeditious removal are required. Purpose. We investigated the features and treatment of patients with bronchial foreign bodies. Method. We reviewed cases of bronchial foreign bodies treated at our hospital over the 18-year period, from 2005 to 2022. Results. There were ten cases of bronchial foreign bodies. All patients were adults, and all were over 60 years old (range: 68-88 years old). Most of the patients were men (nine men and one woman). Clinical symptoms included dyspnea, cough, and a fever, but approximately half of the patients had no subjective symptoms. Foreign bodies were found in the right bronchus in seven cases, the left bronchus in two cases, and the trachea in one case. Among all foreign bodies, five were dental crowns, three were food, and two were press-packaged capsules (PTPs). Among the nine patients who underwent chest X-ray, foreign bodies consisted of radiopaque materials in five cases and radiolucent materials in four cases. All radiopaque materials were foreign dental bodies. Foreign bodies were confirmed in all six patients who underwent chest computed tomography (CT). We removed the foreign body under local anesthesia in all cases. In nine cases of the forceps used could be confirmed, we used alligator-type forceps in seven cases and biopsy forceps in two cases. The period from aspiration of the foreign body to removal ranged from one hour to six months. The time required to remove the PTP varied greatly depending on whether or not the drug remained inside. Conclusion. It is conceivable that the incidence of bronchial foreign bodies in the elderly will increase in the future. Chest X-ray alone is not sufficient for a diagnosis; an imaging diagnosis using CT is necessary in addition to a detailed interview.

Background. We herein report a case in which the mechanism of injury was unclear, and a diagnosis was ultimately made based on imaging and bronchoscopy findings. Case. An 83-year-old man fell while using an electric mower and bruised the chest. Subsequently, persistent hemoptysis with coughing was observed, and the patient was referred to our hospital. A small incision had been made in the anterior neck and chest. Thoracic computed tomography revealed bilateral lung-dominant ground-glass opacity, suggestive of blood accumulation, along with bright nodules suspected of being foreign bodies in the tracheal endometrium and subcutaneous area of the right anterior chest. Bronchoscopy suggested a penetrating injury to the trachea, but the foreign body could not be directly observed. Finally, the foreign body was surgically removed using a lateral left cervical approach. It was found to be a fragment of the electric mower. Conclusion. We encountered a case in which a foreign body in the airway due to trauma was found. It may be difficult to diagnose foreign bodies with small puncture wounds. An early diagnosis based on a detailed history taking is important.

Background. Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a malignant lymphoma in which mature B cells proliferate in a monoclonal fashion and infiltrate into the peripheral blood, lymph nodes, and spleen. It is a rare disease in Japan, accounting for 2-3% of all leukemias, and there have been no reports from Japan of CLL/SLL diagnosed using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In addition, securing a sufficient amount of tissue is necessary for making a definitive diagnosis by EBUS-TBNA. Case. A 76-year-old man visited our hospital complaining of cough, bloody sputum, and dyspnea. Airway constriction sounds were heard with a stethoscope, and a mass shadow with a maximum diameter of 75 mm in the mediastinum was found on chest CT. EBUS-TBNA puncture was performed five times via bronchoscopy, and CLL/SLL was diagnosed via a histopathological examination. Conclusion. We herein report a case of CLL/SLL diagnosed using EBUS-TBNA. It is necessary to consider the possibility of malignant lymphoma, including CLL/SLL, when airway constriction sounds are auscultated.

Background. Sarcoidosis with stenosis of the proximal bronchi is rare. Case. A 71-year-old woman was referred to our hospital due to mediastinal lymphadenopathy in year X-4. Endobronchial ultrasound-guided transbronchial needle aspiration of the mediastinal lymph nodes was performed; however, no definitive diagnosis was made, and follow-up was continued. From year X-2, dyspnea on exertion appeared. From year X-1, obstructive ventilatory impairment developed. She was treated for bronchial asthma and her symptoms showed slight improvement. In February of year X, chest computed tomography (CT) showed thickening of the bronchovascular bundle of both segmental bronchi on the proximal side, and bronchoscopy was performed to conduct a detailed examination. The right B², left upper division bronchus, and left B⁶ were obstructed. Examination of a biopsy specimen obtained from the right B² revealed non-caseating granuloma. Based on chest CT findings, and the pathological findings of the bronchial biopsy, a diagnosis of sarcoidosis was made. Therapy with prednisolone (15 mg) was initiated, and her respiratory symptoms and obstructive ventilatory impairment markedly improved. The improvement of bronchial obstruction was also confirmed by bronchoscopy. Conclusion. We should consider sarcoidosis with stenosis of the bronchi and actively perform bronchoscopy for the diagnosis of patients with progressive obstructive ventilatory impairment.

Background. Mucosa-associated lymphatic tissue (MALT) lymphoma localized in the trachea or bronchus is a rare disease. The prognosis of primary tracheobronchial MALT lymphoma is reportedly good. However, the progression of symptoms associated with tracheal stenosis necessitates tracheal dilatation or bronchodilation. Case Presentation. A 75-year-old woman presented to our hospital with a 10 month history of dyspnea on exertion, and chest computed tomography (CT) revealed a tracheal tumor. The tracheal tumor occupied 80% of the tracheal lumen. We performed a bronchoscopic biopsy to establish a diagnosis and argon plasma coagulation (APC) therapy for tracheal dilatation. A histopathological diagnosis of MALT lymphoma was made. The patient underwent positron emission tomography-CT and a bone marrow biopsy and was diagnosed with primary tracheobronchial MALT lymphoma. Conclusion. Bronchoscopic APC is a useful diagnostic biopsy technique. It also proved useful for tracheal dilatation of MALT lymphoma of tracheal origin with tracheal stenosis.

Background. An endobronchial ultrasound-guided transbronchial forceps biopsy (EBUS-TBFB) can improve the diagnostic yield when added to EBUS transbronchial needle aspiration (TBNA). Case. A 65-year-old woman was urgently admitted to the hospital because of difficulty walking after suffering a fall at home, and computed tomography (CT) suggested lung cancer in the right lower lobe and right femoral metastasis. Bronchoscopy was performed, and a specular biopsy was planned because the tumor obstructed the right truncus intermedius on CT. However, because the mucosal surface was normal, secondary EBUS-TBNA was performed. Unfortunately, despite changing the needle and endoscopists, and adjusting the negative pressure, specimens could not be collected. Therefore, an EBUS-TBFB was attempted through the puncture hole by inserting an Olympus FB433D^® into the BF-UC290F^®. The insertion of forceps in the lesion was confirmed by ultrasound, and the biopsy was repeated. Hematoxylin-eosin staining confirmed that the alveolar region had been sampled, and lung adenocarcinoma was diagnosed. RET gene rearrangement was detected using next-generation sequencing, and selpercatinib treatment was initiated. The primary tumor almost disappeared two weeks after treatment initiation, and the patient was discharged. Conclusion. EBUS-TBNA is a useful technique for diagnosing lung cancer, however tissue collection is often difficult. An EBUS-TBFB is thus a useful additional technique for EBUS-TBNA.

Background. Patients with interstitial pneumonia are known to have high rates of comorbidity with lung cancer. Invasive mucinous adenocarcinoma (IMA) often has a pneumonia-like consolidation shadow, which makes it difficult to distinguish between cancer and interstitial shadows on imaging. Case. A 77-year-old man was introduced to our hospital with interstitial pneumonia detected on chest radiography performed by a family physician. The patient was diagnosed with idiopathic pulmonary fibrosis. The consolidation shadows were mixed with some interstitial pneumonia shadows in the left upper and right lower lobes of the lungs. The consolidation shadow in the left upper lobe worsened on imaging after six months. Because of the rapid exacerbation, we suspected infection or cancer complications and performed bronchoscopy. IMA was diagnosed from the tissue samples. The patient underwent chemotherapy. Conclusion. For patients with interstitial pneumonia, complications of lung cancer should always be considered. In particular, it should be noted that IMA has a pneumonia-like consolidation shadow, making it difficult to differentiate between cancer and interstitial pneumonia on imaging. Bronchoscopy should be performed aggressively in patients having strong consolidation shadows mixed with interstitial pneumonia.