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Insights Into Imaging Feb 2017Anomalies of the bronchus can be both congenital and acquired. Several different congenital aberrations of the bronchial anatomy are commonly encountered including... (Review)
Review
Anomalies of the bronchus can be both congenital and acquired. Several different congenital aberrations of the bronchial anatomy are commonly encountered including tracheal bronchus, accessory cardiac bronchus, and bronchial agenesis/aplasia/hypoplasia. In addition, Williams-Campbell syndrome and cystic fibrosis are two other congenital conditions that result in bronchial pathology. Acquired pathology affecting the bronchi can typically be divided into three broad categories of bronchial disease: bronchial wall thickening, dilatation/bronchiectasis, and obstruction/stenosis. Bronchial wall thickening is the common final response of the airways to irritants, which cause the bronchi to become swollen and inflamed. Bronchiectasis/bronchial dilatation can develop in response to many aetiologies, including acquired conditions such as infection, pulmonary fibrosis, recurrent or chronic aspiration, as well as because of congenital conditions such as cystic fibrosis. The causes of obstruction and stenosis are varied and include foreign body aspiration, acute aspiration, tracheobronchomalacia, excessive dynamic airway collapse, neoplasm, granulomatous disease, broncholithiasis, and asthma. Knowledge of normal bronchial anatomy and its congenital variants is essential for any practicing radiologist. It is the role of the radiologist to identify common imaging patterns associated with the various categories of bronchial disease and provide the ordering clinician a useful differential diagnosis tailored to the patient's clinical history and imaging findings. Teaching Points • Bronchial disorders are both congenital and acquired in aetiology.• Bronchial disease can be divided by imaging appearance: wall thickening, dilatation, or obstruction.• Bronchial wall thickening is the common final response of the airways to irritants.• Imaging patterns must be recognised and the differential diagnosis tailored for patient management.
PubMed: 27966195
DOI: 10.1007/s13244-016-0537-y -
Pneumologie (Stuttgart, Germany) Jun 2011This is an updated overview of indications, contraindications, performance and interpretation of bronchial challenge tests. As speciality, the diagnostic step by step... (Review)
Review
This is an updated overview of indications, contraindications, performance and interpretation of bronchial challenge tests. As speciality, the diagnostic step by step scheme comprises in addition to the clinical case history a detailed exposure (occupational) history, lung function testing, assessment of nonspecific bronchial hyperresponsiveness, allergological diagnostics (skin prick test, measurement of specific IgE antibodies), privation and reexposure test and as gold standard specific bronchial challenge tests. The last mentioned tests are of particular importance in the framework of a diagnostic backup with regard to specific therapeutic and preventive measures and insurance regulations (occupational disease?). Specific bronchial challenge tests and their variant, the workplace-related challenge test, serve to objectify or exclude the clinical relevance and the current state of a respiratory sensitization. They require a comprehensive experience of the physician performing the tests. The majority of diseases does not necessitate these tests, especially if case history, lung function testing, allergy tests, privation and reexposure test provide unanimously positive results. If allergic symptoms of conjunctiva or the upper respiratory tract are of prime importance the performance of a specific conjunctival or nasal challenge test is recommended.
Topics: Allergens; Alveolitis, Extrinsic Allergic; Asthma; Asthma, Occupational; Bronchial Hyperreactivity; Bronchial Provocation Tests; Bronchoconstrictor Agents; Contraindications; Humans; Isocyanates; Methacholine Chloride; Predictive Value of Tests; Respiratory Function Tests
PubMed: 21154201
DOI: 10.1055/s-0030-1255967 -
Respiration; International Review of... 2021The optimal bronchoscopy procedure for diagnosis of pulmonary nontuberculous mycobacteria (NTM) infection is unclear.
BACKGROUND
The optimal bronchoscopy procedure for diagnosis of pulmonary nontuberculous mycobacteria (NTM) infection is unclear.
OBJECTIVE
This study investigated the usefulness of bronchial brushing in bronchoscopy for diagnosis of pulmonary NTM infection in patients with suspected NTM lung disease and nodular bronchiectasis on chest computed tomography (CT) images.
METHODS
Bronchoscopy was prospectively performed for 69 patients with clinically suspected pulmonary NTM infection on chest CT from December 2017 through December 2019. Before and after bronchial brushing, bronchial washing was performed with 20 or 40 mL of normal sterile saline at the same segmental or subsegmental bronchi. Before and after bronchial brushing, samples of the washing fluid (pre- and postbrushing samples) and brush deposits (brush samples) were obtained and cultured separately.
RESULTS
NTM was detected in 37 of the 69 (53.6%) patients (Mycobacterium avium in 27, Mycobacterium intracellulare in 7, M. abscessus in 2, and M. kansasii in 2). NTM was detected in 34 (49.3%) prebrushing samples, in 27 (39.1%) postbrushing samples, and in 20 (29.0%) brush samples from the 69 patients. In 2 (2.9%) patients, NTM was detected only in postbrushing samples; in 1 (1.4%) patient, NTM was detected only in a brush sample. As compared with bronchial washing only, additional bronchial brushing increased the NTM culture-positive rate by 4.3% (3/69). Bronchial brushing caused bleeding, requiring hemostasis in 5 (7.2%) patients.
CONCLUSION
Additional bronchial brushing increased the NTM culture-positive rate by only 4.3% (3/69), as compared with bronchial washing alone. Thus, the usefulness of brushing appears to be limited.
Topics: Bronchiectasis; Bronchoscopy; Humans; Lung; Mycobacterium Infections, Nontuberculous; Mycobacterium avium Complex; Nontuberculous Mycobacteria
PubMed: 34044411
DOI: 10.1159/000515605 -
Therapeutic Advances in Respiratory... 2018Asthma is a common chronic inflammatory condition of the airways. Conventional therapy comprises inhaled corticosteroid and bronchodilators as well as trigger avoidance... (Review)
Review
Asthma is a common chronic inflammatory condition of the airways. Conventional therapy comprises inhaled corticosteroid and bronchodilators as well as trigger avoidance and management of comorbid conditions. A small group remain symptomatic despite these strategies and novel therapies have been developed. Bronchial thermoplasty is a nonpharmacological therapy which targets airway smooth muscle to improve asthma control. Clinical trials to date have shown the efficacy and safety of bronchial thermoplasty with a persistent effect on extended follow up. Questions remain regarding the exact mechanism of action of bronchial thermoplasty, the cost effectiveness of the procedure and the ideal criteria for patient selection.
Topics: Airway Remodeling; Asthma; Bronchi; Bronchial Hyperreactivity; Bronchial Thermoplasty; Bronchoconstriction; Bronchoscopy; Disease Progression; Humans; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 30132377
DOI: 10.1177/1753466618792410 -
Journal of Thoracic Disease Oct 2020Prevention of bronchial complications after airway surgery must be our primary goal. Understanding bronchial and anastomotic healing is the first step to success. This... (Review)
Review
Prevention of bronchial complications after airway surgery must be our primary goal. Understanding bronchial and anastomotic healing is the first step to success. This can be improved by standardizing operating technique (bronchial closure and end-to-end anastomosis) as well as postoperative care. Bronchopleural fistula after pneumonectomy still remains a feared complication with a high mortality rate. Especially after sleeve resection interpretation of endobronchial healing and postoperative measures of care with the help of an algorithm, may avoid anastomotic insufficiency and therefore reduced the secondary pneumonectomy rate.
PubMed: 33209456
DOI: 10.21037/jtd.2020.03.63 -
Cureus Apr 2023Background Bronchial brushing and biopsy are used for the diagnosis of lung carcinoma as most of these tumors are unresectable. Recently, the subclassification of...
Background Bronchial brushing and biopsy are used for the diagnosis of lung carcinoma as most of these tumors are unresectable. Recently, the subclassification of non-small cell lung carcinoma (NSCLC) into adenocarcinoma (ADC) and squamous cell carcinoma (SCC) has become mandatory due to the emergence of targeted therapies. Due to the inherent limitations of small samples, subcategorization of a tumor is not always possible. Immunohistochemical and mucin stains are being used for this purpose, especially for tumors with poorly differentiated features. In our study, we utilized mucicarmine mucin stain to refine the differentiation of SCC and ADC on bronchial brushing and determine its agreement with bronchial biopsy. This study aimed to measure the degree of agreement between mucicarmine-stained bronchial brushing and bronchial biopsy for subtyping NSCLC into SCC and ADC. Methodology This descriptive, cross-sectional study was conducted in the pathology department of Allama Iqbal Medical College. Samples were collected by the pulmonology department of Jinnah Hospital Lahore. The study was conducted for 10 months from June 2020 to April 2021. A total of 60 cases diagnosed as NSCLC, aged between 35 and 80 years, were included in this study. After cytohistological evaluation of bronchial brushing and bronchial biopsy specimens, the agreement was deduced using kappa statistics. Results The strength of agreement between mucicarmine-stained bronchial brushing and bronchial biopsy for subtyping NSCLC into SCC and ADC was found to be substantial. Conclusions As significant agreement exists between the two modalities, mucicarmine-stained bronchial brushing can be used for a reliable and rapid categorization of NSCLC.
PubMed: 37214061
DOI: 10.7759/cureus.37848 -
Singapore Medical Journal Aug 2017
Topics: Bronchial Neoplasms; Bronchoscopy; Female; Humans; Lipoma; Middle Aged; Radiography, Thoracic; Tomography, X-Ray Computed
PubMed: 28261742
DOI: 10.11622/smedj.2017015 -
Pneumologie (Stuttgart, Germany) Mar 2010Bronchopulmonary aspergillosis is becoming more frequent, is often hard to diagnose and with today's antimycotics better to treat than before. It is therefore of current...
Bronchopulmonary aspergillosis is becoming more frequent, is often hard to diagnose and with today's antimycotics better to treat than before. It is therefore of current interest. This also concerns bronchial aspergillosis which is less common than pulmonary aspergillosis and the topic of this paper. A total of 39 patients with bronchial aspergillosis are presented: 1) 4 cases with endobronchial aspergilla, two which are visual bronchoscopically, 2) one case with chronic necrotising pulmonary aspergillosis (CNPA), where a bronchus has necrotised, 3) an invasive aspergillosis in the region of a bronchial anastomosis, 4) 7 cases with an Aspergillus invasion from endobronchial tumour tissue and 5) 26 cases with allergic bronchopulmonary aspergillosis (ABPA). 37 of the 39 cases are part of a single centre study with a total of 116 bronchopulmonary aspergilloses, which were collected over seven years. The focus of attention in this paper is on the bronchoscopic and radiological results.
Topics: Adolescent; Adult; Bronchography; Bronchoscopy; Female; Humans; Male; Middle Aged; Pulmonary Aspergillosis; Young Adult
PubMed: 20072959
DOI: 10.1055/s-0029-1215306 -
Insights Into Imaging May 2020The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. In this... (Review)
Review
The enlargement of the bronchial arteries occurs in a multitude of congenital and acquired diseases and is responsible for the majority of cases of hemoptysis. In this review, we provide a simplified imaging approach to the evaluation of the bronchial arteries. We highlight the anatomy and function of the bronchial arteries, typical imaging findings, how to recognize bronchial artery dilatation, and its underlying causes. Contrast-enhanced computer tomography plays a major role in diagnosing bronchial artery enlargement and also improves treatment planning. Bronchial artery embolization has proven to be effective in controlling the potential hazardous hemoptysis.
PubMed: 32430593
DOI: 10.1186/s13244-020-00877-4 -
Journal of Asthma and Allergy 2019Bronchial thermoplasty is approved in many countries worldwide as a non-pharmacological treatment for severe asthma. This review summarizes recent publications on the... (Review)
Review
PURPOSE
Bronchial thermoplasty is approved in many countries worldwide as a non-pharmacological treatment for severe asthma. This review summarizes recent publications on the selection of patients with severe asthma for bronchial thermoplasty, predictors of a beneficial response and developments in the procedure and discusses specific issues about bronchial thermoplasty including effectiveness in clinical practice, mechanism of action, cost-effectiveness, and place in management.
RESULTS
Bronchial thermoplasty is a treatment option for patients with severe asthma after assessment and management of causes of difficult-to-control asthma, such as nonadherence, poor inhaler technique, comorbidities, under treatment, and other behavioral factors. Patients treated with bronchial thermoplasty in clinical practice have worse baseline characteristics and comparable clinical outcomes to clinical trial data. Bronchial thermoplasty causes a reduction in airway smooth muscle mass although it is uncertain whether this effect explains its efficacy since other mechanisms of action may be relevant, such as alterations in airway epithelial, gland, and/or nerve function; improvements in small airway function; or a placebo effect. The cost-effectiveness of bronchial thermoplasty is greater in countries where the costs of hospitalization and emergency department are high. The place of bronchial thermoplasty in the management of severe asthma is not certain, although some experts propose that bronchial thermoplasty should be considered for patients with severe asthma associated with non-type 2 inflammation or who fail to respond favorably to biologic therapies targeting type 2 inflammation.
CONCLUSION
Bronchial thermoplasty is a modestly effective treatment for severe asthma after assessment and management of causes of difficult-to-control asthma. Asthma morbidity increases during and shortly after treatment. Follow-up studies provide reassurance on the long-term safety of the procedure. Uncertainties remain about predictors of response, mechanism(s) of action, and place in management of severe asthma.
PubMed: 31819539
DOI: 10.2147/JAA.S200912