• Tuberculosis and Respiratory Diseases
• /
• v.42 no.5
• /
• pp.772-776
• /
• 1995

Aspiration of foreign body, a clinical problem seen more commonly in the pediatric age group, is infrequently seen in the adult population. Although rigid bronchoscopy has been the mainstay of treatment, recently, easier manipulation, greater range of visulization, flexibility, topical anesthesia has made flexible bronchoscopy of choice for dealing with aspirated foreign body in adult. Operation increase morbidity and mortality, delay foreigh body removal. A 41-year old male was admitted to this hospital due to aspiration of pushpin. He showed high opaque density protruding in the orifice of right lower lobar bronchus. We report a case of foreign body removal by flexible bronchoscopy with brief review of the literature.

• Tuberculosis and Respiratory Diseases
• /
• v.86 no.4
• /
• pp.245-250
• /
• 2023

The healing process of tracheobronchial tuberculosis (TB) results in tracheobronchial fibrosis causing airway stenosis in 11% to 42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia, and often life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management 30 years ago, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. Similar to pulmonary TB, tracheobronchial TB is treated with combination of anti-TB medications. The indication of rigid bronchoscopy is more than American Thoracic Society (ATS) grade 3 dyspnea in PTTS patients. First, the narrowed airway is dilated by multiple techniques including ballooning, laser resection, and bougienation under general anesthesia. Then, most of the patients need silicone stenting to maintain the patency of dilated airway; 1.5 to 2 years after indwelling, the stent could be removed, this has shown a 70% success rate. Acute complications without mortality develop in less than 10% of patients. Subgroup analysis showed successful removal of the stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.

• Tuberculosis and Respiratory Diseases
• /
• v.67 no.1
• /
• pp.21-26
• /
• 2009

Background: Non-invasive positive pressure ventilation (NPPV) ensures adequate gas exchange during bronchoscopy in spontaneously breathing, hypoxemic patients, thus avoiding endotracheal intubation. However, in some patients, endotracheal intubation is eventually required after bronchoscopy. This study investigated the incidence of intubation and predictors of a need for emergency intubation prior to NPPV bronchoscopy initiation. Methods: On a retrospective basis, we reviewed the medical records of 36 patients (median age, 55 years; interquartile range [IQR], 43~65 years) with acute hypoxemic respiratory failure who required NPPV during bronchoscopy between January 2005 and October 2007. Results: All patients were hypoxemic (median $PaO_2/FiO_2$ ratio 155; IQR 90~190), but tolerated bronchoscopy with NPPV support. SOFA score and SAPS II score immediately before NPPV initiation were 4 (3~7) and 36 (30~42), respectively. Seventeen (47%) patients needed endotracheal intubation at a median time of 22 (2~50) hours after bronchoscopy. Patients who needed intubation after bronchoscopy had a higher in-hospital mortality (11 [65%] vs. 4 [21%], p=0.017). Upon multiple logistic regression analysis, the need for intubation after bronchoscopy was independently associated with a $P_aO_2/FiO_2$ ratio (OR, 0.961; 95% CI, 0.924~0.999; p=0.047) immediately before NPPV initiation for bronchoscopy. Conclusion: The severity of the hypoxemia immediately prior to NPPV initiation for bronchoscopy was associated with the need for intubation after bronchoscopy in patients with hypoxemic respiratory failure.

• Tuberculosis and Respiratory Diseases
• /
• v.49 no.3
• /
• pp.353-364
• /
• 2000

Background : Bronchoscopy is a useful diagnostic tool, for accurate localization of the bleeding site and the management of hemoptysis. However, there is some controversy about the optimal timing of bronchoscopy. Method : To determine the optimal timing of bronchoscopy in hemoptysis, we reviewed the medical records of 118 patients and analyzed the following relationships amongst simple chest PA findings, namely, the duration and amount of hemoptysis, and the timing of bronchoscopy retrospectively. Results : The major causes of hemoptysis were active tuberculosis(28.8%), inactive tuberculosis(10.2%), bronchiectasis(17.0%), lung cancer(7.6%), and aspergilloma(7.6%). Localization of the bleeding focus by bronchoscopy was possible in 87.5% (21/24 cases) during active bleeding, and it was possible in 40.4% after bleeding had stopped(p<0.05). The localization rate of bleeding focus was 59.8% when the chest PA showed certain abnormalities, but it decreased to 27.8% when the chest PA finding was normal(p<0.05). When chest PA showed diffuse abnormalities or its finding was normal, the localization rate of bleeding focus significantly increased if bronchoscopy was performed during bleeding or within 48 hours of the cessation of active bleeding. The localization rate was higher as the amount of hemoptysis became larger(p<0.05). The localization rate of early bronchoscopy(during bleeding or within 48 hours of the cessation of active bleeding) was significantly higher when the duration of hemoptysis was less than 1 week, but there was no advantage if the duration was 1 week or longer. Early bronchoscopy was also necessary to localize the bleeding focus for surgical resection in 4 patients, and the bronchoscopy itself was therapeutic in 1 patient whose bleeding was successfully managed with thrombin-application via bronchoscope. Conclusion : It is concluded that flexible bronchoscopy is useful at not only localizing the bleeding focus but also in preparing a therapeutic plan, and early bronchoscopy is more favorable in hemoptysis.

• Korean Journal of Bronchoesophagology
• /
• v.2 no.2
• /
• pp.244-247
• /
• 1996

Most of bronchial foreign bodies can be removed by ventilation bronchoscopy through transoral route but sometimes, ventilation bronchoscopy through tracheostomy is helpful procedure. Recently, we have experienced a case of bronchial foreign body which could be easily removed by nasal endoscopy and Blakesley forcep instead of bronchoscopy. So we report this case with a review of literatures.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1983.05a
• /
• pp.9.1-9
• /
• 1983

By the technological improvement of bronchoscopy, radiology, and biochemical analysis, the broncholithiasis can be easily diagnosed. But because of its low incidence it has been frequently overlooked in the differential diagnosis of bronchial obstruction, thereby losing the opportunity of early detection and causing complications which are mandatory to surgical intervention. The authors had a case of broncholithiasis which was diagnosed by radiological study of chest and fiberoptic bronchoscopy, and was removed under rigid bronchoscopy.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.13 no.4
• /
• pp.189-193
• /
• 2013

We experienced dfficult airway management in a patient who had Ludwig angina with morbid obesity, dfficulty with mouth opening and neck extension. We planned to perform awake-nasotracheal intubation with fiberoptic bronchoscopy but the patient's condition was not suitable to do this procedure. Thus, we tried fiberoptic nasotracheal intubation under general anesthesia but we experienced difficult airway management due to epistaxis. We tried to use video laryngoscope instead of fiberpotic bronchoscopy but also failed to guide the tube into trachea due to limited mouth opening. We used video laryngoscope to make a view of vocal cord and used fiberoptic bronchoscope as an intubation guide of endotrachedal tube and successfully intubated the patient.

• Tuberculosis and Respiratory Diseases
• /
• v.67 no.2
• /
• pp.140-144
• /
• 2009

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

• Tuberculosis and Respiratory Diseases
• /
• v.45 no.4
• /
• pp.882-887
• /
• 1998

In healthy adults, diagnosis of aspiration of foreign body into tracheobronchial tree is not difficult because various symptoms such as dyspnea, coughing, or cyanosis develop when foreign body is aspirated into tracheobronchial tree. But unless a clear history of an aspiration event can be obtained, diagnosis will be delayed. Early complications of tracheobronchial foreign body aspiration include asphyxia, cardiac arrest, dyspnea, laryngeal edema, and cyanosis. Late complications include pneumonia, lung abscess, bronchiectasis, hemoptysis, bronchial stenosis, and polyp. Treatment is removal of foreign body by operation or bronchoscopy. Currently, flexible bronchoscopy is preferred in adults than rigid bronchoscopy. A 36-year-old male visited to Dongkang hospital due to productive coughing and dyspnea. On auscultation, focal inspiratory wheezing was heard. On chest PA, mild emphysematous change was seen Flexible bronchoscopy was done. Bronchoscopically, mucoid impaction, surrounding inflammation, foreign body lodged in the right lower lobe bronchus, and interbronchial fistula(between right middle and lower lobe bronchus) were seen Foreign body($2.4\{times}1.3cm$ sized antacid package) was removed by flexible bronchoscopy. Later, history of aspiration of a piece of antacid package was found. We report a case of recurrent bronchitis with interbronchial fistula as a result of occult aspiration of foreign body with review of the literatures.

• The KIPS Transactions:PartB
• /
• v.10B no.5
• /
• pp.509-514
• /
• 2003

The virtual bronchoscopy was implemented using chest CT images to visualize inside of tracheo-bronchial wall. The optical endoscopy procedures are invasive, uncomfortable for patients and sedation or anesthesia may be required. Also, they have serious side effects such as perforation, infection and hemorrhage. In order to determine the navigation path, we segmented the tracheo-bronchial wall from the chest CT image. We used the coordinates as a navigation path for virtual camera that were calculated from medial axis transformation. We used the perspective projection and marching cube algorithm to render the surface from volumetric CT image data. The tracheobronchial disease was classified into tracheobronchial stenosis causing from inflammation or lung cancer, bronchiectasis and bronchial cancer. The virtual bronchoscopy is highly recommended as a diagnosis tool with which the specific place of tracheobronchial disease can be identified and the degree of tracheobronchial disease can be measured qualitatively, Also, the virtual bronchoscopy can be used as an education and training tool for endoscopist and radiologist.