Journal of bronchology & interventional pulmonology
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J Bronchology Interv Pulmonol · Apr 2012
Multicenter Study Comparative StudyA comparison of the diagnostic yield of rigid and semirigid thoracoscopes.
Medical thoracoscopy has an important place in the diagnosis and management of pleural disease. However, the application of this procedure is limited in the United Kingdom. This may be partly because respiratory physicians remain unfamiliar with standard rigid thoracoscopy instruments. ⋯ Statistically, this difference was not significant (95% confidence intervals, -0.11 to 0.17). Our study demonstrates that the semirigid thoracoscope achieves a diagnostic yield similar to that of the conventional rigid instrument despite the smaller biopsy size. Both instruments remain valuable in the evaluation and management of pleural disease.
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J Bronchology Interv Pulmonol · Apr 2012
Review Case ReportsTunneled pleural catheter dysfunction: case report and review of complications.
Tunneled pleural catheters (TPC) are often used for management of malignant pleural effusion. They have proven to be safe, effective, and are associated with low rates of complications. We describe the case of a patient with metastatic renal cell carcinoma who inadvertently cut his TPC causing leakage of pleural fluid, requiring urgent removal. We review the reported complications of TPC in the literature and suggest close vigilance of patients at risk to have altered mental status who undergo placement of TPC.
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J Bronchology Interv Pulmonol · Apr 2012
Secondary carina Y-stent placement for post-lung-transplant bronchial stenosis.
Post-lung-transplant bronchial stenosis (TBS) may cause significant morbidity and mortality. Although often transiently relieved by balloon bronchoplasty, stents may be required for long-term airway patency. We report a series of lung transplant patients in whom a silicone Y-stent was placed at the secondary carina for long-standing relief of post-transplant-airway stenosis. ⋯ Secondary carina silicone Y-stent placement in TBS decreased the number of therapeutic procedures and provided longer-lasting results in most posttransplant patients who required multiple prior procedures for TBS.
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J Bronchology Interv Pulmonol · Apr 2012
Case ReportsObstructive fibrinous tracheal pseudomembrane.
Obstructive fibrinous tracheal pseudomembrane is a rare but potentially fatal complication associated with endotracheal intubation. Little is known about the mechanisms that play a role in the development of tracheal pseudomembrane, but it requires early diagnosis and treatment to prevent its major consequences. In this report, we present a case of obstructive fibrinous tracheal pseudomembrane, which developed a day after extubation in a patient who was intubated for 2 days. Therapeutic bronchoscopy was highly successful in removing the lesion and improving the clinical course.
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J Bronchology Interv Pulmonol · Apr 2012
Case ReportsUltrasound-guided percutaneous biopsy to diagnose indwelling pleural catheter metastasis.
Malignant pleural effusion is a common cause of morbidity and mortality in patients suffering from end-stage metastatic cancer. Malignant pleural effusion is associated with a shortened survival of 3 to 12 months after diagnosis, with 1- and 6-month mortality rates of 54% and 85%, respectively. Nearly all medical management in these patients is directed toward palliation of symptoms caused by pleural fluid accumulation. ⋯ Although pleural catheter complications are low, malignant seeding of the pleural tract can occur. Transthoracic ultrasound use to determine the presence of pleural tract seeding in conjunction with guided percutaneous biopsy has not been described. We report the use of ultrasound-guided percutaneous biopsy to diagnose metastatic seeding of an IPC.