: Narrow band imaging (NBI) is a new type of imaging technology that enhances the visibility of blood vessels used in the detection of abnormal angiogenesis in preneoplastic and neoplastic lesions. This technique is used in the diagnosis and management of dysplastic and malignant endobronchial lesions. To our knowledge, this is the first description of the use of NBI to diagnose and manage benign lesions, hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to implement NBI as a tool for use in the bronchoscopic visualization leading to the diagnosis and management of nonmalignant lesions in the tracheobronchial tree. This is including but not limited to HHT. NBI was used to detect the origin of significant hemoptysis in a patient with HHT. The patient had conventional white light (CWL) bronchoscopy, followed by NBI. NBI illuminated the abnormal blood vessels significantly better than CWL bronchoscopy. This led to a more effective diagnosis and management of the abnormal vessels causing the hemoptysis. NBI may provide a higher probability of locating abnormal endobronchial lesions in both benign and malignant diseases than CWL bronchoscopy. It can be used to treat these abnormal lesions as in our patient who presented with hemoptysis. A prospective study is needed to determine whether NMI and CWL are additive as in malignant disease. Furthermore, NBI can be used in lesions of the tracheobronchial tree and the gastrointestinal tract, and pleura, so that the appropriate management can be initiated.
There is significant morbidity and mortality from pneumonia in leukemic and bone marrow transplant patients. We sought to explore the diagnostic yield of bronchoalveolar lavage (BAL) in these patients with new pulmonary infiltrates. A retrospective chart review of approximately 200 Non- human immunodeficiency virus (HIV) leukemic and Hematopoietic stem cell transplantation (HSCT) patients who underwent bronchoscopy at a single academic cancer center was performed. Antimicrobial use for less than 24 hours at the time of BAL was associated with a higher yield in this population (56.8% versus 32.8%, p<0.001). This supports performing bronchoscopy with BAL within 24 hours of antimicrobial therapy in leukemic and HSCT patients.
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) remains a poorly understood clinical entity. It is currently classified as a premalignant condition by the World Health Organization (WHO). Symptoms are similar to those associated with obstructive lung disease, including breathlessness and cough. The presentation is often initially ascribed to other diseases such as asthma or chronic obstructive pulmonary disease. Here, we present what we believe is the first described case of DIPNECH diagnosed by transbronchoscopic cryoprobe biopsy. The patient presented with chronic cough, dyspnoea, pulmonary function tests consistent with obstruction, and a computed tomography (CT) scan of chest with multiple nodules. The patient went on to have transbronchoscopic cryoprobe biopsies of the lung, which confirmed the diagnosis of DIPNECH.
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