Medical Inspection – Health Blog

Routine chest roentgenograms following TBB rarely demonstrate a pneumothorax in patients without both chest pain and fluoroscopic findings of a pneumotho­rax. In no instance did any of the 305 routine chest roentgenograms obtained after TBB reveal an unsus­pected pneumothorax. The two pneumothoraces which did occur were immediately diagnosed in the bronchoscopy suite by symptoms and the appearance of fluoroscopic findings of lung collapse.

The combination of chest pain and abnormal fluor­oscopy appears to be an indicator of a pneumothorax after TBB. No false negative results occurred in our series using the combination of chest pain and abnor­mal fluoroscopy as a test for pneumothorax after TBB. We do not know how many of the 303 patients without a pneumothorax had chest pain and abnormal fluor­oscopy. However, our estimate of the false positive rate is low, since in a subgroup of 42 patients without a pneumothorax, only one patient had both chest pain and fluoroscopic findings suggestive of lung collapse. As there were only two patients with a pneumothorax, estimates of false negative and false positive rates of these clinical indicators of pneumothorax lack preci­sion.

Read More…

There were 190 men and 115 women studied with a mean age of 51 years (range 18 to 87). Two of these patients had bronchoscopy and TBB during mechani­cal ventilation. Of the 305 patients, 146 had spirometry performed at the University of Virginia. Forty-one of these 146 patients (28 percent) had findings on spirom­etry of obstructive lung disease (ie, FEV1/FVC<70 percent). All patients were able to acknowledge chest pain or other symptoms during the bronchoscopy.

None of the 305 routine chest roentgenograms demonstrated an unsuspected pneumothorax. Two of 305 patients developed a pneumothorax following TBB. Both had immediate pleuritic chest pain and the sudden appearance of a pleural line suggesting lung collapse in the bronchoscopy suite. Therefore, no patient without symptoms and fluoroscopic findings of lung collapse had a pneumothorax demonstrated on the postbiopsy chest roentgenogram. One of these two patients had bullous emphysema and the other had restrictive lung disease due to sarcoidosis.

Read More…

Transbronchial biopsy via the flexible fiberoptic bronchoscope is a common procedure in pulmo­nary medicine. Because pneumothorax is a recognized complication of this procedure, most bronchosco- pists routinely obtain chest roentgenograms after TBB. However, the proportion of these routine chest x-ray films which demonstrate an unsuspected pneumotho­rax is unknown. We hypothesized that routine post- biopsy chest roentgenograms rarely demonstrate a pneumothorax in patients who have no symptoms or fluoroscopic evidence of lung collapse. To test this hypothesis, we studied 305 consecutive patients un­dergoing fluoroscopically guided TBB all of whom had a postbiopsy chest roentgenogram.

Methods

We reviewed the medical records and chest roentgenograms of 305 consecutive patients undergoing fiberoptic bronchoscopy with fluoroscopically guided TBB. These 305 patients were all the patients undergoing fiberoptic bronchoscopy with fluoroscopically guided TBB at the University of Virginia Health Sciences Center between January 1983 and November 1988. The bronchoscopies and TBB were performed by eight pulmonary fellows supervised by six attending physicians from the Division of Pulmonary Medi­cine at the University of Virginia.

Read More…

In the present study, we measured bronchial re­sponsiveness to acetylcholine in patients with left heart disorders and noticed that the median value for PC20-FEV1 in patients with a history of congestive heart failure was lower than that in patients without such history. Makino et al have reported with the same protocols as our bronchial provocation test that the PC20-FEV1 value of asthmatic subjects was lower than 1 mg/ml and that of normal control subjects was higher than 10 mg/ml. In our study, because all patients without a clinical history of congestive heart failure (group 1) have a PC20-FEV1 above 1 mg/ml, their bronchial responsiveness was considered to be within normal limits. In contrast, the PC20-FEV! in patients with a history of congestive heart failure (group 2) was lower than 1 mg/ml in 23 (70 percent) of 33. Their bronchial responsiveness seems to have increased considerably. Read More…

The baseline pulmonary function test results are shown in Table 1 and Figure 1. Each mean value for age, FVC, FEV1 and Zrs at 3 Hz did not statistically differ among the groups. The AFEV, in group 1 (0.19 ±0.18 mg/ml) was lower than that in group 2 (0.48 ±0.24 mg/ml; p<0.05 by Student Mest).

“O ronchial hyperresponsiveness to nonspecific stim­uli is an almost universal finding in patients with bronchial asthma. On the other hand, paroxysmal dyspnea similar to an asthma attack frequently occurs in patients with congestive heart failure; however, no data are available in the literature on bronchial hyper­responsiveness in these patients. Therefore, to inves­tigate the relationship between pulmonary congestion due to congestive heart failure and bronchial respon­siveness, we measured bronchial responsiveness to acetylcholine in 51 patients with left heart disorders.

Read More…

The only cases of pneumothoraces seen in our institutions AIDS patients since 1983 have occurred in association with focal recurrences of PCP in patients who received therapeutic and/or prophylactic aerosolized pentamidine. Aerosolized pentamidine may be associated with an increased incidence of focal radiographic presentations of PCP, particularly in the upper lobes. Radiotracer aerosol studies have confirmed poor apical delivery of the aerosol.

Read More…