Computed tomography and bronchoscopy in chest radiographically occult main-stem neoplasm diagnosis and Nd-YAG laser treatment in 8 patients.
We studied 8 adult patients with variable symptoms of cough, dyspnea, stridor, wheezing, or hemoptysis. Fiberoptic bronchoscopy in all showed complete or nearly complete endobronchial obstruction of a main-stem bronchus by neoplasm with a mean bronchial diameter of 1.9 mm +/- 1.6 mm (mean +/- standard deviation). In 4 patients, a lobar bronchus was also completely obstructed. No mass was visible on chest radiographs of any patient; however, computed tomography in each showed main-stem endobronchial obstruction, lobar obstruction (4 instances in 3 patients), and in 6 patients hypoperfusion of the involved lung. Computed tomographic scan showed additional abnormalities that were unsuspected on viewing chest radiographs or at bronchoscopy, including mediastinal adenopathy in 3 patients and an extraluminal tumor component in 4. After therapy with Nd-YAG laser, main-stem airway diameter increased to a mean of 9.6 mm +/- 1.0 mm (P less than .05) and pulmonary functions improved. Results suggest the complementary role of computed tomography and fiberoptic bronchoscopy in the detection and laser-treatment planning of chest radiographically occult severe neoplastic obstruction of the main-stem bronchus.
Gelb
A F
AF
Department of Medicine, Doctor's Hospital of Lakewood, California.
Aberle
D R
DR
Schein
M J
MJ
Naidich
D P
DP
Epstein
J D
JD
Tashkin
D P
DP
D001984:Bronchial Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D001999:Bronchoscopy / Q000379:methods*; D005336:Fiber Optic Technology; D006801:Humans; D053685:Laser Therapy; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed