title: Endobronchial ultrasonography with a guide-sheath and virtual bronchoscopy navigation aids management of peripheral pulmonary nodules.
abstract: Occasionally, we have difficulty in diagnosing small peripheral pulmonary nodules. However, efforts have been made to resolve this problem. For instance, computed-tomography (CT), positron emission tomography (PET), flexible bronchoscopy examination (BF), and video-assisted thoracic surgery (VATS) have been performed to investigate such nodules. We have used endobronchial ultrasonography with a guide-sheath (EBUS-GS) for BF examination, and recently applied the virtual reality technique "virtual bronchoscopy (VB)". Here, we present a case in which a combined technique with VB and EBUS-GS was useful. The patient was a 54-year-old man with a persistent cough and chest pain. Small nodules were seen in the bilateral lungs on the chest CT taken at the local hospital. A slight increase in the CEA level (6.1 ng/ml; normal level < 5.0 ng/ml) was shown as well as an uptake in the latter term on PET. As a result, he was referred to our hospital for a detailed work-up. We applied VB to confirm the location of the tumor, which allowed us to approach the lesion easily. Furthermore, we precisely localized the lesion using EBUS-GS. Then a biopsy was performed, which demonstrated bronchiolitis obliterans organizing pneumonia (BOOP). As seen in this case, combining VB and EBUS-GS seems beneficial for diagnosing peripheral pulmonary nodules.
authors.affiliation: Department of Surgery, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan. sokimasa@mail.goo.ne.jp
authors.forename: Seiji
authors.initials: S
authors.lastname: Okimasa
authors.forename: Shinkichiro
authors.initials: S
authors.lastname: Yoshioka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shibata
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Awaya
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Nagao
authors.forename: Isao
authors.initials: I
authors.lastname: Murakami
authors.forename: Eriko
authors.initials: E
authors.lastname: Shigeto
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Asahara
mesh_terms: D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008495:Medical Oncology / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*