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Background The increase in immunohistochemical and molecular predictive tests in lung cancer requires new strategies for managing small samples taken during bronchoscopic procedures. The value of Rapid On Site Evaluation (ROSE) during conventional bronchoscopic procedures on endobronchial neoplasms in optimizing small biopsies and cytologlogical tissue specimens for diagnostic testing, and ancillary studies was evaluated. Method ROSE on touch imprint cytology (TIC) and brushing was performed on 690 consecutive cases of patients undergoing biopsies, using fiber optic bronchoscopy. Immunohistochemical assay for PD-L1, ALK, and ROS1 and molecular testing, via next generation technique for EGFR, KRAS, and BRAF, were performed. Results The concordance between ROSE and final diagnoses was almost perfect for brushing (sensitivity: 0.84; specificity: 0.96), and less so for touch preparations (sensitivity: 0.77; specificity: 0.89). Immunohistochemical assay for PD-L1 was evaluated on 256 bioptic cases with only six unsuitable samples. Material available for immunohistochemistry for ALK was sufficient in 151 biopsies with no inadequate cases. ROS1 was evaluated in 132 biopsies, with only two unsuitable samples. Molecular analysis was performed on 128 biopsies, 29 TIC, and 17 brushing. Out of these, only ten were considered to be unsuitable. Conclusions ROSE is an effective procedure for monitoring the quality and quantity of material taken during conventional bronchoscopic procedures for evaluating the suitability of small samples that must undergo immunohistochemical and molecular assay.

Introduction: Fiber-optic bronchoscopy (FOB) is commonly performed in the first line in diagnostic process of haemoptysis. However, lots of evidences suggest that in haemoptysis FOB do not always provide additional, useful information to radiological diagnostics. Therefore, this study aimed to evaluate the validity of performing FOB as a method of choice in first line diagnostics of haemoptysis. Material and methods: Data comprised consecutively collected results from patients referred for FOB assessment for clinical purposes were retrospectively analysed. We included all examinations, which were performed due to haemoptysis as the only indication, excluding any other lung-related conditions. Results: 114 patients were finally included to the study. The median age was 59 (IQR: 46–64.75). Active bleeding was visualized during examination of 13 (11.4%) patients. Patients with active bleeding did not differ significantly according to age: 59 (54–69) vs. 59 (45–64) years; W = 532.5, p-value = 0.27, and gender: c2 = 1.68, p-value = 0.2. On the other hand, in 29 (25.44%) patients, FOB revealed no visible abnormalities. This subgroup of patients was significantly younger — 46 (34–62) years vs. 60 (53–67) years; W = 782, p-value = 0.003. Conclusion: Low number of visualized active bleeding sites suggest overuse of bronchoscopy in diagnosis of haemoptysis. Indications for this examination should be reconsidered especially in young patients with non-massive haemoptysis.

Objective: To compare the efficacy, safety, and incidence of complications between fiber-optic bronchoscopy-guided percutaneous dilatational tracheostomy (FOB-PDT) and ultrasound-guided percutaneous dilatational tracheostomy (US-PDT) and to determine whether US-PDT is a viable alternative to FOB-PDT. Methods: This randomized prospective study was carried out in 80 patients who were randomly divided into US-PDT and FOB-PDT groups. Demographic data and Acute Physiology and Chronic Health Evaluation II (APACHE II), procedure duration, hemorrhage status, complications, procedure difficulty, displacement of entry location after US, and hemodynamic data were evaluated in both groups. Tracheal incision was performed with real-time US and a transverse probe position in the out-of-plane mode. Results: No significant differences were observed between the 2 groups in terms of demographic data, oral intubation time, APACHE II values, difficulty of the procedure, or the number of needle interventions ( P > .05). The mean hemorrhage ratio of the FOB-PDT group was significantly higher than that of the US-PDT group ( P < .05). The entry location was changed in 6 patients in the US-PDT group following neck examination with US. The mean duration of the procedure for the FOB-PDT group was significantly longer than that for the US-PDT group ( P < .05). Conclusion: Ultrasound-guided percutaneous dilatational tracheostomy is a safe procedure for critically ill patients and has the advantages of a low complication rate, short duration of procedure, being informative with regard to neck anatomy, and facilitating prevention of vascular puncture. Thus, US-PDT can be used as an alternative to FOB-PDT.

Bronchoscopy relies on two techniques: fiber-optic bronchoscopy, which is the most common, and rigid bronchoscopy, which is technically more difficult. Local anesthesia facilitates a quick and immediate examination, which makes it the most widely used. It requires subsequent clinical and vital signs monitoring. General anesthesia prevents the operator from cooperating with the patient and from having access to a few fine observations. Fiber-optic bronchoscopy allows to observe and diagnose trachea–bronchial diseases; it also makes it possible to collect samples for pathology and infectious diseases.

Although tuberculosis is a rather common disease in the Indian subcontinent, tracheobronchial involvement in tuberculosis is still rare. Fistula formation between bronchi is very rare considering that only four cases have been published in the English literature. We present a case of multislice computed tomography (CT) and virtual bronchoscopy diagnosis of interbronchial fistula in a patient with tuberculosis along with a review of literature of the same. This happens to be the smallest of the interbronchial fistula identified on imaging so far and the first case from the Indian subcontinent. This is also the first instance where the diagnosis appears to have been made using only multislice CT generated virtual bronchoscopy without the aid of fiber optic bronchoscopy.

Introduction: Contrast enhanced computed tomography (CECT) thorax & Fibre Optic Bronchoscopy (FOB) are main investigations in patients of hemoptysis with normal chest X-ray. But there are limited data on their diagnostic yield especially from South East Asia. Methods : An observational study on 60 patients with hemoptysis with normal chest X -ray was conducted from April 2012 to April 2014. CECT thorax and FOB were done in all of them. Results : Out of 60 patients 38 (63.3%) were male with even age distribution. Yield of CECT was 40% (24 patients) and main diagnosis were bronchiectesis (25%) and tuberculosis (11.6%). Diagnostic yield of FOB was 47% (28 patients) with predominant diagnosis of tuberculosis (18.33%), bronchitis (18.33%) and bronchogenic carcinoma (6.66%). Overall diagnostic yield was 76.6% (46 cases). Bronchogenic carcinoma cases were all male smokers and 3 of them were more than 40 years old. Conclusion : CECT thorax and FOB are complimentary to each other in evaluation of hemoptysis with normal chest x-ray. Bronchogenic carcinoma and tuberculosis cases require specific treatment and they were diagnosed in confirm way only by FOB. So, FOB have advantage over CT scan, especially among patients with increased risk of bronchogenic carcinoma (male-smokers with age > 40 years).

Interstitial lung disease (ILD) is a final common pathway of a broad heterogeneous group of parenchymal lung disorders. It is characterized by progressive fibrosis of the lung leading to restriction and diminished oxygen transfer. Clinically, the presenting symptoms of ILD are non-specific (cough and progressive dyspnea on exertion) and are often attributed to other diseases, thus delaying diagnosis and timely therapy. Clues from the medical history along with the clinical context and radiologic findings provide the initial basis for prioritizing diagnostic possibilities for a patient with ILD. An accurate prognosis and optimal treatment strategy for patients with ILDs can only be after an accurate diagnosis. This review will assist pulmonary physicians and medicine specialist in recognition of ILD. Extensive literature search has been made through PubMed and also Book References has been used for writing this review.

Objective : The aim of this study was to compare the results of virtual bronchoscopy (VB) images in defining tracheobronchial pathologies with those of fiber-optic bronchoscopy (FOB) in patients with clinical indication for bronchoscopy. Methods : Twenty-two patients with bronchoscopy indication were evaluated with FOB and VB. The VB results were evaluated blindly, independent of the FOB results. Results : In 19 of the 22 patients, tracheobronchial abnormalities were present on FOB, whereas 3 patients had normal findings on FOB. In 17 of 19 patients, VB demonstrated the FOB diagnosis of tracheobronchial abnormality. While FOB detected 11 endoluminal lesions, VB detected 6. While FOB detected 20 obstructive lesions, VB detected 26. In evaluating external compression, FOB detected 2 lesions and VB detected 15. Conclusions : VB is a non-invasive, uncomplicated, and reproducible examination method in patients with an indication for thorax examination. Virtual bronchoscopy could find a clinically broader field of application in the future.

Endobronchial aspergilloma is a rare, noninvasive aspergillosis. It may be associated with a parenchymal lesion and/or cavity. We describe a case of endobronchial aspergillosis mimicking bronchogenic carcinoma subsequently removed completely through fiber-optic bronchoscope itself. This case report, while highlighting the existence of this unique clinical entity, also throws light on potential treatment option which can be curative.

Hemoptysis is a very common symptom in the practice of pulmonary physicians of India. We present a case of uncontrolled hemoptysis managed with bronchial artery embolization. Bronchial artery embolization is an effective treatment for patients with hemoptysis. Serious complications are rare, but may occur if the arterial supply to other structures is compromised.

Compare virtual bronchoscopy (VB) to fiberoptic bronchoscopy (FOB) for scoring smoke inhalation injury (SII).Swine underwent computerized tomography (CT) with VB and FOB before (0) and 24 and 48 h after SII. VB and FOB images were scored by 5 providers off line.FOB and VB scores increased over time (p0.001) with FOB scoring higher than VB at 0 (0.30±0.79 vs. 0.03±0.17), 24 h (4.21±1.68 vs. 2.47±1.50), and 48h (4.55±1.83 vs. 1.94±1.29). FOB and VB showed association with PaO2-to-FiO2 ratios (PFR) with areas under receiver operating characteristic curves (ROC): for PFR≤300, VB 0.830, FOB 0.863; for PFR≤200, VB 0.794, FOB 0.825; for PFR≤100, VB 0.747, FOB 0.777 (all p0.001). FOB showed 80.3% specificity, 77% sensitivity, 88.8% negative-predictive value (NPV), and 62.3% positive-predictive value (PPV) for PFR≤300 and VB showed 67.2% specificity, 85.5% sensitivity, 91.3% NPV, and 53.4% PPV.VB provided similar injury severity scores to FOB, correlated with PFR, and reliably detected airway narrowing. VB performed during admission CT may be a useful screening tool specifically to demonstrate airway narrowing induced by SII.

Context: Non-resolving pneumonia is often an area of concern for pulmonologists. Fiber optic bronchoscopy (FOB) may have a special role in etiologic evaluation of non-resolving pneumonias. There is paucity of recent studies in this field. Aims: This study aimed to assess the patients of non-resolving or slowly resolving pneumonia with special emphasis on efficacy of FOB and computed tomography (CT)-guided fine needle aspiration cytology (FNAC) in diagnosis. Settings and Design: Prospective, observational study conducted in a tertiary care institute over a period of one year. Materials and Methods: After fulfilling the definition of non-resolving pneumonia by clinical and radiological parameters, patients were evaluated by FOB with relevant microbiological, cytological, histopathological investigations and CT scan of thorax. CT-guided FNAC was done in selected cases where FOB was inconclusive. Results: Sixty patients were enrolled in the study. Mean age was 51.33 ± 1.71 years with male to female ratio 2:1. Right lung was more commonly involved (65%), and right upper lobe was the commonest site (25%). Pyogenic infection was the commonest etiology (53.3%), bronchogenic carcinoma and tuberculosis accounted for 26.7% and 16.7% cases, respectively. Both, FOB (85.7%) and CT-guided FNAC (91.67%) were very useful for etiological diagnosis of non-resolving pneumonia. Both the procedures were safe, and no major complication was observed. Conclusions: Because of the high yield of FOB, it is very useful and safe diagnostic tool for evaluation of non-resolving pneumonia. CT-guided FNAC also gives good yield when cases are properly selected.