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Introduction: Percutaneous microwave ablation (MWA) is clinically accepted for the treatment of lung tumors and oligometastatic disease. Bronchoscopic MWA is under development and evaluation in the clinical setting. We previously reported on the development of a bronchoscopy-guided MWA system integrated with clinical virtual bronchoscopy and navigation and demonstrated the feasibility of transbronchial MWA, using a maximum power of 60 W at the catheter input. Here, we assessed the performance of bronchoscopy-guided MWA with an improved catheter (maximum power handling of up to 120 W) in normal porcine lung in vivo (as in the previous study). Methods: A total of 8 bronchoscopy-guided MWA were performed (n = 2 pigs; 4 ablations per pig) with power levels of 90 W and 120 W applied for 5 and 10 min, respectively. Virtual bronchoscopy planning and navigation guided transbronchial or endobronchial positioning of the MWA applicator for ablation of lung parenchyma. Following completion of ablations and post-procedure CT imaging, the lungs were harvested and sectioned for gross and histopathologic ablation analysis. Results: Bronchoscopy-guided MWA with applied energy levels of 90 W/5 min and 120 W/10 min yielded ablation zones with short-axis diameters in the range of 20–28 mm (56–116% increase) as compared to ∼13 mm from our previous study (60 W/10 min). Histology of higher-power and previous lower-power ablations was consistent, including a central necrotic zone, a thermal fixation zone with intact tissue architecture, and a hemorrhagic periphery. Catheter positioning and its confirmation via intra-procedural 3D imaging (e.g., cone-beam CT) proved to be critical for ablation consistency. Conclusion: Bronchoscopy-guided MWA with an improved catheter designed for maximum power 120 W yields large ablations in normal porcine lung in vivo.

Endobronchial tuberculosis (EBTB) presents significant clinical challenges, particularly when complete bronchial obstruction occurs. In this case, a young woman with right main bronchus occlusion due to tuberculosis (TB) was treated using a novel approach. Instead of using a traditional rigid bronchoscope, a flexible approach was adopted. Under precise fluoroscopic guidance, a 21‐gauge transbronchial aspiration needle was used to puncture the obstruction, allowing passage of the guidewire and subsequent balloon dilation. The use of virtual bronchoscopy, developed using computed tomography scans, ensures safe navigation around critical vascular structures. Postoperatively, the patient showed significant symptomatic improvement without complications. This innovative approach not only demonstrates the efficacy and safety of using biopsy needles and virtual bronchoscopy for managing complete bronchial obstructions in EBTB but also opens the door for future innovative solutions in such complex cases. [ABSTRACT FROM AUTHOR]

Mediastinal masses pose one of the great challenges for any anesthesiologist during airway maintenance, underlining the need to devise a well-formulated plan to avoid perioperative complications. As a general rule, such patients are managed with spontaneous ventilation without the use of muscle relaxants and awake intubation. We report a case of a 66-year-old male with severe dyspnea, having a very large invasive anterior mediastinal mass, causing left lung collapse for urgent debulking surgery. The tracheobronchial compromise was ruled out using three-dimensional reconstruction on computed tomography imaging (virtual bronchoscopy) and that helped in using general anesthesia with muscle relaxation for subsequent endotracheal intubation and surgery.

Mediastinal masses pose one of the great challenges for any anesthesiologist during airway maintenance, underlining the need to devise a well-formulated plan to avoid perioperative complications. As a general rule, such patients are managed with spontaneous ventilation without the use of muscle relaxants and awake intubation. We report a case of a 66-year-old male with severe dyspnea, having a very large invasive anterior mediastinal mass, causing left lung collapse for urgent debulking surgery. The tracheobronchial compromise was ruled out using three-dimensional reconstruction on computed tomography imaging (virtual bronchoscopy) and that helped in using general anesthesia with muscle relaxation for subsequent endotracheal intubation and surgery. [ABSTRACT FROM AUTHOR]

Abstract Endobronchial tuberculosis (EBTB) presents significant clinical challenges, particularly when complete bronchial obstruction occurs. In this case, a young woman with right main bronchus occlusion due to tuberculosis (TB) was treated using a novel approach. Instead of using a traditional rigid bronchoscope, a flexible approach was adopted. Under precise fluoroscopic guidance, a 21‐gauge transbronchial aspiration needle was used to puncture the obstruction, allowing passage of the guidewire and subsequent balloon dilation. The use of virtual bronchoscopy, developed using computed tomography scans, ensures safe navigation around critical vascular structures. Postoperatively, the patient showed significant symptomatic improvement without complications. This innovative approach not only demonstrates the efficacy and safety of using biopsy needles and virtual bronchoscopy for managing complete bronchial obstructions in EBTB but also opens the door for future innovative solutions in such complex cases.

Background: Accurate assessment of stenosis site, degree, and length in post-intubation laryngotracheal stenosis patients is crucial for procedure selection and prognosis prediction. Despite being the preferred method, bronchoscopy has its drawbacks in severely ill patients, with potential complications and limitations in evaluating airway features beyond high-grade stenosis. Computed Tomography (CT) scans with multiplanar reconstructions are suggested as a safer and alternative diagnostic tool to overcome these limitations. The present work aims to compare the diagnostic performance of CT virtual bronchoscopy (VB) and multiplanar reformatting (MPR) with conventional bronchoscopy (CB) in post-intubation laryngotracheal stenosis patients. Methods: This prospective comparative study, enrolled 30 patients with post-intubation laryngotracheal stenosis from October 2020 to October 2022. All patients were subjected to detailed history taking, thorough clinical examination, endoscopic and radiological investigations. All patients went through CT examination, rigid bronchoscope and underwent tracheal resection anastomosis operation. The evaluated parameters were the length, diameter, and cranio-caudal extent of stenosis in all settings, and the results were compared. Results: No statistically significant differences between computed tomography virtual bronchoscopy and MPR with crico-tracheal resection operation results regarding length (p-value = 0.943), diameter (p-value = 0.939), and craniocaudal extent (p-value = 0.988). Regarding conventional bronchoscopy and crico-tracheal resection, a statistically significant difference in lumen diameter (p-value = 0.024) was noted. No significant difference in length (p-value = 0.943). No statistically significant difference (p-value = 0.951) as regards cranio-caudal extent. Conclusions: CT multiplanar reformatting and virtual bronchoscopy offer accurate, noninvasive assessment of laryngotracheal stenosis, surpassing conventional bronchoscopy. They prove beneficial for precise evaluation of lesion length and lumen diameter, especially beyond high-grade stenosis where conventional bronchoscopy faces limitations. These techniques serve as dependable alternatives for patients at risk for anesthesia, providing a safer diagnostic approach. [ABSTRACT FROM AUTHOR]

Diagnostic bronchoscopy is a minimally invasive procedure that plays a crucial role in the diagnosis and management of various respiratory conditions. This paper explores the advancements in technology that have revolutionized the field and focuses on the new diagnostic procedures in bronchoscopy that have emerged in recent years. These innovative techniques have expanded the diagnostic capabilities of bronchoscopy, allowing for more accurate and comprehensive evaluation of respiratory conditions. This paper will also discuss the challenges in the diagnostic process with bronchoscope.

Pulmonary hamartomas are common benign lung tumors; however, endobronchial hamartomas are relatively rare. We report a case of asymptomatic endobronchial hamartoma in a 51-year-old man. Chest computed tomography revealed a 10-mm protrusion in the right main bronchus. Preoperative virtual bronchoscopy (VBS) was performed; subsequently, minimally invasive bronchoscopic resection was safely performed under local anesthesia. The use of VBS is a useful treatment strategy and follow-up modality.

Background: The purpose of this paper is to present the spatial navigation system prototype for localizing the distal tip of the cannula–guide assembly. This assembly is shifted through the channel of a bronchoscope, which is fixed in relation to the patient. The navigation is carried out in the bronchial tree, based on maneuvers of the aforementioned assembly. Methods: The system consists of three devices mounted on the guide handle and at the entrance to the bronchoscope working channel. The devices record the following values: cannula displacement, rotation of the guide handle, and displacement of the handle ring associated with the bending of the distal tip of the guide. Results: In laboratory experiments, we demonstrate that the cannula displacement can be monitored with an accuracy of 2 mm, and the angles of rotation and bending of the guide tip with an accuracy of 10 and 20 degrees, respectively, which outperforms the accuracy of currently used methods of bronchoscopy support. Conclusions: This accuracy is crucial to ensure that we collect the material for histopathological examination from a precisely defined place. It makes it possible to reach cancer cells at their very early stage. [ABSTRACT FROM AUTHOR]

Congenital bronchial webs are extremely rare and usually remain undiagnosed due to nonspecific symptoms. Herein, we reported a 4‐year‐old case of the bronchial web who was initially undiagnosed upon bronchoscopy following foreign body aspiration and afterward misdiagnosed as childhood asthma through his consistent cough and exertional dyspnea for several months. [ABSTRACT FROM AUTHOR]

Abstract Congenital bronchial webs are extremely rare and usually remain undiagnosed due to nonspecific symptoms. Herein, we reported a 4‐year‐old case of the bronchial web who was initially undiagnosed upon bronchoscopy following foreign body aspiration and afterward misdiagnosed as childhood asthma through his consistent cough and exertional dyspnea for several months.

Introduction: The size of the changes is important for determining the invasiveness of the process and the stage of development of the neoplastic processes of the lung. The use of the method of virtual bronchoscopy as a diagnostic method in central lung carcinoma provides non-invasive visualization, but also abilities to measure changes. Purpose: The study aims to present the results of the application of the VB method in determining the size of the changes in patients with central lung carcinoma. Methods: 130 patients, diagnosed with central carcinoma, went VB method, using 64 MDCT Siemens Definition AS. The criteria size of the changes in different localization (right or left) and sex (women, men) was considered in the work. Results: 98 men and 32 women, aged 26-83 years, diagnosed with central lung cancer were examined using the method of virtual bronchoscopy, in which the size of the changes was monitored. In central right carcinoma of men, the formations in CT ranged in average from 5 to 68 mm (36.5 ± 18.62) and the largest number of findings were of 21–43 mm (44.5 ± 14) in length. The length of the changes in men with central left carcinoma ranged from 0.45 mm to 31 mm (12.7 ± 10.59). The length of the changes in women with central right carcinoma was from 0.44 to 1.86 mm (6.45 ± 6.83), and in those with left localization - from 0.6 to 13.1 mm (10.35 ± 6.74). In men, all six groups of stenoses were presented, most of them with sizes over 20 mm, followed by those with sizes below 3 mm. In women, stenoses were presented in only 3 groups, most of which were less than 3 mm in size. A significant relation was found between the sex of the studied patients with central carcinoma and the length of the stenoses. Sex was a determining factor for the length of the stenoses (χ2 = 212.77, p = 0.0000). Conclusions: Virtual bronchoscopy allows accurate metry in all planes. The magnitude of the measured changes is important for determining the invasiveness of the process. The results obtained in VB should always be interpreted with axial and multiplanar images.

Objective:The aim of this study was to compare virtual bronchoscopy (VB) with multi-slice CT (MSCT) in the diagnosis of centrally located lung cancer and to investigate the effectiveness of VB in the diagnosis of the radiologist.Methods:These patients had central lung mass detected during thorax tomography and were diagnosed as having centrally located lung cancer by histopathological examination. Detection and localization of lesions were determined by MSCT and VB. In addition, the evaluation time was determined in seconds with an electronic stopwatch.Results:The mean age of 32 patients included in the study was 58.14±15.09. Centrally located squamous cell carcinoma (n=19) and small cell carcinoma (n=13) were included. Eighteen (54.8%) patients were male and 14 (47.6%) were female. All patients diagnosed as having centrally located lung cancer detected by MSCT were also detected by VB (100%). In the evaluation of patients with MSCT and VB; obstruction and/or lesion and their localization completely overlapped. The mean duration of MSCT evaluation of the patients was determined as 58.7 sec, and the mean duration of VB assessment was 549.9 sec. The mean VB evaluation duration was found to be statistically significantly longer than the mean MSCT evaluation duration.Conclusion:Virtual bronchoscopy does not provide a significant additional contribution to MSCT in the diagnosis of centrally located malignant lung tumor. We think that using VB for diagnosis and navigation will be important in terms of efficiency especially in selected patients due to its low specificity and high sensitivity.

Central airway abnormalities are the most overlooked part of the respiratory system during high-resolution computed tomography thorax specifically when these are subtle and read by less experienced eyes. In this article, we have tried to emphasize the importance to include central airways in reporting checklist. Systematically, analysis of airways can give important clues and narrow down the differentials and clinch the diagnosis in some cases like in our index one.

VB is a non-invasive technique and follow-up tool tolerant of most patients, requiring a precise method of diagnosis, especially in ruptures with the formation of high-grade stenoses for which FB is not applicable, as well as in children and elderly or severely ill patients. The study aims to track the technical parameters, key indicators, and criteria for optimizing the diagnostic capabilities of Virtual bronchoscopy (VB) in tracheal and bronchial ruptures. Optimization of the technical parameters of the scans taking into account the age of the patient, the weight, the size, the nature of the ruptures and the severity of the diagnosis; the application of appropriate criteria and parameters for the diagnosis and evaluation of the tracheobronchial tree, combined with the capabilities of modern equipment, guarantee the high reliability, sensitivity, and specificity of the VB method.

Traumatic injuries of major airways (trachea and main bronchus) are rare in medical practice but represent extremely life-threatening conditions. The study aims to present a summary of research findings on the diagnostic capabilities of Virtual bronchoscopy (VB) in ruptures of trachea and bronchi. There is very little research into the applicability of VB in Bulgaria. Still, the modern equipment for MDCT VB during the last years provides to use the VB in diagnostic practice and for scientific examinations. The method of VB is recognized as a reliable tool in diagnostic practice and the research of tracheal and bronchial ruptures.

The objective is to present diagnostic capabilities of virtual bronchoscopy (VB) and fiberoptic bronchoscopy (FB) for determining the localization and shape of stenoses in patients with central lung carcinoma. A systematic study was performed on 220 patients aged 11-83 (54.36±17.24) years with endobronchial disease using the FB and VB methods during the 2013-2017 period. Central carcinoma of the lung was found on VB in 130 patients and on FB in 120 patients. Other nosologic diseases were found in 22 patients. Right localization of central carcinoma prevailed over left localization in both sexes. A significant difference in the localization criterion was found in female patients examined by VB (U-test, p=0.01). VB and FB yielded 86.5% vs. 91.60% precision and 85% vs. 94.5% sensitivity. In conclusion, VB was found to be a successful noninvasive method for determining the localization of lung tumors and shape of stenoses, which are essential in the diagnosis of malignant processes.

The esophageal lung is a variant of the communicating bronchopulmonary foregut malformation (CBPFM). It needs a high index of suspicion for diagnosis because it is a rare condition and does not have specific symptoms. A CT scan or an esophageal contrast study, showing direct communication between the airways and the esophagus or stomach, confirms the diagnosis. Patients with esophageal lung need flexible bronchoscopy for evaluating tracheobronchial anomalies.We present a three-month-old boy with a right esophageal lung in which the CT virtual bronchoscopy showed an absence of the right main bronchus at the carina level. This case report highlights the importance of CT virtual bronchoscopy as an alternative to flexible bronchoscopy for the diagnosis of tracheobronchial anomalies associated with CBPFM.

Background: The purpose of this paper is to present the spatial navigation system prototype for localizing the distal tip of the cannula–guide assembly. This assembly is shifted through the channel of a bronchoscope, which is fixed in relation to the patient. The navigation is carried out in the bronchial tree, based on maneuvers of the aforementioned assembly. Methods: The system consists of three devices mounted on the guide handle and at the entrance to the bronchoscope working channel. The devices record the following values: cannula displacement, rotation of the guide handle, and displacement of the handle ring associated with the bending of the distal tip of the guide. Results: In laboratory experiments, we demonstrate that the cannula displacement can be monitored with an accuracy of 2 mm, and the angles of rotation and bending of the guide tip with an accuracy of 10 and 20 degrees, respectively, which outperforms the accuracy of currently used methods of bronchoscopy support. Conclusions: This accuracy is crucial to ensure that we collect the material for histopathological examination from a precisely defined place. It makes it possible to reach cancer cells at their very early stage.

Introduction: Percutaneous microwave ablation (MWA) is clinically accepted for the treatment of lung tumors and oligometastatic disease. Bronchoscopic MWA is under development and evaluation in the clinical setting. We previously reported on the development of a bronchoscopy-guided MWA system integrated with clinical virtual bronchoscopy and navigation and demonstrated the feasibility of transbronchial MWA, using a maximum power of 60 W at the catheter input. Here, we assessed the performance of bronchoscopy-guided MWA with an improved catheter (maximum power handling of up to 120 W) in normal porcine lung in vivo (as in the previous study)., Methods: A total of 8 bronchoscopy-guided MWA were performed ( n = 2 pigs; 4 ablations per pig) with power levels of 90 W and 120 W applied for 5 and 10 min, respectively. Virtual bronchoscopy planning and navigation guided transbronchial or endobronchial positioning of the MWA applicator for ablation of lung parenchyma. Following completion of ablations and post-procedure CT imaging, the lungs were harvested and sectioned for gross and histopathologic ablation analysis., Results: Bronchoscopy-guided MWA with applied energy levels of 90 W/5 min and 120 W/10 min yielded ablation zones with short-axis diameters in the range of 20-28 mm (56-116% increase) as compared to ∼13 mm from our previous study (60 W/10 min). Histology of higher-power and previous lower-power ablations was consistent, including a central necrotic zone, a thermal fixation zone with intact tissue architecture, and a hemorrhagic periphery. Catheter positioning and its confirmation via intra-procedural 3D imaging (e.g., cone-beam CT) proved to be critical for ablation consistency., Conclusion: Bronchoscopy-guided MWA with an improved catheter designed for maximum power 120 W yields large ablations in normal porcine lung in vivo., Competing Interests: J.S., W.L.B., M.A.H., N.H., D.S.H., D.S.B., R.A.M., and S.L. have no relevant disclosures. S.G. and H.W. were employees of phenoMapper at the time of this study. A.S. and K.-C.Y. were employees of Broncus Medical Inc., at the time of this study. P.P. reports grants from the National Institutes of Health during the conduct of the study; and grants from the National Institutes of Health, National Science Foundation, and Jano.Life, outside the submitted work. In addition, P.P. is an inventor on issued patents and pending patent applications on microwave ablation technology., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Introduction: The size of the changes is important for determining the invasiveness of the process and the stage of development of the neoplastic processes of the lung. The use of the method of virtual bronchoscopy as a diagnostic method in central lung carcinoma provides non-invasive visualization, but also abilities to measure changes. Purpose: The study aims to present the results of the application of the VB method in determining the size of the changes in patients with central lung carcinoma. Methods: 130 patients, diagnosed with central carcinoma, went VB method, using 64 MDCT Siemens Definition AS. The criteria size of the changes in different localization (right or left) and sex (women, men) was considered in the work. Results: 98 men and 32 women, aged 26-83 years, diagnosed with central lung cancer were examined using the method of virtual bronchoscopy, in which the size of the changes was monitored. In central right carcinoma of men, the formations in CT ranged in average from 5 to 68 mm (36.5 ± 18.62) and the largest number of findings were of 21-43 mm (44.5 ± 14) in length. The length of the changes in men with central left carcinoma ranged from 0.45 mm to 31 mm (12.7 ± 10.59). The length of the changes in women with central right carcinoma was from 0.44 to 1.86 mm (6.45 ± 6.83), and in those with left localization - from 0.6 to 13.1 mm (10.35 ± 6.74). In men, all six groups of stenoses were presented, most of them with sizes over 20 mm, followed by those with sizes below 3 mm. In women, stenoses were presented in only 3 groups, most of which were less than 3 mm in size. A significant relation was found between the sex of the studied patients with central carcinoma and the length of the stenoses. Sex was a determining factor for the length of the stenoses (X2 = 212.77, p = 0.0000). Conclusions: Virtual bronchoscopy allows accurate metry in all planes. The magnitude of the measured changes is important for determining the invasiveness of the process. The results obtained in VB should always be interpreted with axial and multiplanar images. [ABSTRACT FROM AUTHOR]

Background and objective Virtual bronchoscopic navigation (VBN) assisted endobronchial ultrasonography with guide sheath (EBUS-GS) has reduced the difficulty and even avoiding radiation exposure during performing transbronchus lung biopsy (TBLB). To evaluate the feasibility and safety of virtual bronchoscopic navigation assisted endobronchial ultrasonography with guide sheath for peripheral pulmonary lesions. Methods We performed a retrospective analysis of the patients with PPLs who received VBN assisted EBUS-GS-TBLB in Peking University Cancer Hospital from January 2016 to December 2017. Their clinicopathologic data and complications were assessed. Results A total of 121 patients were enrolled in the study. The patients included 65 men and 56 women, with a mean age of (58.8±10.3) years. A total of 121 PPLs were examined, and 108 lesions of which could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 73.5%. The diagnostic yield of malignancy was 82.5%. The combination of transbronchial lung biopsy, brush smear and bronchoalveolar lavage fluid provided the greatest diagnostic yield (χ2=6.084, P=0.014). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesions (χ2=20.372, P=0.000) and PPLs located in the central two-thirds of the lung (χ2=10.810, P=0.001). 1 patient (0.8%) suffered from intraoperative bleeding which could be managed under endoscopy. Conclusion VBN assisted EBUS-GS-TBLB for PPLs was an effective and safe procedure.

Central airway abnormalities are the most overlooked part of the respiratory system during high‑resolution computed tomography thorax specifically when these are subtle and read by less experienced eyes. In this article, we have tried to emphasize the importance to include central airways in reporting checklist. Systematically, analysis of airways can give important clues and narrow down the differentials and clinch the diagnosis in some cases like in our index one. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare virtual bronchoscopy (VB) with multi-slice CT (MSCT) in the diagnosis of centrally located lung cancer and to investigate the effectiveness of VB in the diagnosis of the radiologist. Methods: These patients had central lung mass detected during thorax tomography and were diagnosed as having centrally located lung cancer by histopathological examination. Detection and localization of lesions were determined by MSCT and VB. In addition, the evaluation time was determined in seconds with an electronic stopwatch. Results: The mean age of 32 patients included in the study was 58.14±15.09. Centrally located squamous cell carcinoma (n=19) and small cell carcinoma (n=13) were included. Eighteen (54.8%) patients were male and 14 (47.6%) were female. All patients diagnosed as having centrally located lung cancer detected by MSCT were also detected by VB (100%). In the evaluation of patients with MSCT and VB; obstruction and/or lesion and their localization completely overlapped. The mean duration of MSCT evaluation of the patients was determined as 58.7 sec, and the mean duration of VB assessment was 549.9 sec. The mean VB evaluation duration was found to be statistically significantly longer than the mean MSCT evaluation duration. Conclusion: Virtual bronchoscopy does not provide a significant additional contribution to MSCT in the diagnosis of centrally located malignant lung tumor. We think that using VB for diagnosis and navigation will be important in terms of efficiency especially in selected patients due to its low specificity and high sensitivity. [ABSTRACT FROM AUTHOR]

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Utilizing complex lighting models, cinematic rendering is a novel technique for demonstrating computed tomography data with exquisite 3D anatomic detail. The tracheal lumen, tracheal wall, and adjacent soft tissue structures are represented with photorealistic detail exceeding that of conventional volume rendering or virtual bronchoscopy techniques. We applied cinematic rendering to a spectrum of emergent tracheal pathologies: traumatic tracheal tears, tracheoesophageal fistulas, tracheal foreign bodies, tracheal stenosis (intrinsic and extrinsic causes), tracheal neoplasms, and tracheomalacia. Cinematic rendering images enable visually accessible evaluation and comprehensive understanding of acute tracheal pathology, which is likely to be of value to both interventional pulmonologists and thoracic surgeons who are determining patient treatment plans. [ABSTRACT FROM AUTHOR]

Background Multidetector computed tomography-generated virtual bronchoscopy (VB) is a recent technical development that allows visualization of the lumen and wall of the trachea and proximal part of the bronchial tree. A dynamic image is produced that resembles what is seen with fiberoptic bronchoscopy (FOB). Patients and methods This prospective study was conducted on 54 patients examined in National Cancer Institute, Radiology Department, between January 2017 and February 2020. All patients underwent both multidetector computed tomography and VB. We included patients with histologically proved lung cancer either by true-cut needle biopsy or FOB guidance. The local ethical committee had approved the study protocol, and the patients had given informed consent before the examinations. Results We detected 53 lesions by VB, whereas 56 bronchial lesions were detected by FOB. Two patients with findings of bronchial lesions on FOB had normal findings on VB. One patient had normal findings on both VB and FOB. Two patients with normal bronchial findings on FOB had a bronchial lesion according to VB (as the endobronchial masses were located distal to obstruction. Conclusion VB should be performed in cases with bronchial obstructing tumors owing to its ability to detect obstructive masses distal to high-grade stenosis and bypassing beyond the obstructing mass lesion to detect the distal changes beyond the tumor. Moreover, by adding multiplanar reformat (MPR), we can determine the extrabronchial part of bronchial mass and its actual size and can detect any other extrabronchial associated findings such as lymphadenopathies and metastases. Moreover, it can detect the etiology of the external compression and carinal widening. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is not only the most common tumor, but also the tumor of supreme incidence and death rate in all malignant tumors. Bronchoscopy has been widely used in the diagnosis of space occupying lung lesions, but the diagnostic rate of pulmonary peripheral lesions (PPL) is relatively low. The emergence of intra-airway ultrasound technology is a milestone for the development of respiratory endoscopy technology. The appearance of miniature lung ultrasound probe has greatly improved the accuracy of diagnosis of peripheral lung diseases, especially peripheral lung cancer. In recent years, guided sheath (GS) endobronchial ultrasonography with trans-bronchial lung biopsy (EBUS-TBLB) has been used to diagnose pulmonary peripheral lesions. The diagnostic rate is over70%, and the incidence of adverse reactions is low. Objectives: The aim of the current study was to determine the diagnostic value of endobronchial ultrasonography with a guide sheath combined with virtual bronchoscopic biopsy (EBUS-GS-TBLB+VB) for PPL, and to find the factors that were correlated with greater diagnostic accuracy of EBUS-GS-TBLB. Patients and Methods: In this retrospective study, 87 patients with PPL were grouped according to different instrument-guided TBLB techniques, which included conventional TBLB, EBUS-GS-TBLB (E-TBLB), and EBUS-GS-TBLB+VB (E+V-TBLB). The diagnostic accuracy and duration of the operations were compared. Correlative factors were determined and any complications related to the operations were recorded. Results: The diagnostic accuracy of E+V-TBLB (16/20, 80%) and E-TBLB (22/29, 75.9%) were significantly better (P < 0.05) than that of TBLB (18/38, 47.4%), and the duration of the operation (minutes) was significantly shorter in E+V-TBLB (7.78 ± 2.0) than in E-TBLB (12.97 ± 3.4) (P = 0.018). We found that lesions with a diameter ≥ 2 cm (27/29, 93.1%) that were probe-penetrable (30/32, 93.5%), and with a computed tomography (CT) attenuation value >20 HU were related to higher diagnostic accuracy in EBUS-GS-TBLB. All the patients tolerated the TBLB operations well. Bleeding occurred in one patient from the TBLB group. There was no pneumothorax, hemoptysis, or other complications in the other groups. Conclusion: The diagnostic accuracy of EBUS-GS-TBLB was much greater than that of TBLB, and patients showed better tolerance to it. [ABSTRACT FROM AUTHOR]

Diagnostic bronchoscopy is a minimally invasive procedure that plays a crucial role in the diagnosis and management of various respiratory conditions. This paper explores the advancements in technology that have revolutionized the field and focuses on the new diagnostic procedures in bronchoscopy that have emerged in recent years. These innovative techniques have expanded the diagnostic capabilities of bronchoscopy, allowing for more accurate and comprehensive evaluation of respiratory conditions. This paper will also discuss the challenges in the diagnostic process with bronchoscope., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pápai-Székely, Grmela and Sárosi.)

Aspirations of foreign bodies are life-threatening among children and elderly patients requiring urgent medical assistance. The aim of the study is to present summarized results from various authors' studies to reveal VB's diagnostic abilities for suspected aspiration of a foreign body. VB has been shown to be a particularly useful non-invasive modality for the complex tracheobronchial tree assessment for suspected aspiration of a foreign body due to its high sensitivity, specificity and validity. MDCT VB with MPR allows accurate localization of the foreign body, but in secondary inflammatory changes and secretions it does not provide accurate information about the form and type of the finding. VB cannot replace FB ("gold standard") but successfully supports and complements it. MDCT could provide early diagnosis in cases of suspected aspiration of a foreign body in children and adults and avoid real bronchoscopy in patients with poor overall condition.

VB is a non-invasive technique and follow-up tool tolerant of most patients, requiring a precise method of diagnosis, especially in ruptures with the formation of high-grade stenoses for which FB is not applicable, as well as in children and elderly or severely ill patients. The study aims to track the technical parameters, key indicators, and criteria for optimizing the diagnostic capabilities of Virtual bronchoscopy (VB) in tracheal and bronchial ruptures. Optimization of the technical parameters of the scans taking into account the age of the patient, the weight, the size, the nature of the ruptures and the severity of the diagnosis; the application of appropriate criteria and parameters for the diagnosis and evaluation of the tracheobronchial tree, combined with the capabilities of modern equipment, guarantee the high reliability, sensitivity, and specificity of the VB method. [ABSTRACT FROM AUTHOR]

With the advent of lung cancer screening, and the increasingly frequent use of computed tomography (CT) scanning for investigating non-pulmonary pathology (for example CT coronary angiogram), the number of pulmonary nodules requiring further investigation has risen significantly. Most of these nodules are found in the lung periphery, which presents challenges to biopsy, and many centers rely on trans-thoracic needle biopsy performed under image guidance by radiologists. However, the desire to minimize complications is driving the development of increasingly accurate navigation bronchoscopy platforms, something that will be crucial in the new era of bronchoscopic therapeutics for lung cancer. This review describes these platforms, summarizes the current evidence for their use, and takes a look at future developments. [ABSTRACT FROM AUTHOR]

Traumatic injuries of major airways (trachea and main bronchus) are rare in medical practice but represent extremely life-threatening conditions. The study aims to present a summary of research findings on the diagnostic capabilities of Virtual bronchoscopy (VB) in ruptures of trachea and bronchi. There is very little research into the applicability of VB in Bulgaria. Still, the modern equipment for MDCT VB during the last years provides to use the VB in diagnostic practice and for scientific examinations. The method of VB is recognized as a reliable tool in diagnostic practice and the research of tracheal and bronchial ruptures. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is not only the most common tumor, but also the tumor of supreme incidence and death rate in all malignant tumors. Bronchoscopy has been widely used in the diagnosis of space occupying lung lesions, but the diagnostic rate of pulmonary peripheral lesions (PPL) is relatively low. The emergence of intra-airway ultrasound technology is a milestone for the development of respiratory endoscopy technology. The appearance of miniature lung ultrasound probe has greatly improved the accuracy of diagnosis of peripheral lung diseases, especially peripheral lung cancer. In recent years, guided sheath (GS) endobronchial ultrasonography with trans-bronchial lung biopsy (EBUS-TBLB) has been used to diagnose pulmonary peripheral lesions. The diagnostic rate is over 70%, and the incidence of adverse reactions is low. Objectives: The aim of the current study was to determine the diagnostic value of endobronchial ultrasonography with a guide sheath combined with virtual bronchoscopic biopsy (EBUS-GS-TBLB+VB) for PPL, and to find the factors that were correlated with greater diagnostic accuracy of EBUS-GS-TBLB. Patients and Methods: In this retrospective study, 87 patients with PPL were grouped according to different instrument-guided TBLB techniques, which included conventional TBLB, EBUS-GS-TBLB (E-TBLB), and EBUS-GS-TBLB+VB (E+V-TBLB). The diagnostic accuracy and duration of the operations were compared. Correlative factors were determined and any complications related to the operations were recorded. Results: The diagnostic accuracy of E+V-TBLB (16/20, 80%) and E-TBLB (22/29, 75.9%) were significantly better (P < 0.05) than that of TBLB (18/38, 47.4%), and the duration of the operation (minutes) was significantly shorter in E+V-TBLB (7.78±2.0) than in E-TBLB (12.97±3.4) (P = 0.018). We found that lesions with a diameter ≥ 2 cm (27/29, 93.1%) that were probe-penetrable (30/32, 93.5%), and with a computed tomography (CT) attenuation value > 20 HU were related to higher diagnostic accuracy in EBUS-GS-TBLB. All the patients tolerated the TBLB operations well. Bleeding occurred in one patient from the TBLB group. There was no pneumothorax, hemoptysis, or other complications in the other groups. Conclusion: The diagnostic accuracy of EBUS-GS-TBLB was much greater than that of TBLB, and patients showed better tolerance to it. [ABSTRACT FROM AUTHOR]

The relevance of the problem is related to the continued increase in the neoplastic processes, and at the same time also to the development and improvement of the endoscopic and CT equipment, and thus expanding the diagnostic capabilities. Purpose: The presented research examines the results of the study of a rare case of ruptured trachea as a result of cancer of the esophagus. Methods: Fiberoptic esophagoscopy (FOE) and CT of the chest followed by virtual bronchoscopy on a patient with a ruptured trachea, a 63 year-old man, were performed. Result: Performing MDCT with virtual bronchoscopy, according to this study, is crucial as the sole and complex methodology for the described case in connection with the finding of the trachea-oesophageal fistula and evaluation of the mediastinum and the pulmonary parenchyma. Conclusion: The VB is a successful method equally effective compared to the FB, to diagnose of advanced neoplastic processes.

Introduction: The introduction of a foreign body in the respiratory tract is a serious global problem requiring urgent medical assistance. Purpose: The aim of the study is to assess the applicability of the Virtual bronchoscopy with MDCT for patients (adults and children) with suspected foreign body. Methods: To all 9 patients Virtual bronchoscopy and Fiberoptic bronchoscopy were carried out. The studies were carried out with an optimized protocol. In order to compare the results of FB and VB the sensitivity and precision indicators were determined. Results: When comparing the results of the study of patients with suspected foreign body, both methods established 4 positive results each (44.45%). Conclusions: VB is particularly reliable and suitable for children and adults with poor general condition. The results of VB with MDCT could be used for early diagnosis of suspected foreign bodies.

Virtual bronchoscopy (VB) is 3-dimensional computer-generated technology, creating endobronchial images from spiral CT data. The study aims to present summarized results from researches of different foreign authors about the advantages of VB, the possibilities for its application and the effectiveness of its use in routine practice in the diagnosis of tumors of the trachea and bronchi. The three-dimensional model of the tracheobronchial tree allows assessment of the airways from inside. The majority of the examined studies relate to the diagnosis of new formations of the respiratory tract, preparation for surgery, assessment of the results of surgery, etc. VB is a noninvasive method allowing to examine the smallest bronchi. Relatively few studies in Bulgaria as well as the ensured during recent years new modern equipment for VB and MDCT, provide great opportunities for making VB examinations to study the effectiveness and its wide application in daily X-ray practice.

Introduction: Since the National Lung Screening Trial demonstrated the utility of low-dose computed tomography screening for lung cancer, the detection rate of ground-glass nodules (GGNs) has increased. Endobronchial ultrasound with a guide sheath (EBUS-GS) is widely performed to diagnose peripheral pulmonary lesions, but there are not enough reports on the predictive ability of EBUS-GS in diagnosing GGNs. The aim of this study is to investigate the predictive factors for a successful diagnostic bronchoscopy for GGNs. Methods: Consecutive patients who underwent diagnostic bronchoscopy for GGNs from September 2012 to January 2016 were enrolled in this study. From these, cases who underwent EBUS-GS were selected. They were reviewed and analyzed to examine the association between the diagnostic yield and the following clinical factors: lesion size, lobar position, location, consolidation-to-tumor ratio, visibility on X-ray, use of virtual bronchoscopy, bronchus sign, guide sheath size, and number of biopsies. Results: We enrolled 254 cases, of which 167 were diagnosed using EBUS-GS (65.7% diagnostic yield). Univariate analysis indicated that a positive bronchus sign was a significant factor for higher diagnostic yield (72.9% vs. 34.0%; P < 0.001). The use of virtual bronchoscopy also tended toward a higher yield, but the result was not significant (69.0% vs. 54.4%; P = 0.058). However, multivariate analysis indicated that both were significantly associated with higher diagnostic yield (P < 0.001, odds ratio [OR]: 5.35; P < 0.001, OR: 1.97, respectively). Conclusions: Our results suggest that a positive bronchus sign and the use of virtual bronchoscopy are positive predictive factors for successful diagnostic bronchoscopy of GGNs.

Objective: To evaluate the efficacy and safety of tranbronchial cryobiopsy ( TBCB) with 1.9-mm and 1.1-mm cryoprobes in patients with peripheral pulmonary lesions (PPLs)., Material and Methods: We analyzed 34 patients (mean age 60 years) with PPLs who underwent bronchoscopy with TBCB. Mean lesion size was 31.5 mm, upper lobe localization was predominant (47% of cases). CT signs of appropriate bronchus were identified in 79% (27/34) of cases. Manual branch tracking and virtual bronchoscopy (VB) were performed pre-procedurally, and radial endobronchial ultrasonography (rEBUS) was performed during bronchoscopy for accurate positioning of PPLs. TBCB was performed using 1.9-mm ( n =19) or 1.1-mm ( n =15) cryoprobes without fluoroscopic guidance. Incidence and severity of bleeding and pneumothorax were evaluated in all patients., Results: Total efficacy of TBCB was 76.5% (26/34): 78.9% (15/19) for 1.9-mm cryoprobe and 73.3% (11/15) for 1.1-mm cryoprobe ( p =0.702). Efficacy depended on the presence of CT signs of bronchus (presence - 94%, absence 14.3%, p <0.001) and PPL size (94% for PPL >30 mm and 58.8% for PPL <30 mm, p =0.016). Central probe position during rEBUS was associated with 94.7% diagnostic efficacy (18/19), adjacent probe position - 72.7% (8/11) ( p =0.088). Bleeding grade 3 (Nasville) occurred in 5.8% (2/34) of cases, and no pneumothorax was observed., Conclusion: TBCB is an effective and safe diagnostic method for PPLs.