Practical guide to diagnosis and treatment of lung diseases using fiberoptic bronchoscopy
Presents numerous cases seen by the author
Case studies of benign and malignant pulmonary diseases enhance learning
Includes more than 450 X-Rays, CT images and bronchoscopic pictures

1. History of Bronchoscopy................................................................................................................................1
2. Normal Bronchial Anatomy and Nomenclature...........................................................................................2
Upper airway 2
Lower airway 3
Nomenclature of the tracheobronchial tree 6
Endoscopic visualization 10
Categorization of bronchoscopic findings 10
3. Abnormal Patterns of Bronchial Anatomy..................................................................................................19
Anomalies of bronchus 19
4. Machine and Instrumentation......................................................................................................................22
Flexible fiberoptic bronchoscope 22
Light source 23
Fiberoptic bronchoscope accessories 23
Bronchoscopy suite 26
Mobile or portable bronchoscopy unit 26
5. Cleaning, Disinfection and Sterilization of Fiberoptic Bronchoscopes and Other Accessories..............27
Care of bronchoscopes 27
6. Indications and Contraindications for Fiberoptic Bronchoscopy.............................................................29
Diagnostics 29
Therapeutic indications 30
Contraindications 30
7. Prerequisites for Performing Bronchoscopy............................................................................................... 32
8. Topical Anesthesia..........................................................................................................................................33
local anesthetics 33
Techniques for topical anesthesia 34
General anesthesia 36
9. Fiberoptic Bronchoscopy Procedure ...........................................................................................................37.
Procedure for fiberoptic bronchoscopy 37
10. Specimen Collection.......................................................................................................................................42
Brush biopsy 42
Bronchial washing 43
Endobronchial forceps biopsy 43
Transbronchial needle aspiration 44
Bronchoalveolar lavage 45
Transbronchial lung biopsy 47
Biopsy from peripheral mass lesions 49
Contents
xii Atlas of Fiberoptic Bronchoscopy
11. Staging of Bronchogenic Carcinoma by Bronchoscopy.............................................................................51
Staging of bronchogenic carcinoma 51
12. Complications.................................................................................................................................................54
Premedication 54
Local anesthesia 54
Hypoxia 54
Hypercarbia 55
Bronchospasm 55
Hemodynamic effects of bronchoscopy 55
Cardiac arrhythmias 55
Infectious complications 56
Other complications 56
13. Bronchoscopy-induced Hemorrhage............................................................................................................59
Predisposing factors 59
Treatment of bronchoscopy-induced hemorrhage 60
Prevention of bronchoscopy-induced hemorrhage 61
14. Pediatric Bronchoscopy.................................................................................................................................63
Anatomical considerations 63
15. Advances in Fiberoptic Bronchoscopy.........................................................................................................66
Use of laser in bronchoscopy 66
Endobronchial electrocautery 66
Argon plasma coagulation 67
Cryotherapy for endobronchial lesions 67
Endobronchial brachytherapy 67
Photodynamic therapy 68
Tracheobronchial stenting 68
Autofluorescence bronchoscopy 68
Indications for fluorescence endoscopy 69
Endobronchial ultrasound 69
16. Case Reports Bronchoscopic Findings in Benign Pulmonary Diseases.................................................71
Case 1: Endobronchial polyp in a 25-year-old female 71
Case 2: Bronchial carcinoid in a 22-year-old female 71
Case 3: Carcinoid tumor in a 26-year-old male 71
Case 4: Ruptured hydatid cyst in a 31-year-old male 74
Case 5: Sarcoidosis in a 45-year-old male 74
Case 6: Sarcoidosis in a 38-year-old female 74
Case 7: Lympho tracheal fistula in a 30-year-old male 77
Case 8: Endobronchial tuberculosis in a 30-year-old female 79
Case 9: Endobronchial tuberculosis in a 26-year-old female 79
Case 10: Endobronchial tuberculosis in a 44-year-old female 82
Case 11: Endobronchial tuberculosis in a 44-year-old male 82
Case 12: Tuberculous endobronchial sinus in a 21-year-old male 83
Case 13: Chronic bronchitis in a 50-year-old male 83
Case 14: Bronchiectasis in a 30-year-old male 86
Case 15: Bronchiectasis in a 50-year-old male 86
17. Case Reports Bronchoscopic Findings in Malignant Pulmonary Diseases...........................................88
Case 16: Squamous cell carcinoma in a 51-year-old male 88
Case 17: Squamous cell carcinoma in a 53-year-old male 88
Contents xiii
Case 18: Squamous cell carcinoma in a 58-year-old male 88
Case 19: Squamous cell carcinoma in a 71-year-old male 90
Case 20: Squamous cell carcinoma in a 52-year-old male 90
Case 21: Squamous cell carcinoma in a 60-year-old male 91
Case 22: Squamous cell carcinoma in a 50-year-old male 91
Case 23: Squamous cell carcinoma in a 50-year-old male 93
Case 24: Squamous cell carcinoma in a 50-year-old male 93
Case 25: Squamous cell carcinoma in a 45-year-old female 93
Case 26: Squamous cell carcinoma in a 56-year-old male 93
Case 27: Squamous cell carcinoma in a 53-year-old male 97
Case 28: Squamous cell carcinoma in a 65-year-old male 97
Case 29: Squamous cell carcinoma in a 55-year-old male 97
Case 30: Squamous cell carcinoma in a 55-year-old male 97
Case 31: Adenocarcinoma in a 53-year-old male 101
Case 32: Squamous cell carcinoma in a 47-year-old male 101
Case 33: Squamous cell carcinoma in a 58-year-old male 101
Case 34: Adenocarcinoma in a 40-year-old male 101
Case 35: Squamous cell carcinoma in a 60-year-old male 107
Case 36: Large cell carcinoma in a 70-year-old male 107
Case 37: Adenocarcinoma in a 65-year-old female 109
Case 38: Squamous cell carcinoma in a 55-year-old male 109
Case 39: Small cell carcinoma in a 53-year-old male 109
Case 40: Adenocarcinoma in a 45-year-old female 109
Case 41: Large cell carcinoma in a 45-year-old male 112
Case 42: Squamous cell carcinoma in a 61-year-old female 112
Case 43: Adenosquamous cell carcinoma in a 40-year-old male 112
Case 44: Squamous cell carcinoma in a 71-year-old female 112
Case 45: Squamous cell carcinoma in a 50-year-old male 116
Case 46: Large cell carcinoma in a 56-year-old male 116
Case 47: Squamous cell carcinoma in a 38-year-old male 116
Case 48: Squamous cell carcinoma in a 53-year-old female 117
Case 49: Squamous cell carcinoma in a 45-year-old male 117
Case 50: Squamous cell carcinoma in a 60-year-old male 117
Case 51: Large cell carcinoma in a 70-year-old male 117
Case 52: Squamous cell carcinoma in a 55-year-old male 122
Case 53: Bronchioloalveolar carcinoma in a 50-year-old male 122
Case 54: Squamous cell carcinoma in a 52-year-old male 122
Case 55: Small cell carcinoma in a 70-year male 122
Case 56: Small cell carcinoma in a 51-year-old male 122
Case 57: Small cell carcinoma in a 56-year-old male 123
Case 58: Squamous cell carcinoma in a 65-year-old male 128
Case 59: Squamous cell carcinoma in a 48-year-old male 128
Case 60: Squamous cell carcinoma in a 40-year-old male 130
Case 61: Squamous cell carcinoma
with superior vena cava syndrome in a 61-year-old male 132
Case 62: Squamous cell carcinoma in a 65-year-old male 132
Case 63: Tracheoesophageal fistula by squamous cell carcinoma esophagus in a 48-year-old male 132
Case 64: Undifferentiated carcinoma in a 70-year-old female 136
Index.......................................................................................................................................................................139