Archive for the ‘Bronchoscopy’ Category


Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: ConclusionWhether further evaluation to detect these cancers should be undertaken routinely, and if so, what form it should take, is not yet clear. Repeat bronchoscopy failed to detect the two cancers which appear to have been missed at initial bronchoscopy in our series, presumably because of their peripheral location. Serial chest roentgenograms may be worthwhile, but their value in screening other high-risk populations for lung cancer remains unproven. Computerized tomography can occasionally detect cancers missed by chest roentgenogram and bronchoscopy, as shown in our series and others, but its overall impact may be too small to justify routine use. Thus, while some form of continued observation of the high-risk patient with hemoptysis and a negative bronchoscopic examination appears warranted, management must be individualized pending further study. Reading here
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  • Differences between patients with and without cancer in other clinical features shown in Table 3 were in the direction expected but were not statistically significant, possibly due to the small number of patients with cancer. Patients with cancer tended to have greater duration, but not volume, of hemoptysis, consistent with the results of other studies.2* Chronic obstructive pulmonary disease, recently shown to be an independent risk factor for lung cancer, was more common in cancer patients. In addition, cancer patients were somewhat more likely to have weight loss and hoarseness and less likely to have evidence of acute bronchitis than patients without cancer. so
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  • Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: DiscussionApart from the diagnosis of cancer, fiberoptic bronchoscopy contributed little to the evaluation of hemoptysis. Except for the two cases of tracheitis and some cases of bronchitis, the non-cancer diagnoses listed in Table 2 were based on clinical presentation rather than on bronchoscopic findings. With regard to bronchitis, only 26 of 54 patients ultimately given this diagnosis had mucosal inflammation seen at bronchoscopy, and nine patients who had such inflammation received diagnoses other than bronchitis.
    There were no complications of fiberoptic bronchoscopy reported in this series. fully
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  • Cardiomegaly might be expected to have a similar effect, particularly if the hilar regions were obscured. However, the cardiomegaly which occurred in our patients tended to be mild and was not associated with an increased likelihood of cancer (present in one patient with cancer who also had tortuous aorta, and in ten patients without cancer).
    Four of the five bronchogenic carcinomas appeared to be surgically resectable. Three of these were apparently very early diagnoses; two were described as polyps and one as a patch of elevated mucosa. In two of the four cases, resection was not undertaken because of the patients poor medical condition. Follow-up information was available for one of the two surgically treated patients. This patient was cancer-free at three years. (more…)

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  • Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest Roentgenograms: ResultsThere were 58 current smokers, 41 ex-smokers, and seven patients who had never smoked. Chest roentgenogram findings are shown in Table 1. About one third of the patients had a chest roentgenogram read as normal, with the remainder having the abnormalities shown. Patients with normal chest roentgenograms were significantly younger than patients with nonlocalizing abnormalities (mean age, 58.9 years vs 62.5 years, p<0.05).
    Table 2 shows the final diagnoses of the cause of hemoptysis. Six patients (5.7 percent) had cancer diagnosed at bronchoscopy; five had non-small cell bronchogenic carcinomas and one had a pulmonary metastasis of a previously undiagnosed renal cell carcinoma. (more…)

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  • The reports of all bronchoscopic examinations done at the Minneapolis Veterans Administration Medical Center hospital and clinic from Jan 1, 1979, through Dec 31, 1987, were reviewed. Charts were obtained and reviewed on all potentially eligible patients. Medical histories and final diagnoses were obtained from the attending physicians’ notes, and chest roentgenograms were classified according to the radiologists report. Eligible patients included men more than 40 years old who underwent fiberoptic bronchoscopy for hemoptysis of any amount with a nonsuspicious chest roentgenogram, defined as one without definite mass, infiltrate (including diffuse interstitial disease), cavity, lobar atelectasis, or large pleural reaction or effusion. This definition is similar to that used in earlier studies. Patients were excluded if they had a previous history of lung cancer. (more…)

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  • Bronchoscopy to Evaluate Hemoptysis in Older Men with Nonsuspicious Chest RoentgenogramsTen to 30 percent of all fiberoptic bronchoscopy examinations are performed in patients with hemoptysis, primarily to exclude cancer as a cause. A thorough evaluation is clearly indicated for a patient whose chest roentgenogram shows localizing findings suspicious of lung cancer. However, there has been debate concerning whether the risk of cancer is high enough to warrant bronchoscopy in patients with hemoptysis and a nonsuspicious chest roentgenogram, ie, one which is either normal or shows only nonlocalizing abnormalities. After reviewing the literature on this topic, Jackson et al concluded that the risk of cancer was negligible in patients less than 40 years old but that additional data were needed to determine which patients more than 40 years old required bronchoscopy. more (more…)

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