Sushma Dugad ¹, Saurabh Ambadekar ¹, Anand Singh ¹

Affiliations
1 Department of TB Chest, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN

Abstract

A 15 year old male was diagnosed to have central nervous system (cns) tuberculosis with ataxia. After starting him on conventional anti tuberculous treatment he deteriorated both clinically and radiologically. On investigation the diagnosis of drug resistant tuberculosis was ruled out and corticosteroid treatment was added. Eventually patient improved symptomatically and had good weight gain.

Keywords

Brain, Paradoxical reaction, Tuberculoma

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B. K. Mutha ¹, Sushma Duggad ¹, Saurabh Ambadekar ¹, Anand Singh ¹

Affiliations
1 Department of TB & Chest, Dr. Vasantrao Pawar Medical College Hospital & Research Centre Nashik, IN

Abstract

Introduction: Lung cancer may manifest in various ways. It may have typical symptoms such as weight loss, cough, heamoptysis and can be confused with pneumonia or it may manifest as a part of paraneoplastic syndrome. Occasionally it may be detected incidentally during evaluation for other medical illness. The early detection rate of lung cancer is rising due to cancer screening programmes, improvement in resolution of Computerised tomography scanners and also refinements in bronchosocpy techniques such as endobrochial ultrasound and electromagnetic navigation, fluoroscopy guidance and virtual bronchoscopy. The aim of this study was to correlate bronchoscopic findings with clinicoradiological profile of patients with suspected lung cancer visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a prospective study, conducted in a tertiary care medical college hospital over a period of 2 years. Patients were recruited from department of pulmonary medicine and referred cases from other departments were also included. Results: Complete data records from 52 patients were available for statistical analysis. Maximum numbers of patients were in age group 41-60. All bronchoscopies were done under local anesthesia and short conscious sedation. Majority of bronchoscopies were done in males. There were no fatal complications. Biopsy of visible growth was the most useful diagnostic tool followed by bronchoalveolar fluid. Squamous cell carcinoma was the most frequent diagnosis. Conclusion: Bronchoscopy is an excellent tool to evaluate lung carcinoma and multimodality approach is always helpful. Experience of bronchoscopist is crucial and accuracy of procedure increase with experience. Incidence of adenocarcinoma is increasing in India but squamous cell carcinoma remains most frequent lung cancer. Transbronchial lung biopsy, Transbronchial needle aspiration and brush biopsy, brochoalveolar fluid aspiration are helpful tools. However the yield can be enhanced by using Endo bronchial ultrasound (ebus), fluoroscopic guidance and electromagnetic navigation, virtual brochoscopy. There is good correlation between clinicoradiological and bronchoscpoic diagnosis and early diagnosis of lung malignancy will help improve survival and quality of life of patients.

Keywords

Bronchoscopy, Clinicoradiological, Correlation.

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Gauri Kulkarni ¹, Saurabh Ambadekar ¹

Affiliations
1 Department of Pulmonary Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, IN

Abstract

Introduction: Bronchoscopy is a procedure to visualize the tracheobronchial tree. There are three types of Bronchoscopy, rigid, flexible, and virtual Bronchoscopy. Rigid bronchoscopy visualizes the proximal airways. Flexible bronchoscopy is the most common type of bronchoscopy. It visualizes the trachea, proximal airways, and segmental airways up to the third generation of branching and can be used to sample and treat lesions in those airways. Flexible bronchoscopy is generally performed in a procedure room with conscious sedation. Aims and Objectives: To study the bronchoscopic findings in patients undergoing fiberoptic bronchoscopy. To study clinical and radiological profile of patients undergoing fiberoptic bronchoscopy. To correlate the bronchoscopic findings with clinical and radiological profile of patients undergoing fiberoptic bronchoscopy. Methodology: Present study was conducted in the department of Respiratory Medicine of a Medical College and tertiary health centre. A total of 72 patients were included in this study after satisfying inclusion and exclusion criteria. The cases were recruited from the department of Respiratory and the referred cases from other department were also included. Written informed consent was taken from all the patients after explaining complications occurring during and after bronchoscopy. Procedure was done under local anesthesia. Information regarding clinical features and radiological findings were noted in predesigned proforma. Results: In this study 72 patients underwent fiberoptic bronchoscopy. Procedure was done under local anesthesia in all these patients. All these were diagnostic bronchoscopies. The bronchoscopy was done more in male (68.05%) as compared to females (31.94%). Consolidation (43.06%) was most common radiological finding followed by meditational mass lesion (26.39%). The most common finding on bronchoscopy was growth (25%) followed by secretions (22.22%). However in 27.78% patients no bronchoscopic finding was seen; these were patients with subcarinal lymph node, some cases of pneumonias, some cases of bronchiectasis. In those cases where no finding was seen bronchoalveolar lavage was taken. BAL (68 cases) was the most common procedure done, second most common was lung biopsy of the visible growth (21) However biopsy of the visible growth was more accurate with the accuracy rate of 76.91% followed by trans bronchial lung biopsy of the suspected lesion. Bronchoscopy was conclusive to give final diagnosis in 56 out of 72 cases. There was positive correlation between clinicoradiological diagnosis and bronchoscopic diagnosis. In 59.72% cases there was positive correlation between bronchoscopy and clinicoradiological findings.consolidation (43.06%) was most common radiological finding followed by meditational mass lesion (26.39%). Conclusions: Bronchoscopy is an excellent tool for the diagnosis of lung diseases, Radiological and clinical evaluation is very important prior to the bronchoscopy. There is a correlation between clinicoradiological and bronchoscopic diagnosis. A multimodality approach for the diagnosis is always helpful.

Keywords

Bronchoscopy, Clinical, Radiological.

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