Page 90 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED VIDEO SESSION
INORGANIC ENDOBRONCHIAL FOREIGN BODY EXTRACTION USING RIGID + FLEXIBLE BRONCHOSCOPY
Blanca De Vega Sanchez1,2, Carlos Disdier Vicente1, Marta Belver Blanco1
1 Interventional Pulmonology Division. Hospital Clinico Universitario Valladolid, Spain
2 Interventional Pulmonology SEPAR Emergent Group
VID04
Foreign body aspiration (FB) is a rare event in adult patients, with an estimated incidence of 0.2% of all bronchoscopies performed.The presence of chronic sedative medication, mental disorders, alcoholism, loss of consciousness, and dental or tracheostomy manipulation have been identified as risk factors for aspiration.
We present the case of a 77-year-old man with a psychiatric history (obsessive-compulsive disorder), referred to our center due to an intense cough of one week of evolution after accidental aspiration of inorganic CE (18 mm diameter glass marble) while handling it the buccal region. The patient was hemodynamically stable, eupneic, and with a baseline saturation of 94% (pulse oximetry) at the time of admission to the emergency room, with radiological location of the CE in the right main bronchus.
Intubation using a rigid bronchoscope was performed, visualizing the CE lodged in the intermediate bronchus, occluding almost all of its lumen. After several unsuccessful extraction attempts with wire basket-type endoscopic instruments (2.5mm diameter Roth net foreign body ®), due to the bronchial impaction of the CE, an Olympus® Fogarty balloon (11mm diameter, 4Fr, and maximum diameter 1.95mm) was placed distally to the CE to unlock the ball. However, after proximal displacement, the marble would reengage in the same location. Several attempts to imprison it between the distal end of the bronchoscope and the fogarty® balloon were unsuccessful.
Previous attempts produced a migration of the CE to the left main bronchus and after assessing the possibilities, the wire basket was introduced through the rigid bronchoscope through endoscopic vision of the flexible bronchoscope, and subsequent opening into the main bronchus right (anatomical subdivision of right upper lobe versus intermediate bronchus). Using fogarty ® balloon and flexible bronchoscope, the marble was mobilized from the left to the right tree and trapped in the net to be extracted en bloc with the rigid and flexible endoscope. Finally, the bronchial tree was endoscopically reviewed, observing edema and superficial laceration of the mucosa of the left lateral-posterior wall of the intermediate bronchus, the site of impaction of the CE. The patient could be extubated and discharged from the hospital was possible 24 hours after the procedure
In this case, the rigid bronchoscopy approach achieved complete extraction of the CE, avoiding the need for surgical intervention and the possible risks derived from it. It must have experienced medical staff allow to solve the possible complications derived from the procedure.
VID05
Introduction: Assessment of a pleural effusion can be diagnostically challenging. When after the initial assessment the etiology remains unclear, advanced diagnostic procedures might provide the required clues which are often evaluated in combination. We describe an interesting case of pleural effusion depicting the synergetic use of CT imaging, Chest ultrasound,Thoracoscopic Biopsies and Histopathology techniques.
Case Description: A 92 years old man, lifelong non-smoker, with no comorbidities or medications, presented with dyspnea on exertion and slight weight loss over last month. He denied asbestos exposure or pulmonary tuberculosis, or suspicious contact with TB patients. A chest radiograph revealed a right pleural effusion. A Thoracic ultrasound examination confirmed a complex pleural effusion with an impressive fibrin or sail swinging sign. The pleural fluid analysis disclosed a 100% lymphocytic exudate with normal glucose level, PH of 7.42, and total adenosine deaminase activity of 56 IU/L. The contrast-enhanced CT of the thorax revealed a moderate size pleural effusion without apparent pleural thickening or nodules, no enlargement of mediastinal lymph nodes, and no evidence of an underlying malignancy. Tuberculin skin test and QuantiFERON were both positive, suggesting a possible Tuberculosis Pleurisy despite negative pleural fluid ZN and PCR for M.Tuberculosis. Definite diagnosis required deep pleural biopsies of the characteristically affected pleura through medical thoracoscopy under local anesthesia. The diagnosis of tuberculosis pleurisy was established based on the microscopic examination of the parietal pleural that revealed numerous necrotic epithelioid granulomas with multinucleated giant cells. PCR for Mycobacterium Tuberculosis at the pleura tissue came up positive.
Conclusion: Tuberculosis pleurisy is seldom reported among elderly individuals. This case report highlights the utility of combining imaging, endoscopic and advanced histopathology modalities in the investigation and management of this condition.
PLEURAL EFFUSION AT 92!
Rajaa Alsaggaf, Katerina Bakiri, Nektarios Anagnostopoulos, Grigoris Stratakos
National and Kapodistrian University of Athens,“Sotiria” General Hospital, Athens, Greece
90 6th European Congress for Bronchology and Interventional Pulmonology