Bronchoscopy Cases Raj Kumar
INDEX
A
Absolute eosinophil count 50, 194
Acid-fast bacillus 50, 84, 142, 156, 169, 180, 194, 196, 199, 203, 227
ADA See Adenosine deaminase
Adenosine deaminase 84, 227
AEC See Absolute eosinophil count
AFB See Acid-fast bacillus
Air
bronchogram 29, 31
space opacification 29
Airflow limitation, mild 91, 117
Alveolar volume 84, 169, 227, 231
ANA See Antinuclear antibodies
Antinuclear antibodies 84, 102, 169, 194
Antitubercular
drugs 40, 42
treatment 2, 6, 12, 16, 20, 26, 30, 34, 38, 46, 50, 84, 102, 169, 194, 227, 231
Appetite, loss of 84, 102, 150, 170, 179, 200, 201, 222
Aspergillus 202
infection 202
ATT See Antitubercular treatment
B
Basal reticular shadows 88
Bilateral cavitating nodules 219, 220
Bilateral centrilobular nodules 80, 96, 141, 147, 157, 173, 177, 179, 188, 192, 230
Bilateral cysts 106
Bilateral ground glass
appearance 159, 165
opacities 112, 129, 135, 139
Bilateral interlobular septal thickening 57, 74, 82, 100, 133, 143, 144, 149, 151, 153, 155, 156
Bilateral lower zone reticulation 175
Bilateral miliary pattern 45
Bilateral nodular
opacities 76, 82, 161
shadows 116, 165, 228
Bilateral patchy
consolidation 27
ground glass opacity 94
Bilateral pleural effusion 33, 213
Bilateral reticulonodular shadow 170
Blood sugar, random 84, 169
Blood urea 3, 5, 7
Breathlessness 84, 102, 150, 156, 201, 220, 222
Bronchial aspirate 6, 8, 12, 14, 16, 18, 20, 22, 24, 26, 28, 29, 32, 34, 36, 38, 41, 43, 50, 53, 55, 58, 69, 72, 75, 79, 86, 95, 97, 99, 104, 111, 115, 136, 152, 158, 168, 171, 174, 180, 189, 193, 198, 222, 226
and needle 198
Bronchial epithelial cells 180
Bronchiolitis 229
Bronchoalveolar lavage 2, 41, 50, 64, 194, 231
cytology 10
Bronchoscopy 182
C
CAD See Coronary artery disease
Calcium 84
cANCA See Cytoplasmic anti-neutrophil cytoplasmic antibodies
Carbon monoxide, diffusion capacity for 84, 102, 169, 194, 227, 231
Carcinoid tumor 226
Cavitary lesion 161
CCP See Cyclic citrullinated peptide
Cellular bronchiolitis 229
Centrilobular nodules 25, 63, 90, 110, 129, 139, 190
Chest
auscultation 5, 61
pain 170, 179
Chronic interstitial inflammation 185
Colds, repeated 73
Connective tissue disease 102
Coronary artery disease 50, 84, 102, 169, 194, 231
Cough 87, 102, 105, 150, 200, 201, 220, 222
productive 12, 18, 73, 84, 214, 185
roductive 156
C-reactive protein 84
CRP See C-reactive protein
CTD See Connective tissue disease
Cyclic citrullinated peptide 84, 102, 169, 194
Cytoplasmic anti-neutrophil cytoplasmic antibodies 169, 227
D
Diabetes mellitus 50, 84, 102, 169, 194, 227, 231
Differential leukocyte count 50, 84, 102, 169, 194, 227, 231
Diffusion impairment
mild 168
impairment moderately 104
restriction with moderate 130
moderate 55, 69, 86, 89, 109, 162, 171, 176
restriction with moderate 121
restriction with severe 128
severe 124
Directly observed treatment short 169
DLC See Differential leukocyte count
DLCO Ses Diffusion capacity for carbon monoxide
DM See Diabetes mellitus
DOTS See Directly observed treatment short
Dry cough 65, 178
Dry eyes 170, 179
Dysphagia 170, 179
Dyspnea 73, 87, 105
E
EBB See Endobronchial biopsy
EBLB See Endobronchial lung biopsy
Endobronchial biopsy 4, 8, 14, 16, 20, 26, 50, 53, 55, 69, 86, 104, 111, 115, 168, 171, 174, 176
Endobronchial lung biopsy 36, 50, 84
Endobronchial mass 202, 210
biopsy 198
Exertional dyspnea 12, 185, 212
F
FET See Forced expiratory time
Fever 73, 84
Fiberoptic bronchoscopy 231
Fibrotic lesions 125
Fine needle aspiration cytology 50
FNAC See Fine needle aspiration cytology
FOB See Fiberoptic bronchoscopy
Forced expiratory time 84, 102, 169, 194, 231, 227
Forced vital capacity 84, 102, 169, 194, 227, 231
FVC See Forced vital capacity
G
Gastroesophageal reflux disease 169
GERD See Gastroesophageal reflux disease
Granulomatous inflammation 26, 38, 81, 189
Ground glass
appearance 118
opacities 96, 116, 123, 127, 133, 157, 167, 170, 173, 179, 192, 228, 230
H
Hemoglobin 3, 5, 7
Henoch–Schönlein purpura 194
Hilar lymph nodes 63
Hilar mass 199
Honey combing 133
HSP See Henoch–Schönlein purpura
HTN See Hypertension
Hypersensitivity
pneumonia 185, 187
pneumonitis 170, 172, 174, 176, 178, 180, 183, 189, 193
Hypertension 50, 84, 102, 169, 194, 227
I
IGE See Immunoglobulin E
IGG See Immunoglobulin G
ILD See Interstitial lung disease
ILD-IPF See Interstitial lung disease-idiopathic pulmonary fibrosis
Ill-defined granuloma 4
Immunoglobulin
E 50, 84
G 50
Inflammation, nonspecific 113, 148, 154
Interlobular septal thickening 61, 66, 167
Interseptal thickening 85
Interstitial inflammation, nonspecific 107
Interstitial lung disease 102
IPF 103, 105, 152, 169
NSIP 103, 109, 119, 124, 132, 158, 164
fibrotic 117, 122, 128, 130, 160, 166
scleroderma 87, 91, 93
Interstitial pneumonia 99
nonspecific 144, 154, 160, 162, 169, 194
Interstitial septal thickening 93, 94, 120, 137, 163
Intralobular septal thickening 66, 98
J
Joint pain 170, 179
L
Lactate dehydrogenase 84, 227
LDH See Lactate dehydrogenase
Left destroyed lung 43
Left lower lobe 25, 198, 201, 215
bronchus 202
cavity in 85
collapse 39
infiltrates 13
Left main bronchus 205
mass obstructing 216, 224
Left medial posterior segment 13
Left opaque hemithorax 197
Left pleural
effusion 37, 195
thickening 175
Left upper lobe 125, 215
apicoposterior segment of 21
bronchus 210, 217, 218
centrilobular nodules 9
collapse in 29, 209
mass lesion 223
opacity 37
Loculated effusion, right 215
Loss of weight 200
Lower lobe
centrilobular nodules 49
peripheral honeycombing in 103
right 31, 207
Lung
adenocarcinoma of 208, 210, 212, 214, 220
collapse, right-sided 213
small cell carcinoma of 204, 206, 224
squamous cell carcinoma of 196, 200
Lymph node
enlargement
paratracheal 19
pretracheal 19
subaortic 181
subcarinal 106, 181
Lymphadenopathy 3, 100, 151
Lymphocytic predominantly 185
M
Main bronchus, right 221
Malignancy 195
Mediastinal lymphadenopathy 131
Mediastinum, shift of 195
Medical Research Council 50, 84, 102, 169, 194, 227, 231
mMRC See Modified Medical Research Council
Moderately severe
impairment 89
restriction 111, 162
Multiple bilateral
hilar lymphadenopathy 51
mediastinal lymphadenopathy 51, 68, 120
miliary nodules 5
Multiple nodules 59
right middle zone 54
Multiple small centrilobular nodules 167
Mycobacterium 10, 22, 24
and fungi 58, 67, 69, 89, 166, 214
N
Nodular opacity 118, 123
Nodule 11
Noncaseating granuloma 56, 73, 77
Non-small cell
carcinoma 222
lung cancer 216, 218
NSIP See Nonspecific interstitial pneumonia
O
Obstruction, moderate 81
Opaque hemithorax, left sided 195
P
pANCA See Perinuclear anti-neutrophil cytoplasmic antibodies
Para-aortic and hilar lymphadenopathy 15
Para-aortic lymph node 106, 181
Paratracheal lymph node
enlargement, right 76
right 78
Paratracheal lymphadenopathy 71, 73, 133, 178
right 7, 11, 125
Paroxysmal nocturnal dyspnea 50, 169, 184, 227
Pedal edema 184
Peribronchial beading 51
Peribronchiolar fibrosis 168
Peribronchiolitis 231
Peribronchovascular thickening 74, 114, 120, 131
Perinuclear anti-neutrophil cytoplasmic antibodies 169, 227
PFT See Pulmonary function test
Pleural effusion
left sided 209
right 47, 78, 80, 221
Pleural nodularity 68, 149
PND See Paroxysmal nocturnal dyspnea
Pooling mucoid secretion 55
Postbronchoscopy sputum 24
Pretracheal lymphadenopathy 133
Progressive exertional dyspnea 65, 126, 200, 204, 214
Pulmonary function 99, 136, 138, 142, 144, 146, 193
test 52, 55, 58, 60, 64, 69, 72, 75, 77, 81, 86, 93, 97, 101, 107, 115, 132, 140, 148, 166, 171, 174, 176, 178, 180, 182, 185, 191, 194, 226, 229
Pulmonary tuberculosis 1, 2, 6, 8, 12, 16, 20, 24, 28, 32, 36, 38, 42, 46, 50, 220
R
RA See Rheumatoid arthritis
Raynaud phenomenon 170, 179
RB-ILD See Respiratory bronchiolitis-interstitial lung disease
RBS See Random blood sugar
Residual volume 84, 102, 169, 194, 227, 231
Respiratory bronchiolitis-interstitial lung disease 169
Reticulonodular shadows 112
Rheumatoid arthritis 84, 102, 169, 194, 227
interstitial lung disease 99, 102
Right apical segment, consolidation of 17
Right bronchus intermedius, irregular thickening of 222
Right lower lobe
nodule in 90
right apical segment of 13
Right main bronchus, mass obstructing 226
Right upper lobe 7, 23, 41, 125
anterior segment of 212
centrilobular nodules 1
consolidation 35
honey combing in 135
mass lesion in 211, 225
RV See Residual volume
S
S. ACE See Serum angiotensin-converting enzyme
S. IgE See Serum immunoglobulin E 194
Sarcoidosis 51, 53, 56, 58, 70, 75, 79, 81
Secondary carina widened, widening of 220
Septal and pleural irregularity 63
Septal blood 116
Septal thickening 110, 123
Serum angiotensin-converting enzyme 50, 84, 102, 169, 194
Six minute walking test 84, 102, 169, 194
Skin prick test 169, 194
Small cell carcinoma 206, 224
Small parenchymal nodularity 109
Soft tissue density 201
Spirometry, normal 168
SPT See Skin prick test
Squamous cell carcinoma 198, 199
Steroids 81, 87, 93, 122, 136, 146, 150, 166
Subcarinal lymphadenopathy 177, 178
Subpleural nodules 57
T
TB See Tuberculosis
TBLB See Transbronchial lung biopsy
TBNA See Transbronchial needle aspiration
TLC See Total leukocyte count
Total leukocyte count 50, 84, 102, 169, 194, 227, 231
Traction bronchiectasis 63, 88, 92
Transbronchial lung biopsy 2, 29, 38, 41, 50, 53, 58, 64, 75, 79, 86, 91, 97, 104, 111, 117, 136, 152, 168, 174, 180, 183, 193, 222, 229, 231
Transbronchial needle aspiration 4, 50, 53, 55, 64, 69, 84, 227
Tree-in-bud appearance 7, 9, 15, 25, 159, 165
Tuberculosis 50, 84, 169, 194, 227, 231
V
VA See Alveolar volume
W
Wheeze 213
×
Chapter Notes

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BRONCHOSCOPY CASES
BRONCHOSCOPY CASES
Raj Kumar MD (Pul. Med.) FAMS FIAMS MNASc MNAMS FICAAI FICS FNCCP(I) MAAAAI MACAAI Director Vallabhbhai Patel Chest Institute University of Delhi New Delhi, India Professor and Head, Department of Pulmonary Medicine; Head, National Centre of Respiratory Allergy, Asthma and Immunology (NCRAAI); Vallabhbhai Patel Chest Institute University of Delhi New Delhi, India Coordinator National Tobacco Quitline Services (NTQLS), Vallabhbhai Patel Chest Institute New Delhi, India Chairman World University Services (WUS) Health Centers University of Delhi New Delhi, India Foreword Digambar Behera Padma Awardee
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Bronchoscopy Cases / Raj Kumar
First Edition: 2021
9789352702770
Printed at
My teacher for their guidance, wisdom and inspiration
My parents, wife and children for their love and patience
FOREWORD
The book “Bronchoscopy Cases” is the collection of dynamic examples of bronchoscopy cases with final diagnosis divided in 7 sections with 108 cases such as Pulmonary Tuberculosis, Sarcoidosis, ILD-CTD, ILD-IPF/NSIP, Hypersensitivity Pneumonitis, Malignancy, and other Miscellaneous cases. Patient's clinical profile, history, microscopic analysis, pulmonary function test, and overall case summary are well elaborated. Keen practical examination by the author and their presentation throughout the book with rich pictorial illustration of chest radiographic images is the adorable section of the book. In this book, this is all collection of bronchoscopy cases by the author collected over years has been explained in very illustrated manners.
Professor Raj Kumar is working as the Director, Vallabhbhai Patel Chest Institute (VPCI), a premier research institute funded by Ministry of Health and family Welfare, Government of India and maintained by the University of Delhi. He is a renowned pulmonary physician, with nearly three decades of illustrious teaching experience to the students in the area of DM/MD/DTCD (Pulmonary Medicine)/PhD. He has contributed vastly to the research activities related to chest and allied diseases, with proven excellence in quality patient care. Professor Raj Kumar has vast administrative experience too.
Professor Raj Kumar's contribution has been acclaimed widely all over the country/world in the field of Allergic Bronchopulmonary Aspergillosis, Food Allergy, Respiratory Allergy, Allergy Testing and Immunotherapy, Indoor Air Pollution and Health, Smoking Cessation, Bronchoscopy, Biomass fuel use and their association with common respiratory diseases like Asthma, Lung Cancer, COPD, and Tuberculosis and Multidrug-resistant Tuberculosis (MDR-TB).
Professor Raj Kumar has 421 publications in peer reviewed National and International periodicals. He has authored IB books and 20 abstract books so far. He has supervised about 33 research thesis also. Professor Raj Kumar is holding various positions in National and International Academic and Scientific Societies/Associations and has been recipient of various National and International awards/honors.
I hope this book will enlighten and educate the medical fraternity to lead a crusade against these dreaded diseases. This book is an excellent resource material for medical professionals in training and also deserves a place in the library of every medical health institution.
Digambar Behera MD (Med) FCCP FAMS FNCCP FICP FICA FAPSR FICS MNAMS (Med) Dip.NBE (Resp.Med.)
PADMA AWARDEE
Professor and Ex-HOD
Ex-Dean (Research)
Ex-Chairman of Medical Departments (Group B)
Department of Pulmonary Medicine
(WHO Collaborating Centre for Research and Capacity Building in Chronic Respiratory Diseases)
Postgraduate Institute of Medical Education and Research, Chandigarh, India
Chairman, National Task Force (NTEP/RNTCP)
Ex-OSD, AIIMS, Raebareli, Uttar Pradesh, India
PREFACE
It was the year 1887 when the first bronchoscopy was performed by a German laryngologist Gustav Killian at Freiburg, Germany. Since then, bronchoscopy has evolved to become an integral tool for pulmonologists for both diagnostic and therapeutic purposes. Originally a tool for examining and sampling the central endobronchial tree has broadened considerably to include new techniques for a number of conditions. The demand for experts in bronchoscopy is rising sharply and new interventions in the field of bronchoscopy is increasing day by day.
This book “Bronchoscopy Cases” contains dynamic examples of bronchoscopy cases. All these patients' bronchoscopy has been done by me during these years and has been illustrated from history to diagnosis of respiratory disorders using a bronchoscope Series of case studies covering different pulmonary conditions. Each topic presented in a step by step approach highly illustrated with more than 900 radiographic images and diagrams. The book is written in simple and lucid language to gauge the reader easily understood the techniques in effective way and divided into 7 sections with 108 cases, each section covers a different pulmonary disorder including Pulmonary Tuberculosis, Sarcoidosis, ILD-CTD, ILD-IPF/NSIP, Hypersensitivity Pneumonitis, Malignancy, and other Miscellaneous cases. The scientific manner of the book emphasizing each case starting with the history of the patient and how the diagnosis has been made and ends up with management. Patient's clinical profile, past history, microscopic analysis, and case summary are the pearls of each section. Moreover the book is illustrated in full color from the authors’ extensive library of images accompanied by detailed explanatory text providing a comprehensive image library from one of the most rapidly expanding areas of respiratory medicine.
Through this book, I hope the readers will find the information thought provoking, practical, and readily applicable in their clinical practice.
Raj Kumar
ABOUT THE AUTHOR
Raj Kumar MD FAMS FIAMS MNASc MNAMS FICAAI FICS FNCCP(I), currently, is the Director of Vallabhbhai Patel Chest Institute, a premier postgraduate medical institute devoted to research, teaching and patient care. He is also the Head, Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute; Head-National Centre of Respiratory Allergy, Asthma and Immunology, Coordinator of National Tobacco Quitline Services, and Former Head of Department of Pulmonary Medicine, Faculty of Medical Sciences, University of Delhi for two consecutive terms. He is also the chairman of WUS Health Centres, University of Delhi. He is the member of the pulmonary specialty Committee of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana.
Dr Kumar is an acclaimed Respiratory Clinician par excellence, teacher and researcher of National and International repute, with exceptional achievements and contributions in the field of Medicine (Respiratory) and has served immensely to the public at large and the poor in particular. He is the Fellow of major scientific organisations in the field of Pulmonary Medicine, such as National Academy of Medical Sciences, International Medical Sciences Academy, National College of Chest Physicians of India (NCCP-I), Indian Chest Society, Indian College of Allergy, Asthma and Immunology. He was the Vice President of Indian Association of Allergy, Asthma and Immunology and is Secretary of Society of Tobacco Control, Treasurer of South Asia Association of Allergy, Asthma and Immunology, Joint Secretary of South Asia Thoracic Society. He is the member of more than 25 National and International scientific organisations including National Science Academy (NASI) and National Academy of Medical Sciences.
He has over 421 publications including research papers with 2,179 Citations, H-index of 26, i10-index of 46. Author and editor of 18 books, 20 abstract books, and newsletters. He also supervised 37 research thesis. He is Editor-in-Chief, Indian Journal of Chest Diseases and Allied Sciences, Assistant Editor, Indian Journal of Allergy, Asthma and Immunology. He is an Editorial Board Members of nearly 15 journals and also reviewer in over 10 scientific journals of National and International repute. He is also Principal investigator of many research projects funded by various government organisations, viz. WHO, DST, ICMR, UGC.
His outstanding work has been recognized in the form of 21 National and 7 International awards. To name a few-World No Tobacco Day Award- 2019 by World Health Organization (WHO) for outstanding work in Tobacco Control; David A and Julie A Steven Scholar Award in 2006 Greece, France. He has been instrumental in organising 134 Conferences/Seminars/ Workshops at National and International level such as SAAAACI in 2011, NAPCON-2011.
He has visited many country for academic purpose, to name few—Korea, France, Thailand, Greece, Sweden, Singapore, Bangladesh, Italy, USA, Japan, China, Sri Lanka, Germany, Nepal, Malaysia, etc.
Dr Kumar is in the Medical Profession for over the past 25 years and did his schooling from Ramakrishna Mission Vidyapith, Deoghar and The Mother's International School, New Delhi. He did his MBBS from Maulana Azad Medical College and associated LNJP and GB Pant Hospitals, New Delhi; and MD from Vallabhbhai Patel Chest Institute, University of Delhi.
ACKNOWLEDGEMENTS
I express my sincere and heartfelt gratitude to all my patients who willingly agreed and represented their current medical conditions and deliberately participated with patience in all investigations who gave me experience in the field of bronchoscopy.
I am extremely grateful to my postgraduate students and residents (Dr Mandeep Singh, Dr Mohd Yousoof Dar, Dr Supreet Batra, Dr Anshu Priya, Dr Muhammed Noufal Poongadan, Dr Viswesvaran B, Dr Nipun Malhotra, Dr Gulvir Singh, Dr Arya Gopi, Dr Ambuj Kumar, Dr Neha Kaushik, Dr Lovika Lakhtakia, Dr Naveen Vennilavan RA) for completing the cases and generating much data that can be incorporated in making the sections in the book more evidence based.
I am very grateful to our Department team—Mr Manoj Kumar, Mrs Indu Bisht, Mr Kamal Singh, Mr Anil Mavi, Ms Sanjana Prem, Mr Dherresh, Ms Priyanka Shah, Mr Anil Kumar, Mr Kuldeep, Mr Devesh and Mr Arvind for hard working support in managing and compiling in the preparation of this book. All team members' contribution is invaluable in this work.
To express my gratitude to my wife Dr Neelima Raj for being a pillar of strength for me all the time. A special and loving thanks to my daughter and Son - Ms Sukriti Raj and Mr Aditya Raj for their love, affection and immense tolerance towards me even during times when they felt neglected.
I am especially thankful to all the colleagues of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi for helping us in every way possible to bring out this book.