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Case Reports
. 2024 Sep 16;12(9):e70026.
doi: 10.1002/rcr2.70026. eCollection 2024 Sep.

Combining biopsy needle and virtual bronchoscopy for tuberculosis-induced complete bronchial blockage

Yoshio Nakano  1 , Norio Okamoto  1 , Yuri Enomoto  1 , Iwao Gohma  1 , Hiroyuki Hukuda  2 , Yoko Yamamoto  2 , Naoki Ikeda  2
Affiliations
Case Reports

Combining biopsy needle and virtual bronchoscopy for tuberculosis-induced complete bronchial blockage

Yoshio Nakano et al. Respirol Case Rep. .

Abstract

Endobronchial tuberculosis (EBTB) presents significant clinical challenges, particularly when complete bronchial obstruction occurs. In this case, a young woman with right main bronchus occlusion due to tuberculosis (TB) was treated using a novel approach. Instead of using a traditional rigid bronchoscope, a flexible approach was adopted. Under precise fluoroscopic guidance, a 21-gauge transbronchial aspiration needle was used to puncture the obstruction, allowing passage of the guidewire and subsequent balloon dilation. The use of virtual bronchoscopy, developed using computed tomography scans, ensures safe navigation around critical vascular structures. Postoperatively, the patient showed significant symptomatic improvement without complications. This innovative approach not only demonstrates the efficacy and safety of using biopsy needles and virtual bronchoscopy for managing complete bronchial obstructions in EBTB but also opens the door for future innovative solutions in such complex cases.

Keywords: balloon dilation; complete bronchial obstruction; endobronchial tuberculosis (EBTB); transbronchial aspiration needle; virtual bronchoscopy.

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Conflict of interest statement

None declared.

Figures

FIGURE 1
FIGURE 1
Chest computed tomography (CT) images. (A) Identification of the right main bronchial obstruction site using virtual bronchoscopy. (B) Axial image of the obstruction site. (C) Coronal image of the obstruction site. (D) RaySum (Ray Summation) constructed from CT images.
FIGURE 2
FIGURE 2
Bronchoscopic images. (A) Complete obstruction of the right main bronchus. (B) Puncture at the right main bronchial obstruction site with a biopsy needle. (C) Passage of biopsy forceps through the hole created by the biopsy needle. (D) Passage of a guidewire through the enlarged hole. (E) Dilation with a balloon catheter. (F) Post‐procedure, successful recanalization of the left main bronchus.
FIGURE 3
FIGURE 3
Chest x‐ray images. (A) Preoperative x‐ray showing right atelectasis. (B) Puncture at the right main bronchial obstruction site with a biopsy needle. (C) Passage of biopsy forceps through the hole created by the biopsy needle. (D) Passage of a guidewire through the enlarged hole. (E) Dilation with a balloon catheter. (F) Improvement of atelectasis confirmed in the x‐ray taken 5 days post‐procedure before discharge.
See this image and copyright information in PMC

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