|Year : 2023 | Volume
| Issue : 1 | Page : 32-33
A Vasudevan, R Narasimhan
Department of Pulmonology, Apollo Hospitals, Chennai, Tamil Nadu, India
|Date of Submission||23-Jan-2023|
|Date of Decision||22-Feb-2023|
|Date of Acceptance||03-Apr-2023|
|Date of Web Publication||29-Apr-2023|
Dr. A Vasudevan
Department of Pulmonology, Apollo Hospitals, Greams Road, Chennai - 600 006, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Vasudevan A, Narasimhan R. Bronchoscopy Quiz. J Assoc Pulmonologist Tamilnadu 2023;6:32-3
| Bronchoscopy Quiz|| |
A 50-year-old female, with no known comorbidity presented to the outpatient department with complaints of persistent cough for 3 months and history of hemoptysis of 3 episodes of about 3–5 ml/episode. There was no history of fever, weight loss, or trauma. She was hemodynamically stable with a saturation of 97% on room air.
Chest X-ray and contrast-enhanced computed tomography (CECT) of the chest of this patient were unremarkable. Her coagulation profile was also normal. No prior history of tuberculosis was noted. Hence, a diagnostic bronchoscopy procedure was planned. [Figure 1]a and [Figure 1]b shows the bronchoscopic findings of this patient.
| Questions|| |
- Identify this lesion?
- Enumerate the differential diagnosis of this lesion?
- What are the conditions associated with this lesion?
| Answers|| |
- This bronchoscopy image depicts multiple telangiectasia which is referred as “Endobronchial Telangiectasia”
- Differential diagnosis of this lesion is “Haemorrhagic bronchial mucosa syndrome”
- This endobronchial telangiectasia is usually associated with scleroderma, CREST (C-calcinosis, R-raynaud's phenomenon, E-esophageal dysmotility S-scelerodactyly T-telengiectasias) syndrome, and hereditary hemorrhagic telangiectasia.
| Discussion|| |
The most common cause of hemoptysis is infections and malignancy, although various other pulmonary and systemic conditions can also be the cause.
Endobronchial telangiectasia can also be a cause of hemoptysis in certain patients. This condition is associated with scleroderma, hereditary hemorrhagic telangiectasia, cirrhosis, or as an isolated condition.
Limited scleroderma usually presents as calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST syndrome).
Hereditary hemorrhagic telangiectasia is an autosomal dominant vascular disorder associated with the formation of small arteriovenous malformations in multiple organs including the lungs.
Endobronchial vascular lesions are seen in patients with cirrhosis along with esophageal varices. Isolated endobronchial telangiectasia is quite rare.
These vascular lesions can also lead to massive hemoptysis.
| Diagnosis|| |
As in this case, CECT chest of the patient will be normal in these lesions, and hence, bronchoscopy plays a major role in diagnosing this condition.
| Treatment|| |
Most causes are self-limiting and do not warrant any aggressive investigation. The treatment options include coagulation of the lesion or angioembolization in case of large lesions if a feeding vessel is identified. Surgical resection is reserved for larger lesions not amenable to endovascular or bronchoscopic modalities. Electrocoagulation or argon plasma coagulation is the main therapeutic modalities for the management of superficial telangiectasias.
Argon plasma coagulation is safer than electrocoagulation as it has less risk of perforation or cartilage damage and better control of depth.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
We would like to thank the Department of Pulmonology, Apollo Hospitals, Chennai, Tamil Nadu, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rudrappa M, Kokatnur L. Diffuse endobronchial telangiectasia. Int J Appl Basic Med Res 2020;10:137-9.
Andrea Hana SL, Alain T. Endobronchial telangiectasias. J Bronchol 2006;13:210-1.
Youssef AI, Escalante-Glorsky S, Bonnet RB, Chen YK. Hemoptysis secondary to bronchial varices associated with alcoholic liver cirrhosis and portal hypertension. Am J Gastroenterol 1994;89:1562-3.
Madan K, Dhungana A, Hadda V, Mohan A, Guleria R. Flexible bronchoscopic argon plasma coagulation for management of massive hemoptysis in bronchial Dieulafoy's disease. Lung India 2017;34:99-101.
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