Transbronchial lung biopsy with a flexible cryoprobe: First case report from India

Abstract

Sarcoidosis and tuberculosis are granulomatous disorders that mimic each other both clinically and radiologically. Both can present with fever and pulmonary nodules and often require the performance of transbronchial lung biopsy (TBLB) for diagnosis. In recent studies, the flexible cryoprobe for carrying out TBLB has been found to be useful in the diagnosis of disorders diffusely involving the lung parenchyma. Here, we present the case of a 29-year-old man who presented with fever and cough and was found to have multiple small nodules in both lungs. TBLB with a flexible cryoprobe helped in differentiating between sarcoidosis and tuberculosis.

Transbronchial lung biopsy with a flexible cryoprobe during rigid bronchoscopy: Standardizing the procedure

“…Subsequently, the second bronchoscope was inserted immediately and “wedged” into the biopsied segment to control the bleeding. In the case that we had reported,[ 4 ] we did not encounter any complication. However, in the second patient using the aforementioned technique was employed, significant bleeding was encountered that hindered the introduction of the second bronchoscope into the airway, with resultant spillage of the blood to the contralateral bronchial tree.…”

“…We recently reported the first experience from India of performing cryobiopsy from the lung parenchyma (cryo-TBLB). [ 4 ] Therein, we had described a flexible bronchoscopic technique with the procedure performed under conscious sedation in a spontaneously breathing patient using two bronchoscopes. The first bronchoscope was used to obtain the cryobiopsy and was withdrawn with the lung specimen adhered to the cryoprobe.…”

“…In conclusion, the performance of cryo-TBLB without an artificial airway, although described in previous studies and attempted by us recently, is feasible but may be associated with complications. [ 4 8 ] Cryo-TBLB can be performed much more safely and thoroughly under general anesthesia during rigid bronchoscopy.…”

Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker

“…[ 2 ] Exclusive use of a flexible bronchoscope may allow the performance of this procedure, but without the use of an occlusion balloon, this may be associated with unpredictable severe bleeding. [ 3 4 ] Some authors have reported the use of single flexible bronchoscope while others have used two flexible bronchoscopes in sequential manner or rendezvous method. [ 4 ] Artificial airway management options during the procedure include supraglottic airway, endotracheal tube, or rigid bronchoscope.…”

“…[ 3 4 ] Some authors have reported the use of single flexible bronchoscope while others have used two flexible bronchoscopes in sequential manner or rendezvous method. [ 4 ] Artificial airway management options during the procedure include supraglottic airway, endotracheal tube, or rigid bronchoscope. The use of rigid bronchoscope and a bronchial blocker during the procedure may be preferable to provide airway protection in case of unpredictable bleeding.…”