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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
The right mainstem bronchus has a more straight-line bifurcation from the carina than the left. There are three lobar bronchi in the right lung – the right upper lobar bronchus, the right middle lobar bronchus, and the right lower lobar bronchus.7The right upper lobe generally takes off shortly after the carina. There are generally three segmental bronchi in the right upper lobe – the anterior, posterior, and apical.The right middle and lower lobes take off from the bronchus intermedius.The right middle lobe has two segmental bronchi – the medial and lateral bronchi.The right lower lobe has four basilar segments – the medial, anterior, lateral, and posterior. There is also a superior segment of the right lower lobe that generally takes off just distal to the right middle lobe on the opposite side of the bronchus intermedius.
Respiratory Symptoms
Published in James M. Rippe, Lifestyle Medicine, 2019
Jeremy B. Richards, Richard M. Schwartzstein
Br onchogenic carcinomas in the central airways may cause partial or complete obstruction of a segmental or lobar bronchus, leading to focal atelectasis on the chest X-ray and chronic cough. The cough is typically nonproductive but may be associated with intermittent hemoptysis.
Right-sided pulmonary resections
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Occasionally, the location of a lesion will mandate removal of the middle and lower lobes, a procedure that can be accomplished en bloc because of the common origin of these lobes from the bronchus intermedius. A tumor originating in the bronchus intermedius usually requires removal of both lobes but a lower lobe lesion that involves the external aspect of the lobar bronchus may also mandate taking the middle lobe. Where an indication exists for bilobectomy, the vascular supply for each lobe is isolated and divided as described for each individual lobectomy. Once the pulmonary arterial branches have been divided, the point of division of the bronchus becomes obvious; the bronchus should be divided above the origin of the middle lobe bronchus, just distal to the origin of the upper lobe bronchus (see Figure 12.22). Morbidity and mortality for bilobectomy exceed those for lobectomy alone, so this resection should not be performed solely for ease or convenience. The middle lobe should never just be assumed to be expendable. The bronchial stump placed so close to the upper lobe bronchus may be at somewhat increased risk for breakdown compared with other bronchial closures. Indeed, a postoperative air leak may be prolonged following bilobectomy, especially if the remaining right upper lobe is not large enough to fill the entire space. The residual space, which precludes complete visceral and parietal pleural apposition, facilitates the air leak.
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis
Published in Expert Review of Respiratory Medicine, 2023
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
Central airway obstruction (CAO) is defined as airway stenosis involving the trachea, main bronchus, bronchus intermedius, or lobar bronchus [1,2]. It is a life-threatening disease; if untreated, most of the patients may die from suffocation. The etiologies of CAO can be divided into malignant and nonmalignant types. Malignant CAO is often caused by the extension of adjacent tumors, such as bronchogenic carcinoma, esophageal and thyroid carcinoma [3,4]. The nonmalignant etiologies include airway trauma, prolonged endotracheal intubation, tracheostomy, benign airway tumors, hyperplasia of granulation tissue after surgery, and tracheobronchomalacia [5]. Nonmalignant CAO can also be caused by inflammatory diseases, including sarcoidosis, amyloidosis, and granulomatosis with polyangiitis [5]. Post tuberculosis (TB) infection can also result in CAO [6,7], with tuberculosis cases increasing in incidence worldwide [8].
Pulmonary adverse events related to idelalisib therapy: A single centre experience
Published in Journal of Chemotherapy, 2018
Caroline Migault, Delphine Lebrun, Olivier Toubas, Yohan Nguyen, Aurélien Giltat, Gautier Julien, Dominique Toubas, François Lebargy, Alain Delmer, Firouzé Bani-Sadr
A 68-year-old patient (case 5) developed pneumonitis 1 month after the introduction of idelalisib. Severe neutropenia (<100 mm3) was present before idelalisib treatment. Microbiological investigations of sputum and blood cultures were negative. He was treated with ceftriaxone and idelalisib was stopped for 1 month. Four months later, he presented a second episode of pneumonitis treated with ceftriaxone. The idelalisib dosage was then decreased to a dose of 100 mg twice daily. One year later, he was hospitalized for severe aphtous stomatitis and dyspnoea. Neutropenia (<100 mm3) was still present. The thoracic CT scan revealed alveolar consolidation in the left lower lobe. Bronchial endoscopy found a whitish necrotic lesion budding in the lobar bronchus. A few colonies of Aspergillus fumigatus were present on BAL. Idelalisib was definitively discontinued, and this led to regression of neutropenia (1000 mm3) and the aphtous stomatitis. The patient was treated with piperacillin-tazobactam plus levofloxacin and voriconazole. Prednisone (1 mg/kg/daily) was also introduced due to the persistence of dyspnoea, with a dramatic improvement.
Techniques for lung surgery: a review of robotic lobectomy
Published in Expert Review of Respiratory Medicine, 2018
Sophia Chen, Travis C. Geraci, Robert James Cerfolio
The inferior pulmonary ligament is divided to the level of the inferior pulmonary vein, and the bifurcation of the right superior and inferior pulmonary veins is dissected out. The right middle lobar vein should be identified to avoid accidental transection. A subadventitial plane is established on the ongoing pulmonary artery. If the major fissure is incomplete, it is divided. The superior segmental artery is identified, isolated, and divided. The right middle lobe arterial branch is also identified. The common trunk to right lower lobe basilar segments can be removed, so long as this does not compromise any middle lobar segmental arteries. If it does, the dissection may have to extend further distally for a safe division. The inferior pulmonary vein is then divided. While taking care to visualize the right middle lobar bronchus crossing from left to right, the surgeon should isolate the right lower lobe bronchus. As usual, dissect the surrounding lymph nodes and divide the bronchus. If the right middle lobe bronchus is in danger of getting compromised, the surgeon can ask the anesthesiologist to hand-ventilate the right lung to confirm middle lobe expansion.