Postoperative diagnosis:
#1 right lower lobe hypermetabolic nodule
#2 history of tobacco abuse
#3 history of right breast cancer
#4 newly diagnosed left breast cancer
*
procedure:
#1 electromagnetic navigational bronchoscopy with biopsy of right lower lobe nodule (triple needle brush, FNA, biopsy forceps, mini-BAL)
#2 fluoroscopy with intraoperative visualization and interpretation
*
Intraoperative findings:
On bronchoscopy, the tracheobronchial tree was anatomically normal. There is no evidence of mucosal changes, endobronchial lesions, or infectious processes.
*
Fluoroscopy: Fluoroscopy was used intraoperatively with each biopsy, utilizing fluoroscopy to determine appropriate position of needle brush, FNA, and biopsy forceps appointment.
*
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite and placed on the operating table where she underwent general anesthesia with endotracheal intubation. Monitoring devices were placed by anesthesia. Timeout was used confirm patient identity as well as the procedure be performed. Antibiotics given prior the incision. Next
*
Placement bronchoscope was placed through the endotracheal tube. The distal trachea was normal. The carina was sharp. The left and right bronchial tree were then evaluated and found to be anatomically normal. Findings were as described above.
*
Navigational mapping was performed on computer prior to the procedure. Once this was completed, the mapping was loaded into the electromagnetic navigational system. The bronchoscope was inserted to the level of the mid trachea. The locating guide catheter was then placed. Registration of the tracheobronchial tree was then performed with excellent sinking of the airways with the computer system. Next
*
Once this was completed, the LG catheter was used to guide within 1 cm of the target nodule within the right lower lobe. LG guide was removed. The triple brush was then used under fluoroscopic guidance to biopsy the area of interest and cytology slides were created. After 3 separate passings with the triple brush, FNA was used to make two separate passes into the lesion of question and cytology slides were created with remainder the specimen placed within CytoLyt fluid. Finally, 3 passes with a transbronchial biopsy forceps were performed with specimens submitted to pathology. All of this was performed under fluoroscopic guidance. 10 mL of saline was then injected and a miniBAL was performed and submitted for cytology.
*
The catheter was then removed. The airways were cleaned out with flexible bronchoscope the bronchoscope was removed. The patient tolerated procedure well, was estimated, then transferred recovery.
*
Specimens:
– Multiple cytology slides as well as pathology specimens as described above
estimated blood loss: Minimal
blood replaced: None
drains: None
implants: None
condition at completion of procedure: Stable
#1 right lower lobe hypermetabolic nodule
#2 history of tobacco abuse
#3 history of right breast cancer
#4 newly diagnosed left breast cancer
*
procedure:
#1 electromagnetic navigational bronchoscopy with biopsy of right lower lobe nodule (triple needle brush, FNA, biopsy forceps, mini-BAL)
#2 fluoroscopy with intraoperative visualization and interpretation
*
Intraoperative findings:
On bronchoscopy, the tracheobronchial tree was anatomically normal. There is no evidence of mucosal changes, endobronchial lesions, or infectious processes.
*
Fluoroscopy: Fluoroscopy was used intraoperatively with each biopsy, utilizing fluoroscopy to determine appropriate position of needle brush, FNA, and biopsy forceps appointment.
*
Procedure in detail:
The patient had her history and physical updated prior to the procedure. She was transferred to the operating suite and placed on the operating table where she underwent general anesthesia with endotracheal intubation. Monitoring devices were placed by anesthesia. Timeout was used confirm patient identity as well as the procedure be performed. Antibiotics given prior the incision. Next
*
Placement bronchoscope was placed through the endotracheal tube. The distal trachea was normal. The carina was sharp. The left and right bronchial tree were then evaluated and found to be anatomically normal. Findings were as described above.
*
Navigational mapping was performed on computer prior to the procedure. Once this was completed, the mapping was loaded into the electromagnetic navigational system. The bronchoscope was inserted to the level of the mid trachea. The locating guide catheter was then placed. Registration of the tracheobronchial tree was then performed with excellent sinking of the airways with the computer system. Next
*
Once this was completed, the LG catheter was used to guide within 1 cm of the target nodule within the right lower lobe. LG guide was removed. The triple brush was then used under fluoroscopic guidance to biopsy the area of interest and cytology slides were created. After 3 separate passings with the triple brush, FNA was used to make two separate passes into the lesion of question and cytology slides were created with remainder the specimen placed within CytoLyt fluid. Finally, 3 passes with a transbronchial biopsy forceps were performed with specimens submitted to pathology. All of this was performed under fluoroscopic guidance. 10 mL of saline was then injected and a miniBAL was performed and submitted for cytology.
*
The catheter was then removed. The airways were cleaned out with flexible bronchoscope the bronchoscope was removed. The patient tolerated procedure well, was estimated, then transferred recovery.
*
Specimens:
– Multiple cytology slides as well as pathology specimens as described above
estimated blood loss: Minimal
blood replaced: None
drains: None
implants: None
condition at completion of procedure: Stable
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