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Ann Thorac Surg 1996;62:979-980
© 1996 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 976.

DR L. PENFIELD FABER (Chicago, IL):

I compliment Agasthian and associates on an excellent presentation and a very well written manuscript. In their study, they emphasize the need for preoperative bronchoscopy, and I strongly support this recommendation. It is very important to rule out benign or malignant causes of obstruction and to determine the degree of inflammation in the bronchial wall itself. Severe inflammation may negate resection until better infection control has been achieved.

The preoperative diagnosis of bronchiectasis today can be somewhat of a problem. Dionosil is no longer available, and now we rely on thin-cut computed tomographic scan to define bronchiectasis. In the present series, a bronchogram was done in 66 patients, and computed tomographic scan made the diagnosis in 44. However, in 24 the apparent diagnosis was made on the plain chest roentgenogram. Doctor Agasthian, how could you define true bronchiectasis on a plain chest roentgenogram? My mentor, Dr Hiram Langston, emphatically taught us that bronchiectasis could be diagnosed only with the bronchogram. In that same vein, it would be helpful for Dr Agasthian to explain how the computed tomographic scan is used to define the true anatomic extent of bronchiectasis. In other words, does the computed tomographic scan tell us if the superior segment of the lower lobe is involved, and can we plan an anatomic resection based on this scan alone?

The surgical resections reported in this series are somewhat unusual for bronchiectasis. The majority were lobectomies and pneumonectomies, with very few segmentectomies. There was only . . . [Full Text of this Article]

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Surgical Management of Bronchiectasis

Thirugnanam Agasthian, Claude Deschamps, Victor F. Trastek, Mark S. Allen, and Peter C. Pairolero
Ann. Thorac. Surg. 1996 62: 976-978. [Abstract] [Full Text]