Ann Thorac Surg 2003;76:296
© 2003 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Novel thoracic imaging augments diagnosis of bronchial obstruction
Steven E. Finkelstein, MDa,
David S. Schrump, MDa,
Dao M. Nguyen, MDa,
Rakesh Mullick, PhDa,
Ronald M. Summers, MD, PhDa*
a National Institutes of Health, Bethesda, Maryland, USA
* Address reprint requests to Dr Summers, Diagnostic Radiology Department, Bldg. 10, Room 1C660, 10 Center Drive, Bethesda, MD 20892, USA
e-mail: rms{at}nih.gov
A 58-year-old man who had been treated previously for non–small cell lung carcinoma was referred to the National Cancer Institute for evaluation. The patient presented with increasing dyspnea. Physical examination revealed a respiratory rate of 20 and an oxygen saturation of 90%. In addition to conventional staging studies, novel imaging modalities including super-high-resolution computed tomography of the chest with confocal volume rendering (Fig 1) and virtual bronchoscopy (Fig 2) were obtained.
Confocal volume rendering is an investigational technique to perform segmentation-free rendering at a specific depth below the skin surface. After high-resolution sections of the entire chest are obtained, obstructing structures are "stripped away" to improve visualization of intrathoracic airways and lung masses. Virtual bronchoscopy is another noninvasive technique which allows navigation of the tracheobronchial tree in a three dimensional manner analogous to standard fiberoptic bronchoscopy. In addition, virtual bronchoscopy allows for unconventional images such as extraluminal surface reconstructions. So far, reports of clinical utilization of these new modalities have been limited.
Confocal volume rendering (Fig 1) and virtual bronchoscopy with perspective-rendering surface reconstruction (Fig 2) suggested a high-grade obstruction of the proximal left main stem bronchus (arrows). The distal left mainstem bronchus appeared patent. Fiberoptic bronchoscopy confirmed these findings. For treatment, a rigid bronchoscope was inserted through which Maloney dilators were passed to dilate the stenosis to the level of the secondary carina of the left lung. The patient made an unremarkable recovery; his dyspnea was remarkably improved, enabling him to undergo further investigational therapy.
A video of this procedure can be viewed on the Internet at http://www.cc.nih.gov/drd/cvrvb.html and http://www.sts.org/section/atsvideo.
