000 Endobronchial Finding

  • Etymology
    “Endo-” means within, and “bronchial” pertains to the bronchi, referring to findings within the bronchial tree.
  • AKA and abbreviation
    Endobronchial findings (EBF).
  • What is it?
    Endobronchial findings describe abnormalities identified within the bronchial tree on imaging or during bronchoscopy, ranging from structural changes to pathological obstructions or secretions.
  • Characterized by
    • Visible abnormalities confined to the bronchi, including but not limited to:
      • Masses or nodules.
      • Mucosal irregularities.
      • Airway narrowing or obstruction.
      • Foreign bodies.
      • Secretions (e.g., mucus plugs).
      • Intraluminal calcifications.
  • Caused by
    • Most Common Cause(s): Bronchogenic carcinoma, benign tumors, and infections (e.g., endobronchial tuberculosis).
    • Other Causes Include:
      • Infection: Fungal infections (e.g., aspergillosis), bacterial abscesses.
      • Inflammation/Immune: Sarcoidosis, granulomatosis with polyangiitis.
      • Neoplasm: Benign (e.g., hamartomas) or malignant tumors (e.g., metastases).
      • Mechanical Trauma: Post-intubation injury, foreign body aspiration.
      • Metabolic: Rarely, deposition diseases such as amyloidosis.
      • Congenital: Tracheobronchomalacia, bronchial atresia.
  • Resulting in:
    • Obstruction to airflow or mucus clearance.
    • Recurrent infections or post-obstructive pneumonia.
    • Hemoptysis.
    • Airway collapse or atelectasis.
  • Structural changes:
    • Thickening of bronchial walls.
    • Narrowing or distortion of airway lumens.
    • Presence of intraluminal masses or secretions.
  • Pathophysiology:
    The development of endobronchial findings depends on the underlying cause, such as obstruction by a mass, inflammatory mucosal thickening, or dynamic airway collapse.
  • Pathology:
    • Benign or malignant tissue obstructing the airway.
    • Infection-related debris or secretions.
    • Inflammatory mucosal thickening or granuloma formation.
  • Diagnosis:
    • Clinical signs: Cough, wheezing, hemoptysis, recurrent infections.
    • Imaging: Chest X-ray, CT, and bronchoscopy for direct visualization.
    • Biopsy or culture of suspicious lesions for definitive diagnosis.
  • Clinical:
    Symptoms vary depending on the severity and cause but may include obstructive symptoms, infection, or systemic manifestations of malignancy or inflammatory disease.
  • Radiology Detail:
    • CXR
      • Findings: Atelectasis, airway narrowing, post-obstructive pneumonia.
      • Associated Findings: Masses, consolidation.
    • CT
      • Parts: Intraluminal, mucosal, or extrinsic.
      • Size: Varies with etiology (e.g., large obstructive tumors versus small foreign bodies).
      • Shape: Nodular, smooth, or irregular.
      • Position: Central airways, lobar, or segmental.
      • Character: Solid, calcified, or soft tissue.
      • Time: Acute or chronic findings.
      • Associated Findings: Lymphadenopathy, pleural effusion, bronchial wall thickening.
    • Other relevant Imaging Modalities
      • Bronchoscopy: Gold standard for direct visualization.
      • MRI: Rarely used but can assess extrinsic compressions.
      • PET CT: Evaluates metabolic activity for malignancy.
  • Pulmonary function tests (PFTs):
    May reveal obstructive or restrictive patterns depending on the extent and location of the findings.
  • Recommendations
    • Bronchoscopy for diagnosis and therapeutic interventions (e.g., removal of foreign bodies).
    • Imaging-guided biopsy for histopathological confirmation if malignancy is suspected.
    • Antimicrobial therapy for infectious causes.
    • Surgical intervention for obstructive lesions or masses.
  • Key Points and Pearls
    • Endobronchial findings encompass a wide differential, requiring careful correlation of clinical, imaging, and bronchoscopic findings.
    • Malignant causes should be suspected in patients with systemic symptoms or risk factors such as smoking.
    • Early bronchoscopy is crucial for both diagnosis and management of suspected endobronchial lesions.