- 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.
- Visible abnormalities confined to the bronchi, including but not limited to:
- 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.
- CXR
- 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.