OBJECTIVE: To determine clinical features and diagnostic methods for primary tracheobronchial amyloidosis (TBA).
 METHODS: The clinical manifestations and diagnosis of a male patient who had been misdiagnosed for many years were described and analyzed.
 RESULTS: The patient was a 68-year-old male who complained of recurrent cough, expectoration, and progressive dyspnea for more than 30 years. He had been diagnosed with chronic bronchitis, bronchiectasis, and endobronchial tuberculosis in other hospitals and treated with antibiotics frequently and anti-tubercular agents for 3 months. Despite the treatments, the patient's symptoms were progressively worse. Finally, he came to Xiangya Hospital, Central South University, and was clearly diagnosed with primary TBA based on histopathological evidence after bronchoscopy.
 CONCLUSION TBA, a rare disease resulting from abnormal submucosal amyloid deposition in the trachea and bronchi, may display with many different symptoms. TBA is often misdiagnosed with other pulmonary diseases. The use of bronchoscopic techniques is essential for the diagnosis of TBA. Histopathology remains the gold standard for diagnosis of primary TBA. So, for patients with chronic cough of unknown etiology, bronchoscopy should be performed to obtain biopsy samples for the definitive diagnosis.
Aged ; Amyloidosis ; diagnosis ; Bronchi ; pathology ; Bronchial Diseases ; diagnosis ; Bronchiectasis ; Bronchitis, Chronic ; Bronchoscopy ; Delayed Diagnosis ; Humans ; Immunoglobulin Light-chain Amyloidosis ; Male ; Trachea ; pathology ; Tracheal Diseases ; diagnosis ; Tuberculosis

Small airway diseases are seen in many clinical conditions. The locations of small airway diseases are small bronchioles including terminal and respiratory bronchioles, and alveolar duct. The histopathologic features of bronchiolar injury have been described variously and have led to confusing and overlapping terms. The purpose of this article is to describe the clinical characteristics and histopathologic interpretation of small airway diseases. We classify the small airway diseases as primary bronchiolar diseases, and secondary bronchiolar diseases including pulmonary parenchymal diseases, and large airway diseases with prominent bronchiolar involvement. Primary bronchiolar diseases include respiratory bronchiolitis, acute bronchiolitis, constrictive bronchiolitis, follicular bronchiolitis, diffuse panbronchiolitis, mineral dust airway diseases, and a few other variants. Pulmonary parenchymal diseases with bronchiolar involvement include respiratory bronchiolitis-associated interstitial lung disease, organizing pneumonia, hypersensitivity pneumonitis, pulmonary Langerhans' cell histiocytosis, sarcoidosis and idiopathic pulmonary fibrosis. Bronchiolar changes can also be seen in large airway diseases such as chronic bronchitis, bronchiectasis, cystic fibrosis and asthma. The patterns of bronchiolar response to various injuries are relatively limited and these patterns are generally non-specific in regard to the etiology. Appropriate interpretation and diagnosis of small airway diseases depend on judicious correlation of clinical, radiologic, and histopathologic characteristics.
Alveolitis, Extrinsic Allergic ; Asthma ; Bronchiectasis ; Bronchioles ; Bronchiolitis ; Bronchiolitis Obliterans ; Bronchitis, Chronic ; Cystic Fibrosis ; Diagnosis ; Dust ; Histiocytosis ; Idiopathic Pulmonary Fibrosis ; Lung Diseases, Interstitial ; Pneumonia ; Sarcoidosis

The morphological changes of the allergic immunological lesion is difficult to realize. In 1975, Gell and Coombs classified the allergic- immunological reactions into 4 types. The type I included the anti bodies causes sensitivity for tissues by binding with the mastocytes leading to release of the mediate chemicals. The reactions occurs early and severe which damages mainly the circulation system and organs with smooth muscles. The type II causes cellular toxic and cellulicidal. The type III causes the the tissue lesions due to the toxicity of the antigen antibody complex. The type IV includes the tuberculin reaction. The pneumobronchial allergic-immunological deases according to the classification of Gell and Coombs included the type I reactions: the pneumobronchial diseases with the antigen- antibody reactions (prophylatic, asthma, respiratory allergy: type IV; hypersensityvity occurs only within 24-72 hours after exposured with the antigen, not related with the antibody but related with the cell, found most frequent in the microbial,viral and parasitological infections and the dermatological reactions due to induction with the normal chemicals
Bronchial Hyperreactivity ; Hypersensitivity ; Immune System Diseases

PURPOSE: To determine the utility of HRCT in the diagnosis of chronic airflow obstruction and to correlate the morphologic abnormalities revealed by this modality with functional impairment in patients with chronic air-flow obstruction. MATERIALS AND METHODS:This study involved 80 patients with chronic airflow obstruction who underwent HRCT and a pulmonary function test. Final clinical diagnosis in these patients was determined by a chest physician on the basis of clinical features, bronchoscopy, pulmonary function test, and HRCT. In order to diagnose and determine the extent of areas of decreased attenuation revealed by HRCT (the CT score), the find-ings of HRCT were retrospectively reviewed by two radiologists, who reached a consensus. Clinical and HRCT diagnoses were then compared, and the rate of agreement between them was calculated. The relation-ship between the extent of areas of decreased attenuation revealed by HRCT and by FEV1/FVC was evaluated using Correl 's account and Student 's unpaired t-test. RESULTS: The agreement rate between clinical and HRCT diagnoses was 77.5% (62/80). The rates for bronchiec-tasis (88.9%, 24/27), emphysema (93.9%, 31/33), and bronchiolitis obliterans (100%, 6/6) were considerably higher than those for chronic bronchitis and bronchial asthma. The correlation rate between CT score and FEV1/FVC was significant in bronchiectasis (p<0.05; r: -0.76) and bronchiolitis obliterans (p<0.01; r:-0.66), but not in cases involving emphysema, bronchial asthma, or chronic bronchitis (p>0.05). CONCLUSION: HRCT is valuable in the diagnosis and prediction of physiologic impairment in patients with bronchiectasis and bronchiolitis obliterans, but has limited value in those with emphysema, chronic bronchitis or asthma.
Asthma ; Bronchiectasis ; Bronchiolitis Obliterans ; Bronchitis, Chronic ; Bronchoscopy ; Consensus ; Diagnosis* ; Emphysema ; Humans ; Pulmonary Disease, Chronic Obstructive* ; Pulmonary Emphysema ; Respiratory Function Tests* ; Retrospective Studies ; Thorax

BACKGROUND AND OBJECTIVES: There are evidences that allergic rhinitis and asthma represent a continuity of disease. It is known that bronchial hyperreactivity is a most contributing factor for asthma, yet it remains controversial whether there is a direct cause-and-effect relationship between the upper and lower airway. This study was performed to evaluate a direct cause-and-effect relationship between the two diseases by using early allergic responses and to define the clinical factors for predicting bronchial hyperreactivity in allergic rhinitis patients. SUBJECTS AND METHOD: Seventy three patients with allergic rhinitis and 36 patients without allergic rhinitis were included in this study, where exclusion criteria were diagnosed asthma, chronic obstructive pulmonary diseases, nasal polyp and chronic paranasal sinusitis. Nasal provocation tests with allergen were applied to 29 allergic rhinitis patients. After 30 minutes, we investigated lower airway using symptom scores, bronchial provocation test with methacholine and pulmonary function test. Bronchial provocation test with methacholine was applied to 44 allergic rhinitis patients and 36 non-allergic rhinitis patient. We checked nasal symptom scores and the change of nasal volume by VAS and acoustic rhinometry, respectively. We also investigated the incidence and the predictive factors of bronchial hyperreactivity in allergic rhinitis patients. RESULTS: The early allergic response provocated at nasal cavity had little effect on bronchus. Bronchial stimuli with methacholine did not affect nasal cavity. The incidence of bronchial hyperreactivity is significantly higher in allergic rhinitis patients than in non-allergic rhinitis patients. Type of allergic rhinitis (especially persistent, moderate-severe group) and the disease-durations are valuable predictive factors of the bronchial hyperreactivity. CONCLUSION: Although early allergic response has little effect on the nasobronchial relationship, there may be a significant correlation between allergic rhinitis and bronchial hyperreactivity. The correlation is more significant in the persistent, moderate-severe group of allergic rhinitis with long disease duration.
Asthma ; Bronchi ; Bronchial Hyperreactivity* ; Bronchial Provocation Tests ; Humans ; Incidence ; Lung Diseases, Obstructive ; Methacholine Chloride ; Nasal Cavity ; Nasal Polyps ; Nasal Provocation Tests ; Respiratory Function Tests ; Rhinitis* ; Rhinometry, Acoustic ; Sinusitis

Aged ; Bronchial Arteries ; pathology ; Bronchial Diseases ; complications ; Female ; Fistula ; etiology ; pathology ; Humans ; Pulmonary Artery ; pathology

The study included 64 patients with chronic cardiopulmonary disease caused by chronic bronchitis and bronchial asthma at early stage in Viet Tiep Hai Phong Hospital between 2002 and 2003. Results: Patients who are over 50 years of age accounted for 89.1%; male 87.5%; female 12.5%. Patients had disease duration more than 10 years were 84.2%. Commonest clinical symptoms were breath shortness in excise (100%), tachycardia (87.5%). Major laboratory findings: hyperleukocytosis (34.4%), increased sedimentation rate (37.5%), ECG right axis (40.6%), pulmonary P wave (100%), absence of right ventricular hypertrophy (100%). On Doppler ultrasonography: flat a wave (65.6%), pulmonary hypertension (65.6%)
Bronchitis, Chronic ; Asthma

A prospective trial has based a combination of established technique. Such as conventional diagnostic procedures (endobronchial forcepsbiopsy, bronchial brushing) and transbronchial needle aspiration. These techniques result in an excellent diagnostic yield and safe. Study object 61 patients in clinic, x-ray age at diagnosis 32-75 years, (range 53,5 years) having bronchogenic carcinoma in suspection. All most of them were in brochoscopy and operation. 70,49% patients have mediastinal and hilar lympho node. There was no incidence and complication happened.
Lung Neoplasms ; Bronchial Diseases ; diagnosis

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.
Bronchial Fistula ; Carcinoma, Non-Small-Cell Lung ; Fistula ; Humans ; Lung Neoplasms ; Lymph Nodes ; Lymphatic Diseases ; Male ; Pneumonia ; Thoracic Cavity ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

Swyer-James syndrome is a rare disease with patients presenting with unilateral hyperlucent lungs and hypoperfusion due to hypoplasia of the pulmonary artery and bronchiolitis obliterans. A unilateral hyperlucent lung generally develops after a lower respiratory tract infection during early childhood. In extremely rare cases, an association of bronchogenic carcinoma with Swyer-James syndrome has been reported. We report a case of bronchogenic squamous cell carcinoma associated with Swyer-James syndrome that performed right upper lobectomy and lymph node dissection with a relevant literature review.
Bronchial Neoplasms ; Bronchiolitis Obliterans ; Carcinoma, Bronchogenic ; Carcinoma, Squamous Cell* ; Humans ; Lung, Hyperlucent* ; Lymph Node Excision ; Pulmonary Artery ; Rare Diseases ; Respiratory Tract Infections