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Transplantation |

Evaluation of Airway Strictures Following Lung Transplantation With CT Reconstruction: Comparison Between Virtual and Fiberoptic Bronchoscopy

Ngozika Orjioke*, MD; Alison Wilcox, MD; P. Michael McFadden, MD; Cynthia Herrington, MD; Kamyar Afshar, DO
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University of Southern California, Keck School of Medicine, Los Angeles, CA


Chest. 2012;142(4_MeetingAbstracts):1097A. doi:10.1378/chest.1383705
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Abstract

SESSION TYPE: Lung Transplantation Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: 1.Assess the sensitivity of virtual bronchoscopy(VB) in lung transplant(LT) recipients for detection of anastomotic & non-anastomotic bronchial strictures, including smaller airway generations, that may not be visualized by fiberoptic bronchoscopy(FOB);2.Assess the ability of VB to identify submucosal changes that could potentially be predictive of a requirement for stent deployment vs. balloon dilation to correct bronchial strictures.

METHODS: VB is a 3-D reconstruction of the tracheobronchial anatomy. Recent reconstruction views of multi-slice thoracic computerized tomography(CT) were compared to gross FOB findings. Thin section CT scans were acquired with either: 10 slice(1mm images) or 64 slice(0.5mm images).VB images were reviewed independently of FOB findings. Classification of severity for airway strictures (AS) was mild-moderate (<50% lumen narrowing) or severe (>50% lumen narrowing).

RESULTS: 9 LT recipients (6 M, 3 W, avg age 50 yrs) were found to have AS by FOB. 5 pts underwent SLT and 4 BSLT.Indications for LT:IPF(4;44%), CF(3;33%) and COPD(2;22%).Median time from LT to AS diagnosis was 100 days.All 9 pts evaluated had severe narrowing of the lumen at the level of the anastomosis for which balloon dilation was performed.6 of 8 pts(75%) required deployment of an Ultraflex stent due to persistent AS after balloon dilation.4 pts(50%) had a non-anastomotic AS in addition to the anastomotic AS.VB detected the FOB diagnosis of AS in 8 of 9 pts(89%).In 2 cases VB detected AS at the 4th generation that was not seen by FOB.VB was poor at detecting AS distal to the 4th generation segments. Submucosal thickening was noted in only 1 pt.This pt was one that required a stent deployment, as balloon dilatation was not sufficient to correct the stricture.

CONCLUSIONS: VB can complement the diagnostic evaluation of LT recipients suspected to have anastomotic or non-anastomotic AS,but only to the 4th generation.As seen in 2 cases,VB may add additional information,but due to the current limitations in scanning parameters,FOB still remains the diagnostic and therapeutic method of choice in cases of post LT airway strictures.

CLINICAL IMPLICATIONS: A larger analysis with higher sensitivity CT scans could potentially identify non-anastamotic AS in distal airway generations not evident by FOB.Whether it will be of value in detecting submuocal changes that may be predictive of requiring balloon dilation & endobronchial stent deployment versus balloon dilation for the airway strictures in LTrecipients remains to be determined.

DISCLOSURE: The following authors have nothing to disclose: Ngozika Orjioke, Alison Wilcox, P. Michael McFadden, Cynthia Herrington, Kamyar Afshar

No Product/Research Disclosure Information

University of Southern California, Keck School of Medicine, Los Angeles, CA

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