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Peripheral Pulmonary Diseases: Evaluation with Endobronchial US— Initial Experience¹

¹ From the Department of Respirology (B2), Graduate School of Medicine, (S.O., Y.T., N.T., K.T., H.K., T.K.), Department of Basic Pathology (B3), Graduate School of Medicine, (K.H.), and Health Sciences Center (K.N.), Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan. Received August 24, 2001; revision requested October 11; revision received November 21; accepted January 7, 2002. Supported by the Ministry of Education, Culture, Sports, Science and Technology of Japan. Address correspondence to Y.T. (e-mail: yuichi@med.m.chiba-u.ac.jp).

View larger version (140K): [in a new window]   Figure 1a. Macroscopic close-up view of (a, b) sponges and (c, d) their US images. The sponges were soaked in water to expel the air. The plastic sponge (a) and vegetable sponge (b) were distinctly different with respect to their pore size. The resultant US images of the plastic sponge (c) and vegetable sponge (d) displayed different echoic patterns. The bars in a-d represent 1 mm.

View larger version (141K): [in a new window]   Figure 1b. Macroscopic close-up view of (a, b) sponges and (c, d) their US images. The sponges were soaked in water to expel the air. The plastic sponge (a) and vegetable sponge (b) were distinctly different with respect to their pore size. The resultant US images of the plastic sponge (c) and vegetable sponge (d) displayed different echoic patterns. The bars in a-d represent 1 mm.

View larger version (189K): [in a new window]   Figure 1c. Macroscopic close-up view of (a, b) sponges and (c, d) their US images. The sponges were soaked in water to expel the air. The plastic sponge (a) and vegetable sponge (b) were distinctly different with respect to their pore size. The resultant US images of the plastic sponge (c) and vegetable sponge (d) displayed different echoic patterns. The bars in a-d represent 1 mm.

View larger version (151K): [in a new window]   Figure 1d. Macroscopic close-up view of (a, b) sponges and (c, d) their US images. The sponges were soaked in water to expel the air. The plastic sponge (a) and vegetable sponge (b) were distinctly different with respect to their pore size. The resultant US images of the plastic sponge (c) and vegetable sponge (d) displayed different echoic patterns. The bars in a-d represent 1 mm.

View larger version (101K): [in a new window]   Figure 2. Fluoroscopic image obtained during the endobronchial US procedure. A small-caliber US probe was guided through the forceps channel of a bronchoscope to reach a subpleural lung region. The circumjacent lung was radiopaque (arrows) because of the preceding BAL procedure.

View larger version (161K): [in a new window]   Figure 3a. US images and their corresponding photomicrographs of autopsied lungs. The autopsied lungs were from patients with (a) normal, (b) emphysematous, and (c) honeycomb lung. The lungs were fixed in formalin before being cut into 1-cm-thick samples. The samples were removed from formalin and soaked in normal saline. A small-caliber US probe was inserted into one of the small bronchi to obtain the US images. The point where an image was recorded was marked with a pin, and that part was excised for microscopic examination. The US images appeared different among the three lung tissue patterns. The bars in a-c represent 1 mm. (Hematoxylin-eosin stain; original magnification, x2.5.)

View larger version (162K): [in a new window]   Figure 3b. US images and their corresponding photomicrographs of autopsied lungs. The autopsied lungs were from patients with (a) normal, (b) emphysematous, and (c) honeycomb lung. The lungs were fixed in formalin before being cut into 1-cm-thick samples. The samples were removed from formalin and soaked in normal saline. A small-caliber US probe was inserted into one of the small bronchi to obtain the US images. The point where an image was recorded was marked with a pin, and that part was excised for microscopic examination. The US images appeared different among the three lung tissue patterns. The bars in a-c represent 1 mm. (Hematoxylin-eosin stain; original magnification, x2.5.)

View larger version (142K): [in a new window]   Figure 3c. US images and their corresponding photomicrographs of autopsied lungs. The autopsied lungs were from patients with (a) normal, (b) emphysematous, and (c) honeycomb lung. The lungs were fixed in formalin before being cut into 1-cm-thick samples. The samples were removed from formalin and soaked in normal saline. A small-caliber US probe was inserted into one of the small bronchi to obtain the US images. The point where an image was recorded was marked with a pin, and that part was excised for microscopic examination. The US images appeared different among the three lung tissue patterns. The bars in a-c represent 1 mm. (Hematoxylin-eosin stain; original magnification, x2.5.)

View larger version (114K): [in a new window]   Figure 4a. Six tentative echoic patterns (Table 1, patterns A-F) depicted on endobronchial US scans (left) obtained in the 22 patients with various interstitial and alveolar pulmonary diseases and their corresponding transverse CT images (right). The US images represent transverse planes to the inserted bronchi. Among the six patterns, (a) pattern A (patient 5), characterized by a uniformly diffuse fine granular pattern, was considered the normal echoic pattern because it was most frequently observed in normal appearing areas at CT; (b) pattern B (patient 14) is similar to pattern A except that this pattern contained a diffuse dense hyperechoic region at the inner field (arrows); (c) pattern C (patient 8) is characterized by nodular hyperechoic regions (*) scattered in a field with a fine granular pattern and a relatively hypoechoic field (arrows) when compared with patterns A and B at its center; (d) pattern D (patient 10) is a gross patchy combination of hyperechoic (arrows) and hypoechoic (*) pattern; (e) pattern E (patient 20) consisted mainly of a patchy hyperechoic (arrows) pattern; and (f) pattern F (patient 17) features a hypoechoic central ring (arrows), a hyperechoic middle ring (*), and a fine granular pattern (arrowheads) at the outermost ring. The bars on the US images represent 1 mm.

View larger version (111K): [in a new window]   Figure 4b. Six tentative echoic patterns (Table 1, patterns A-F) depicted on endobronchial US scans (left) obtained in the 22 patients with various interstitial and alveolar pulmonary diseases and their corresponding transverse CT images (right). The US images represent transverse planes to the inserted bronchi. Among the six patterns, (a) pattern A (patient 5), characterized by a uniformly diffuse fine granular pattern, was considered the normal echoic pattern because it was most frequently observed in normal appearing areas at CT; (b) pattern B (patient 14) is similar to pattern A except that this pattern contained a diffuse dense hyperechoic region at the inner field (arrows); (c) pattern C (patient 8) is characterized by nodular hyperechoic regions (*) scattered in a field with a fine granular pattern and a relatively hypoechoic field (arrows) when compared with patterns A and B at its center; (d) pattern D (patient 10) is a gross patchy combination of hyperechoic (arrows) and hypoechoic (*) pattern; (e) pattern E (patient 20) consisted mainly of a patchy hyperechoic (arrows) pattern; and (f) pattern F (patient 17) features a hypoechoic central ring (arrows), a hyperechoic middle ring (*), and a fine granular pattern (arrowheads) at the outermost ring. The bars on the US images represent 1 mm.

View larger version (125K): [in a new window]   Figure 4c. Six tentative echoic patterns (Table 1, patterns A-F) depicted on endobronchial US scans (left) obtained in the 22 patients with various interstitial and alveolar pulmonary diseases and their corresponding transverse CT images (right). The US images represent transverse planes to the inserted bronchi. Among the six patterns, (a) pattern A (patient 5), characterized by a uniformly diffuse fine granular pattern, was considered the normal echoic pattern because it was most frequently observed in normal appearing areas at CT; (b) pattern B (patient 14) is similar to pattern A except that this pattern contained a diffuse dense hyperechoic region at the inner field (arrows); (c) pattern C (patient 8) is characterized by nodular hyperechoic regions (*) scattered in a field with a fine granular pattern and a relatively hypoechoic field (arrows) when compared with patterns A and B at its center; (d) pattern D (patient 10) is a gross patchy combination of hyperechoic (arrows) and hypoechoic (*) pattern; (e) pattern E (patient 20) consisted mainly of a patchy hyperechoic (arrows) pattern; and (f) pattern F (patient 17) features a hypoechoic central ring (arrows), a hyperechoic middle ring (*), and a fine granular pattern (arrowheads) at the outermost ring. The bars on the US images represent 1 mm.

View larger version (90K): [in a new window]   Figure 4d. Six tentative echoic patterns (Table 1, patterns A-F) depicted on endobronchial US scans (left) obtained in the 22 patients with various interstitial and alveolar pulmonary diseases and their corresponding transverse CT images (right). The US images represent transverse planes to the inserted bronchi. Among the six patterns, (a) pattern A (patient 5), characterized by a uniformly diffuse fine granular pattern, was considered the normal echoic pattern because it was most frequently observed in normal appearing areas at CT; (b) pattern B (patient 14) is similar to pattern A except that this pattern contained a diffuse dense hyperechoic region at the inner field (arrows); (c) pattern C (patient 8) is characterized by nodular hyperechoic regions (*) scattered in a field with a fine granular pattern and a relatively hypoechoic field (arrows) when compared with patterns A and B at its center; (d) pattern D (patient 10) is a gross patchy combination of hyperechoic (arrows) and hypoechoic (*) pattern; (e) pattern E (patient 20) consisted mainly of a patchy hyperechoic (arrows) pattern; and (f) pattern F (patient 17) features a hypoechoic central ring (arrows), a hyperechoic middle ring (*), and a fine granular pattern (arrowheads) at the outermost ring. The bars on the US images represent 1 mm.

View larger version (122K): [in a new window]   Figure 4e. Six tentative echoic patterns (Table 1, patterns A-F) depicted on endobronchial US scans (left) obtained in the 22 patients with various interstitial and alveolar pulmonary diseases and their corresponding transverse CT images (right). The US images represent transverse planes to the inserted bronchi. Among the six patterns, (a) pattern A (patient 5), characterized by a uniformly diffuse fine granular pattern, was considered the normal echoic pattern because it was most frequently observed in normal appearing areas at CT; (b) pattern B (patient 14) is similar to pattern A except that this pattern contained a diffuse dense hyperechoic region at the inner field (arrows); (c) pattern C (patient 8) is characterized by nodular hyperechoic regions (*) scattered in a field with a fine granular pattern and a relatively hypoechoic field (arrows) when compared with patterns A and B at its center; (d) pattern D (patient 10) is a gross patchy combination of hyperechoic (arrows) and hypoechoic (*) pattern; (e) pattern E (patient 20) consisted mainly of a patchy hyperechoic (arrows) pattern; and (f) pattern F (patient 17) features a hypoechoic central ring (arrows), a hyperechoic middle ring (*), and a fine granular pattern (arrowheads) at the outermost ring. The bars on the US images represent 1 mm.

View larger version (120K): [in a new window]   Figure 4f. Six tentative echoic patterns (Table 1, patterns A-F) depicted on endobronchial US scans (left) obtained in the 22 patients with various interstitial and alveolar pulmonary diseases and their corresponding transverse CT images (right). The US images represent transverse planes to the inserted bronchi. Among the six patterns, (a) pattern A (patient 5), characterized by a uniformly diffuse fine granular pattern, was considered the normal echoic pattern because it was most frequently observed in normal appearing areas at CT; (b) pattern B (patient 14) is similar to pattern A except that this pattern contained a diffuse dense hyperechoic region at the inner field (arrows); (c) pattern C (patient 8) is characterized by nodular hyperechoic regions (*) scattered in a field with a fine granular pattern and a relatively hypoechoic field (arrows) when compared with patterns A and B at its center; (d) pattern D (patient 10) is a gross patchy combination of hyperechoic (arrows) and hypoechoic (*) pattern; (e) pattern E (patient 20) consisted mainly of a patchy hyperechoic (arrows) pattern; and (f) pattern F (patient 17) features a hypoechoic central ring (arrows), a hyperechoic middle ring (*), and a fine granular pattern (arrowheads) at the outermost ring. The bars on the US images represent 1 mm.