Wallace J M, Catanzaro A, Moser K M, Harrell J H
Am Rev Respir Dis. 1981 Mar;123(3):286-90. doi: 10.1164/arrd.1981.123.3.286.
To assess the diagnostic yield of flexible fiberoptic bronchoscopy (FFB), we reviewed records of 30 patients who had (1) cultural and/or histologic evidence of coccidioidomycosis, (2) abnormal chest roentgenograms, and (3) undergone FFB. Each patient underwent a complete examination including sputum collection for smears and culture. As additional diagnostic information was needed, FFB was performed in all patients, followed by percutaneous needle aspiration in 4 patients and thoracotomy in 10. Prebronchoscopy sputum cultures yielded Coccidioides immitis in 6 of 30 patients (20%). Bronchoscopy provided specimens diagnostic of coccidioidomycosis in 16 of 30 patients (53%), and in 10 of 30 (33%), FFB was the first procedure of the examination to produce a diagnostic specimen. The diagnosis was first obtained by needle aspiration in 1 of 30 (3%), by extrathoracic specimens in 3 of 30 (10%), and by thoracotomy in 10 of 30 (33%). All 8 patients with a solitary pulmonary nodule (SPN) had nondiagnostic FFB and comprised the majority of patients not diagnosed until thoracotomy was performed. When patients with a SPN were excluded, 20 of 29 (69%) FFB procedures documented coccidioidal infection. Seven of 22 (32%) prebronchoscopy sputum collections compared with 17 of 29 (59%) FFB procedures produced positive cultures for C. immitis. One of 22 (5%) prebronchoscopy sputum collections, compared with smears and biopsies from 8 of 29 (28%) FFB procedures, produced immediate microscopic evidence of coccidioidomycosis. Coexisting pulmonary pathologic findings in 4 patients were uncovered by FFB. Except in patients with a SPN, FFB is a valuable procedure for documenting pulmonary coccidioidomycosis when sputum specimens are nondiagnostic.
为评估可弯曲纤维支气管镜检查（FFB）的诊断价值，我们回顾了30例患者的病历，这些患者具备以下情况：（1）有球孢子菌病的培养和/或组织学证据；（2）胸部X线片异常；（3）接受了FFB检查。每位患者均接受了全面检查，包括采集痰液进行涂片和培养。由于需要更多诊断信息，所有患者均接受了FFB检查，其中4例患者随后接受了经皮针吸活检，10例患者接受了开胸手术。支气管镜检查前的痰液培养在30例患者中有6例（20%）培养出粗球孢子菌。支气管镜检查在30例患者中有16例（53%）提供了诊断球孢子菌病的标本，在30例患者中有10例（33%），FFB是检查中首个获取诊断性标本的操作。30例患者中有1例（3%）通过针吸活检首次获得诊断，3例（10%）通过胸外标本获得诊断，10例（33%）通过开胸手术获得诊断。所有8例孤立性肺结节（SPN）患者的FFB检查均未得出诊断结果，这些患者占直到开胸手术才得以诊断的患者的大多数。排除SPN患者后，29例患者中有20例（69%）的FFB检查记录了球孢子菌感染。22例支气管镜检查前的痰液采集中有7例（32%）培养出粗球孢子菌阳性，而29例FFB检查中有17例（59%）培养出阳性。22例支气管镜检查前的痰液采集中有1例（5%）发现球孢子菌病的直接镜下证据，而29例FFB检查中有8例（28%）的涂片和活检发现了球孢子菌病的直接镜下证据。FFB发现了4例患者并存的肺部病理表现。除SPN患者外，当痰液标本无法诊断时，FFB是记录肺部球孢子菌病的一项有价值的检查。
