4. Therapeutic bronchoscopy
The CT scan shows atelectasis of the left lower lobe. The management of atelectasis in mechanically ventilated patients is controversial but most agree there is a role for therapeutic bronchoscopy in selected patients (2,3). The other modalities have not been convincingly demonstrated to improve atelectasis.
Bronchoscopy was performed and revealed a soft, vascular mass in the left mainstem bronchus (Figure 2).
Figure 2. Bronchoscopic view of the left mainstem bronchus.
Biopsies and washings from the endobronchial mass were performed (Figure 3).
Figure 3. Grocott silver stain of lung washings.
At about the same time the patient showed a coffee-ground return from his nasogastric (NG) tube. Esophagogastroduodenoscopy (EGD) was performed and showed numerous gastric ulcers (Figure 4).
Figure 4. View from the EGD showing numerous gastric ulcers.
Biopsy of the ulcers showed organisms similar to those found at bronchoscopy/
What should be done next? (Click on the correct answer to proceed to the fifth and final panel)