Correct!
4. 1 or 3
Rigid bronchoscopy may be considered as this procedure could provide the technical requirements needed to grasp the endobronchial lesion and resect it, as well as control procedural complications, such as hemorrhage. However, given that the right lower lobe has been essentially destroyed by bronchiectasis, undoubtedly post-obstructive in nature, there is an argument for resecting the right lower lobe and simultaneously removing the endobronchial lesion as well as the diseased right lower lobe. Catheter aortography with bronchial artery embolization is commonly employed to control hemorrhage from the airways and / or lung parenchyma resulting from bronchial artery hypertrophy, commonly in the setting of chronic inflammatory conditions of the lung. This patient does have bronchial artery hypertrophy, likely the result of the long-standing recurrent inflammation resulting from the bronchiectasis [itself the result of focal bronchial obstruction], but the patient is not actively bleeding and hence this procedure is not required at this point. Catheter aortography with bronchial artery embolization in this context could be considered as a pre-operative procedure to control hemorrhage prior to surgical resection, however. Endoscopic ultrasound is not a useful procedure here- the lesion is not resectable, and probably even visible, through an esophageal approach.
Rigid bronchoscopy was considered, but the patient ultimately underwent right lower lobe resection (Figure 5).
Figure 5. Intraoperative views of the right lower lobe resection (A and B) showing bronchiectasis.
Which of the following represents the most likely diagnosis for this patient? (Click on the correct answer to proceed to the eighth and final page)