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PREOPERATIVE DIAGNOSIS: Persistent pneumonia, right upper lobe of the lung, possible mass.

POSTOPERATIVE DIAGNOSIS: Persistent pneumonia, right upper lobe of the lung, possible mass.

PROCEDURE: Bronchoscopy with brush biopsies.

DESCRIPTION OF PROCEDURE: After obtaining an informed consent, the patient was taken to the operating room where he underwent a general endotracheal anesthesia. A time-out process had been followed and then the flexible bronchoscope was inserted through the endotracheal tube after 2 cc of 4% lidocaine had been infused into the endotracheal tube. First the trachea and the carina had normal appearance. The scope was passed into the left side and the bronchial system was found to be normal. There were scars and mucoid secretions. Then the scope was passed into the right side where brown secretions were obtained and collected in a trap to be sent for culture and sensitivity of aerobic and anaerobic fungi and TB. First, the basal lobes were explored and found to be normal. Then, the right upper lobe was selectively cannulated and no abnormalities were found except some secretions were aspirated. Then, the bronchi going to the three segments were visualized and no abnormalities or mass were found. Brush biopsy was obtained from one of the segments and sent to Pathology.

The procedure had to be interrupted several times because of the patient's desaturation, but after a few minutes of Ambu bagging, he recovered satisfactorily.

At the end, the patient tolerated the procedure well and was sent to the recovery room in satisfactory condition.

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