PMC6831871_01
Patient procedure preparation.
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PMC6831871_01_gr1.jpg
fig1
Localized pulmonary atelectasis of right middle lobe and slight inflammation of superior segment of left lower lobe (LLL) were shown on the CT scan (Fig. 1A, B). The system not only reconstructed the bronchial tree and major arteries nearby as three-dimensional (3D) structure (Fig. 1C), but also the 3D structure of the foreign body within the BI (Fig. 1D). During the actual procedure, the STORZ rigid bronchoscope (RB) with 12.5mm outside diameter was intubated into the lumen of RMB, then observed that the osseous foreign body's size and location were consistent with preoperative evaluation of VBN (Fig. 1E). The distal end of the RB was carefully adjusted so that the proximal sharp end of the osseous foreign body entered the lumen of the RB (Fig. 1F). The osseous foreign body was 12 x 21 x 8mm in size and consistent with the reconstructed imaging of the foreign body by VBN (Fig. 1H).
PMC6831871_02
Patient procedure preparation.
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PMC6831871_02_gr2.jpg
fig2
After hospitalized thoracic augmented CT scan was done, which revealed high-density curved osseous foreign body shadow in the lumen of left inferior lobar bronchus (Fig. 2A). Obstructive atelectasis in LLL along with moderate amount of pleural effusion in the left thoracic cavity was shown in the enhanced CT scan (Fig. 2B). The image showed the anatomical structure of the foreign body, bronchial tree and large vessels nearby (Fig. 2C). Its distal end located in the lumen of left inferior basal segmental bronchus (Fig. 2C, D), while the proximal end penetrated through the bronchial wall of the orifice of LLL, stabbing into pulmonary parenchyma with 15mm in length. The proximal part of foreign body stabbed into pulmonary parenchyma had a very sharp tip and was very close to the descending aorta only 4mm away (Fig. 2C, E). FB was intubated through the lumen of RB and located the foreign body in the left inferior basal segmental bronchus of LLL, which showed actual location consistent with the VBN preoperative evaluation. Firstly, the thulium laser probe was inserted and separated the intracavitary section of the osseous foreign body with 8W power (Fig. 2F). Endobronchial cryotherapy was applied to deal with the regional granulation tissue (Fig. 2G). The Long curved foreign body was measured with 35 x 20 x 3mm in size, which was consistent with VBN pre-operative evaluation (Fig. 2H).