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Bronchoscopic Visualization of the Alveoli

Nishimura, Naoki MD, PhD; Jinta, Torahiko MD, PhD; Tomishima, Yutaka MD; Chohnabayashi, Naohiko MD, PhD

Journal of Bronchology & Interventional Pulmonology: July 2014 - Volume 21 - Issue 3 - p 227–229
doi: 10.1097/LBR.0000000000000077
Images in Interventional Pulmonology

We report a rare case in which we were able to visualize the lung alveoli through the bronchial wall by a bronchoscope in a patient with marked bronchiectasis and performed lung biopsy safely under direct vision. An 80-year-old woman presented with complaints of a severe persistent cough for the past 6 months. A chest computed tomography scan revealed diffuse interstitial pneumonia with marked bronchiectasis. Bronchoscopy also revealed marked bronchiectasis. After inserting the bronchoscope into the 10th-generation bronchus, we observed a honeycomb pattern through the bronchial wall, which represented the alveoli. We perforated the bronchial wall by using biopsy forceps and performed lung biopsy under direct vision. The pathologic diagnosis revealed interstitial pneumonia with epithelioid granuloma and cholesterin-like substance, which were indicative of hypersensitivity pneumonia. The routine performance of true “trans”-bronchial lung biopsy will be possible if a thin bronchoscope with high-quality imaging is developed in the future.

Division of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan

Disclosure: There is no conflict of interest or other disclosures.

Reprints: Naoki Nishimura, MD, PhD, Division of Pulmonary Medicine, St. Luke’s International Hospital, Chuo City, Tokyo, 104-8560, Japan (e-mail:

Received June 17, 2013

Accepted April 21, 2014

© 2014 by Lippincott Williams & Wilkins.