The Essential cTBNA Bronchoscopist

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Question I.2 Which of the following statements about the right upper lobe bronchus is correct?A. The posterior portion of the right upper lobe bronchus is devoid of any vascularrelationships.B. The anterior portion of the right upper lobe bronchus is devoid of any vascularrelationships.C. The pulmonary vein is in direct contact with the right upper lobe bronchus.Answer: ANo vascular structure is directly adjacent to the posterior aspect of the right upper lobebronchus. Anterior lies the pulmonary vein, but it is not in direct contact with the bronchus. Theright pulmonary artery is adjacent to the anterior wall of the right upper lobe bronchus andorigin of the bronchus intermedius. Needle aspiration at this site would be dangerous. Note thatthe direction of the right upper lobe bronchus in this cast is more vertical than usual.12
Question I.3 While performing transbronchial needle aspiration of nodal station 4R (rightparatracheal), you insert the needle 2 cm above the carina, and laterally at the 3 o’clock position(imagining the interior of the airway as a clock face and using the carina as the central referencepoint). Which of the following is a major anatomic danger?A. The aortaB. The right pulmonary arteryC. The azygos veinD. The esophagusAnswer: CAnterior and to the right of the distal third of the trachea lie the superior vena cava and theazygos vein. Needle insertion at this site risks causing pneumothorax or bleeding. The rightpulmonary artery is anterior to the right main bronchus and origin from the right upper lobebronchus. Needle insertion through the anterior wall of the right main bronchus at the level ofthe origin of the right upper lobe bronchus should be avoided. The esophagus lies closely(within 2-3 mm) behind the posterior wall of the trachea and left main bronchus. Theinnominate artery and the aortic arch lie directly anterior to the trachea, just above the maincarina and coursing slightly to the left of the distal trachea where one can see a slight indent andfaint pulsations. Obviously, it would be unwise to insert a needle into this area!13
Page 2 and 3: FIRST EDITIONThe EssentialcTBNA Bro
Page 4 and 5: The Essential cTBNABronchoscopistCo
Page 6 and 7: Bronchoscopy International, Laguna
Page 8 and 9: Funding statementFunding for The Es
Page 11 and 12: MODULE 1THIRTY MULTIPLE CHOICE QUES
Page 13: Question I.1 The right pulmonary ar
Page 17 and 18: Question I.5 Where are the right pa
Page 19 and 20: Aortic archNeedle through bifurcati
Page 21 and 22: Question I.8 Which of the following
Page 23 and 24: needle through the airway wall. Onc
Page 25 and 26: Question I.11 A patient with subcar
Page 27 and 28: Question I.12 Flexible bronchoscopy
Page 29 and 30: Proposed indications include stagin
Page 31 and 32: Question I.15 Which of the followin
Page 33 and 34: Question I.17 After two aspirates f
Page 35 and 36: Question I.18 While performing cTBN
Page 37 and 38: Question I.19 A patient is referred
Page 39 and 40: Question I.20 While performing cTBN
Page 41 and 42: Question I.22 A 39-year-old man wit
Page 43 and 44: Question I.23 During a cTBNA stagin
Page 45 and 46: may develop unless flow, respirator
Page 47 and 48: helps identify multiloculation and
Page 49 and 50: Example of an endobronchial lesion
Page 51 and 52: Example of transbronchial needle as
Page 53 and 54: Question I.29 A 69 year old smoker
Page 55 and 56: management.References1. Herth F, Be
Page 57 and 58: insertion depth of the needle. By t
Page 59 and 60: CONGRATULATIONSYou have now complet
Page 61 and 62: The Essential cTBNA BronchoscopistM
Page 63 and 64: Question 8.Each of the following is
Page 65 and 66:
ANSWERSTO MODULE 1, TWELVE QUESTION
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CONGRATULATIONSYou have now complet
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CONTRIBUTORSHenri Colt M.D. is Prof
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THE ESSENTIAL cTBNA BRONCHOSCOPIST
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The Essential cTBNA Bronchoscopist

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