Comparison of virtual bronchoscopy with fiberoptic bronchoscopy findings in patients exposed to sulfur mustard gas

Background: Fiberoptic bronchoscopy (FB) is the best modality for evaluation of tracheobronchial endoluminal lesions. Virtual bronchoscopy (VB) with the aid of computed tomography (CT) makes it possible to reconstruct endoscopic-like visualization of major airways. Sulfur mustard (SM) used during the Iraq-Iran war affects respiratory tracts and can lead to tracheobronchial stenosis. Purpose: To compare VB with FB in SM-exposed patients suspected for airway stenosis. Material and Methods: Thirty-one patients were evaluated with CT and bronchoscopic studies about 15 years after chemical attacks. The median age of patients was 40 years. Spiral CT scans were obtained and data were transferred to a workstation to generate VB images of major airways. Less than one week after CT scan, FB was performed. Results: For the tracheal pathologies seen in FB, the sensitivity, specificity, and accuracy of VB was 90.9%, 95%, and 93.5% for tracheal stenosis, 40%, 96.2%, and 87.1% for vocal cord problems, 100%, 100%, and 100% for postoperative changes, and 100%, 96.7%, and 96.8% for intratracheal nodule. The inflammation of mucosal surface could not be assessed by VB. The bronchial pathologies seen in FB included eight cases of stenosis, and one case of nodule. Sensitivity, specificity, and accuracy of VB for detection of bronchial stenosis was 62.5%, 97.8% and 92.6%, respectively. Overall sensitivity, specificity and accuracy of VB in detecting tracheobronchial stenosis were 78.9%, 97.0%, and 92.9%, respectively. Conclusion: Our study indicates that VB is an accurate method for evaluating stenoses, endoluminal nodules, and poststenotic areas within the tracheobronchial tree of SM-exposed victims. This complementary method could be helpful in revealing hidden post-stenotic lesions and also better depict the long tracheal strictures and their actual length.