Abstract
Sir,
We read with interest the manuscript titled ‘Comparison of virtual bronchoscopy with fiberoptic bronchoscopy findings in patients exposed to sulfur mustard gas’, by Akhlaghpoor et al., published in the December issue of Acta Radiologica (1).
The authors have compared virtual bronchoscopy (VB) with fiberoptic bronchoscopy in patients suspected for airway stenosis exposed to sulfur mustard gas. The authors have considered only two isolated anatomical locations: trachea and main bronchi. We wish to add here that with current CT technology (64-, 128–320 slice CT), segmental and subsegmental bronchi can be evaluated easily with thin section multidetector CT images and VB (2, 3). We assume the authors might have stated this as their study was based on a single-slice CT scan. A major drawback of fiberoptic bronchoscopy is that it cannot detect other findings beyond a stenotic site, while VB can detect additional narrowing/pathology in segmental and subsegmental bronchi in airways distal to the obstruction.
Other advantages offered by CT virtual bronchoscopy is that it allows simultaneous evaluation of mediastinal and lung pathologies, vascular anomalies and can help the pediatric surgeon or pulmonologist in prebronchoscopic road mapping.
We agree with the authors' conclusion that VB is an accurate and non-invasive method for evaluating stenosis and post-stenotic areas within the tracheobronchial tree. However, we would like to add from our previous experience that it still fails to disclose the exact nature of obstructing pathology which is finally detected by rigid/flexible bronchoscopy (2, 3). Other possible drawbacks of VB in comparison to fiberoptic bronchoscopy is that it cannot be used to obtain biopsy specimens. However, in this group the most appropriate site for sampling can be chosen interactively by VB. The other limitations of VB are its inability to assess mucosal morphology, vascularity, and color, as also reported by the authors in their study (1).