Wegener's Granulomatosis

Before and After Balloon Bronchoplasty

Table of Contents:

Patient History

Pictures

Original CT Movies

Surfaced Rendered Movies

Volumed Rendered Movies

Measurements of the Airways

Summary

Patient History

by Geoffrey McLennan, M.D.

The subject is a 60 year old male with Wegener's Granulomatosis. This disease has been treated for a number of years with steroids and cyclophosphamide. The patient has been developing increasing breathlessness for the last two years. It is known that he has Wegener's disease in the bronchial tree.

Bronchoscopy showed severe stenosis of the left main bronchus, with extreme stenoss of the left upper lobe orifice and the right middle lobe.

Balloon bronchoplasty was performed with dilatation of the left upper lobe orifice and the right middle lobe using a 4 mm diameter balloon. This did not help his breathlessness. Several weeks later he underwent further balloon bronchplasty. On this occasion, his left main bronchus was dilated using an 8 mm diameter balloon.

Following this procedure, he has felt remarkably improved and has returned to work, with only minimal breathlessness on exertion.

He remains on active therapy for Wegener's, and at each bronchoscopy his airways have appeared inflammed -- especially the lower trachea. In spite of his dramatic clinical improvement, his lung function remains unchanged.

Pictures

MPEG Movies

Original CT Scans

Original Helical CT data (Before Balloon Bronchoplasty)

The original trans axial section Cine CT data set of a bronchial stenosis of the left bronchus before balloon bronchoplasty. The images are 3 mm thick.

Original Helical CT data (After Balloon Bronchoplasty)

The original trans axial section Cine CT data set of a bronchial stenosis of the left bronchus after balloon bronchoplasty. The images are 3 mm thick.

Original CT from March 1999 scan

Original CT from Feb. 16, 2001 scan

The original trans axial section Cine CT data set of a bronchial stenosis of the left bronchus. The images are 1 mm thick, overlapping every 0.5 mm. There are 376 slices.

Surface Rendered

3D Movie of Entire Airway (After Balloon Bronchoplasty)

3D Movie of Left Bronchus (Before Balloon Bronchoplasty).

3D Movie of Left Bronchus (After Balloon Bronchoplasty).

3D Movie of Entire Airway from March 1999 scan.

3D Movie of Entire Airway from Feb. 2001 scan.

Volumed Rendered Movies

Movie from the Feb. 2001 scan.(here is a picture.)

Measurments

Cross-sectional Area Before and After Balloon Bronchoplasty

March 1, 1999 Measurements

Tube Geometry Analysis Summary
Date            : Fri Mar  5 19:30:00 1999
Oblique slices  : 7
Note            : Left Main Bronchus near narrowing
 
Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      23.832   6.152    4.785  (308.07,278.29, 26.08)   6.190   3.486       3.486 
    2      21.496   5.469    4.785  (310.94,277.31, 26.61)   5.637   3.486       4.834 
    3      13.552   4.785    3.418  (313.91,276.53, 27.02)   4.323   2.162       3.681 
    4      10.281   3.418    4.102  (316.79,277.14, 28.00)   4.377   1.933       2.465 
    5      20.094   6.836    2.734  (319.94,275.32, 28.61)   6.971   2.734       2.819 
    6      32.244   5.469    7.520  (323.08,277.13, 29.35)   7.363   4.323       4.323 
    7      42.524   6.836    7.520  (325.79,275.21, 30.90)   7.794   5.511       6.485

Feb 16, 2001 Measurements

Tube Geometry Analysis Summary
Date            : Tue Feb 20 22:28:03 2001
Oblique slices  : 15
Segmented image : airseglmb.s175-244_int_obl
Original image  : airseg
Note            : lmb and lib

Slice Area [mm^2] AP [mm] Lat [mm]               Position   Major   Minor  Orthogonal
    1      42.989   9.730    5.560  (160.34,146.35,  2.74)   9.141   5.012       5.060 
    2      60.861   9.730    7.645  (165.45,146.40,  4.10)   9.453   6.845       7.256 
    3      56.514   8.340    6.950  (170.11,146.40,  5.33)   9.878   6.950       7.388 
    4      42.506   6.950    6.950  (174.76,146.49,  6.60)   8.369   5.603       6.408 
    5      33.329   6.255    6.950  (179.41,146.94,  7.70)   6.985   4.914       4.914 
    6      25.117   4.865    5.560  (183.86,146.08,  9.28)   5.731   3.743       3.743 
    7      23.185   5.560    5.560  (188.52,145.30,  9.87)   5.560   3.932       4.865 
    8      18.355   4.865    4.170  (193.12,144.10, 10.04)   5.012   3.743       4.450 
    9       9.660   2.780    3.475  (197.92,143.21, 10.33)   3.475   1.390       1.390 
   10      18.355   4.170    5.560  (202.65,142.05, 10.71)   5.731   2.949       3.544 
   11      29.948   5.560    6.255  (206.82,139.23, 11.51)   6.408   5.012       5.731 
   12      26.083   5.560    5.560  (209.62,136.72, 14.96)   5.731   4.170       5.060 
   13      22.219   4.170    5.560  (213.63,135.62, 17.21)   5.603   4.228       4.228 
   14      19.321   4.865    4.865  (217.23,134.60, 20.09)   5.603   3.108       3.108 
   15      11.593   2.780    4.170  (220.03,131.45, 22.96)   4.662   2.085       2.506

Summary

This case demonstrates the utility of balloon bronchoplasty for chronic inflammatory conditions.

Last modified: Fri Jul 20 17:12:57 CDT 2001