Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1132-1138
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1132
Bronchoscopy for diagnosis of COVID-19 with respiratory failure: A case report
Qing-Yun Chen, Yu-Sheng He, Kai Liu, Jing Cao, Yong-Xing Chen
Qing-Yun Chen, Kai Liu, Yong-Xing Chen, Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Haikou 570311, Hainan Province, China
Yu-Sheng He, Department of Internal Medicine, Hainan Province's Fucheng Drug Rehabilitation Centre, Haikou 570311, Hainan Province, China
Jing Cao, Infection Department, Hainan General Hospital, Haikou 570311, Hainan Province, China
Author contributions: Chen QY and He YS were responsible for writing the paper; Chen QY and Liu K participated in the management of the patient; Chen QY, Liu K, and Cao J conducted fiberoptic bronchoscopy; Chen YX provided guidance in all aspects of patient management, fiberoptic bronchoscopy, and paper writing. All authors have read and approved the manuscript.
Supported by 2019 Hainan Provincial Health and Family Planning Industry Research Project, No. 19A200037.
Informed consent statement: Written informed consent was obtained prior to the study.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to report.
CARE Checklist (2016) statement: The authors have read the care checklist (2016), and the manuscript was prepared and revised according to the care checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Xing Chen, MSc, Doctor, Department of Respiratory and Critical Care Medicine, Hainan General Hospital, No. 19 Xiuhua Road, Haikou 570311, Hainan Province, China. chenyongxing1969@163.com
Received: September 4, 2020
Peer-review started: September 4, 2020
First decision: November 30, 2020
Revised: December 24, 2020
Accepted: January 5, 2021
Article in press: January 5, 2021
Published online: February 16, 2021
Abstract
BACKGROUND

Although the imaging features of coronavirus disease 2019 (COVID-19) are starting to be well determined, what actually occurs within the bronchi is poorly known. Here, we report the processes and findings of bronchoscopy in a patient with COVID-19 accompanied by respiratory failure.

CASE SUMMARY

A 65-year-old male patient was admitted to the Hainan General Hospital on February 3, 2020 for fever and shortness of breath for 13 d that worsened for the last 2 d. The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive. Routine blood examination on February 28 showed a white blood cell count of 11.02 × 109/L, 86.9% of neutrophils, 6.4% of lymphocytes, absolute lymphocyte count of 0.71 × 109/L, procalcitonin of 2.260 ng/mL, and C-reactive protein of 142.61 mg/L. Oxygen saturation was 46% at baseline and turned to 94% after ventilation. The patient underwent video bronchoscopy. The tracheal cartilage ring was clear, and no deformity was found in the lumen. The trachea and bilateral bronchi were patent, while the mucosa was with slight hyperemia; no neoplasm or ulcer was found. Moderate amounts of white gelatinous secretions were found in the dorsal segment of the left inferior lobe, and the bronchial lumen was patent after sputum aspiration. The right inferior lobe was found with hyperemia and mucosal erosion, with white gelatinous secretion attachment. The patient’s condition did not improve after the application of therapeutic bronchoscopy.

CONCLUSION

For patients with COVID-19 and respiratory failure, bronchoscopy can be performed under mechanical ventilation to clarify the airway conditions. Protection should be worn during the process. Considering the risk of infection, it is not necessary to perform bronchoscopy in the mild to moderate COVID-19 patients.

Keywords: COVID-19, Respiratory failure, Bronchoscopy, Diagnosis, Treatment, Case report

Core Tip: A 65-year-old male patient was admitted to the Hainan General Hospital on February 3, 2020 for fever and shortness of breath for 13 d that worsened for the last 2 d. The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive. Routine blood examination on February 28 showed a white blood cell count of 11.02 × 109/L, 86.9% of neutrophils, 6.4% of lymphocytes, absolute lymphocyte count of 0.71 × 109/L, procalcitonin of 2.260 ng/mL, and C-reactive protein of 142.61 mg/L. Oxygen saturation was 46% at baseline and turned to 94% after ventilation.