Bronchoscopic Diagnosis of Bronchial Dieulafoy Disease in 183 Cases Wuhan Pulmonary Hospital

Objective:&nbsp;A retrospective analysis was performed to investigate the clinical manifestations of 183 confirmed cases of bronchial Dieulafoy disease (BDD) and to evaluate bronchoscopy-based diagnostic approaches, including key procedural techniques and interpretive criteria.&nbsp;<br><br>Methods:&nbsp;Bronchoscopic examination identified suspected bronchial Dieulafoy disease (BDD) lesions. Key endoscopic features—including lesion location, morphology, visible pulsation, and the characteristic vascular filling phenomenon—were systematically documented. Narrow-band imaging (NBI) was employed to enhance visualization of vascular pulsation. All suspected cases underwent independent re-evaluation by two senior bronchoscopists with subspecialty expertise in airway endoscopy (each with ≥20 years of dedicated experience and &gt;30,000 performed bronchoscopies), and final BDD diagnoses were established through consensus. <br><br>Results:&nbsp;Among the 183 cases of BDD, 173 cases (94.5%) showed vascular pulsation during bronchoscopy. 142 cases (77.6%) were diagnosed with the assistance of NBI technology, making the vascular pulsation more obvious. The airways also showed bronchial dilation in 92 cases (50.3%), chronic bronchitis in 67 cases (36.6%), bronchial tuberculosis in 53 cases (29.0%), and bronchial variations in 9 cases (4.9%). The BDD lesions were located in the middle lobe bronchus in 56 cases (30.5%), followed by the right upper bronchus in 36 cases (19.7%) and the left upper bronchus in 33 cases (18.0%). The BDD lesions had 7 manifestations (nodule-like protrusion, longitudinal protrusion, transverse protrusion, diffuse-like protrusion, circular-like protrusion, worm-like protrusion, and peak-like protrusion). Nodule-like protrusion was found in 52 cases (28.4%), longitudinal protrusion in 51 cases (27.9%), and peak-like protrusion in 41 cases (22.4%). In 5 BDD cases during bronchoscopy, 3 cases had massive hemorrhage&nbsp;due to biopsy and bronchial lavage, and 2 cases had moderate hemorrhage. All of these occurred in the right bronchus, and hemostasis through body position was effective.&nbsp;<br><br>Conclusion: BDD refers to abnormal vascular protrusions on the bronchial wall, which are prone to hemorrhage. During bronchoscopy, clamping can easily trigger fatal massive hemorrhage. Therefore, it is contraindicated to clamp any suspicious BDD lesions. Lesions with obvious vascular exposure are contraindicated for all bronchoscopy intervention measures. In BDD cases, males are more common than females. The disease can occur at any age. The cause is related to congenital bronchial variations and chronic inflammatory damage after birth. The definitive treatment methods include bronchial artery embolization and surgical resection of the lung lobe containing BDD. Bronchoscopy physicians should be familiar with the 7 types of BDD lesions, namely nodular protrusion, longitudinal protrusion, transverse protrusion, diffused protrusion, circular-like protrusion, worm-like protrusion, and peak-like protrusion. When bronchoscopy detects protrusive lesions on the bronchial wall, it is necessary to carefully distinguish whether there is pulsation. NBI can be used to assist in determining the presence of pulsation and the filling changes of the blood vessels. CTA is the main method for diagnosing BDD, and pathology can sometimes also assist in diagnosis.