Bronchoscope Inversion during Transbronchial Biopsy with a Guide Sheath for a Right Upper Lobe Lesion

Bronchoscopic inversion may occur intraoperatively. This can make bronchoscopic handling difficult and cause bronchial wall injury; however, there have been only a few reported cases. A 68-year-old man was referred to our hospital for further evaluation of a right upper lobe mass lesion suspected to be lung cancer. Endobronchial ultrasound transbronchial biopsy with a guide sheath (EBUS-GS-TBB) was performed for further examination. During bronchial brushing from the right B1aiα, the bronchoscope was inverted on the bronchoscopic view, and fluoroscopy confirmed that the tip of the bronchoscope had formed a loop in the intermediate bronchus. Under fluoroscopic guidance, the bronchoscope was advanced into the left main bronchus and withdrawn by gentle clockwise rotation, and the inversion was released. In conducting procedures that require deep peripheral insertion of a thin bronchoscope, such as EBUS-GS-TBB, for right upper lobe lesions, the inversion should be handled carefully, and operators should not push it extremely hard. To release the inversion, operators should not try to pull it out forcibly but should check the overall image of the bronchoscope under fluoroscopy.