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Updated: Apr 27, 2026

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Bronchoscopic visualization of the alveoli.

Naoki Nishimura1, Torahiko Jinta, Yutaka Tomishima

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This case study demonstrates visualizing lung alveoli through the bronchial wall during bronchoscopy in a patient with severe bronchiectasis. This rare observation allowed for a safe, direct-vision lung biopsy, aiding diagnosis.

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Area of Science:

  • Pulmonology
  • Interventional Pulmonology
  • Pathology

Background:

  • A severe persistent cough prompted evaluation in an 80-year-old woman.
  • Chest CT revealed diffuse interstitial pneumonia with marked bronchiectasis.

Observation:

  • Bronchoscopy identified significant bronchiectasis.
  • A honeycomb pattern, representing lung alveoli, was visualized through the bronchial wall.
  • Lung biopsy was safely performed under direct vision via bronchial wall perforation.

Findings:

  • Pathologic diagnosis confirmed interstitial pneumonia with epithelioid granuloma.
  • Findings were indicative of hypersensitivity pneumonia, including cholesterin-like substances.

Implications:

  • This case highlights a rare visualization of alveoli via the bronchial wall.
  • Future development of thin bronchoscopes with advanced imaging could enable routine trans-bronchial biopsies.
  • Direct visualization biopsy techniques may improve diagnostic accuracy in complex lung diseases.