September 26, 2017

Bronchoscopy

A bronchoscopy is a simple procedure that involves placing a special instrument, called a bronchoscope, down the patient’s airway to see inside the throat, trachea, and lungs. This examination is important because it allows the doctor to immediately see physical problems or conditions.

What are the uses of bronchoscopy?

  • Immediate identification of physical airway problems such as bleeding, obstruction, or narrowing
  • Sample tissue or lymph nodes to diagnose conditions or cancer (see lung biopsy)
  • Placement of stents to open up airways that have narrowed (strictures)
  • Remove obstructive cancers or tumors found in the airway

There are two types of bronchoscopy, flexible and rigid bronchoscopy.

Flexible Bronchoscopy: This scope is a long and thin tube, with a camera mounted on the end that allows the doctor view inside the lungs through a TV monitor. Flexible bronchoscopy is used more often than a rigid bronchoscope because it is more comfortable for the patient, can be performed whether the patient is awake or asleep, and allows for a variety of tissue sampling.

Rigid bronchoscope: This instrument, used mostly by anesthesia, is a straight, rigid, and hollow metal tube that provides ventilation and access to the airway. This can only be used when the patient is asleep and allows doctors to remove larger tissue samples, treat bleeding, as well as remove objects blocking the airway.

How is a bronchoscopy performed?

A flexible bronchoscopy can be done in the patient’s hospital room, in the intensive care unit (ICU), or ideally in the operating room. If the patient is awake, a sedative will be provided to help the patient relax. Usually a spray of local anesthetic into the nose, mouth, and airway will numb the feeling – allowing for easier insertion of the bronchoscope.

In a bronchoscopy, the scope will either be inserted into the nose or mouth, then advanced past the vocal cords and into the upper and lower airways. The doctor is able to see into the patient’s airway through a TV monitor. The scope allows the doctor to spray lidocaine to numb the airway, a salt solution (saline) to collect samples, as well as suction out any blockages, extra fluids, etc.

A rigid bronchoscopy is usually performed under anesthesia. Once the patient is asleep, his/her head will be carefully tilted back to extend the airway. A tube is placed down the windpipe to help the patient breath while performing the procedure. The bronchoscope tube is then carefully inserted through the mouth and into the airway. This hollow tube allows the surgeon to treat bleeding, remove larger tissue samples, clear the airway of objects that cannot be removed by a flexible bronchoscopy, or perform other special procedures.

Reasons to perform a bronchoscopy:

  • Inspect foreign objects or tumors seen from other tests like X-rays and CT scans
  • Patient is coughing up blood
  • Infection of the lungs
  • Trouble breathing caused from a narrow or obstructed airway
  • Examination for suspected lung disease

Treatments with bronchoscopy:

  • Sample tissue (see lung biopsy)
  • Remove an object blocking the airway
  • Widen (dilate) an airway that is narrow or blocked
  • Remove excess fluid

Risks of bronchoscopy include:

  • Bleeding from a biopsy
  • Infection
  • Breathing difficulties
  • Low blood oxygen
  • Sore throat
  • Collapsed lung (pneumothorax)

Goals of a bronchoscopy:

  • Identify problems or conditions
  • Achieve an accurate diagnosis from a biopsy
  • Perform a minimally invasive procedure
  • Increase ability to breath by removing blockages