Definition and Overview

Bronchoscopy is a medical procedure that is carried out by threading an instrument known as bronchoscope through the throat, larynx, trachea and into the bronchi to view the thoracic region. It may be performed to diagnose and treat a disease, as well as to obtain a tissue sample or mucus biopsy.

The bronchoscope is inserted either through the mouth or nose. It is equipped with a light to illuminate the pathway, highlight the bronchi of the lungs, and make images clearer. It is also equipped with a camera that takes pictures of the organs that are later used for assessment.

There are two types of bronchoscopes that are used for this procedure: rigid or flexible. The flexible bronchoscope provides little to no discomfort. The patient can take the test with only little sedation or local anesthesia. Meanwhile, a rigid bronchoscope requires general anesthesia. However, it may be necessary when the patient coughs up a lot of blood.

Some hospitals offer virtual bronchoscopy, which is a CT scan that targets the same area. The patient lies on the scanning table, while the scanner moves around the body to get a detailed picture of the chest and the trachea. Although this exam creates good results, more detailed information on the airway and the lungs can only be obtained through a standard bronchoscopy.

The test may be performed in a hospital setting or an outpatient clinic. It can also be carried out even if patients have feeding tubes.

Who should undergo and expected results

Bronchoscopy is recommended for patients who have persistent lung problems, such as an inflammation of the bronchial tubes, chronic coughing, or breathing difficulties. This may be performed after other lung tests such as an X-ray or physical exam produced abnormal or suspicious results. Meanwhile, some hospitals now use laser along with the bronchoscope to destroy tumours.

The test can also be performed to remove a tumour or obtain a tissue sample for biopsy, which will determine if the mass or the cells in the tissue are benign or malignant (cancerous). In cases that involve foreign bodies lodged in the airway, bronchoscopy can be used to locate the blockage so it can easily be removed.

Bronchoscopy is also necessary when the patient's lungs have collapsed, a condition known as pneumothorax. This occurs when the air that goes out of the lungs surrounds the organs, putting immense pressure on them. This narrows the space of the lungs, which leads to difficulty in breathing.

Any breathing abnormality may also require bronchoscopy, especially if it's laboured or too loud (e.g., obstructive sleep apnoea).

After the exam, the patient may be placed in a monitoring room for at least an hour or until the medicine such as the anaesthesia completely wears off. The patient will then be advised to avoid drinking and any strenuous activity within the next 24 to 48 hours.

How the procedure works

Patients who are scheduled for bronchoscopy are required to fast after midnight, except when medications have to be taken in which only sips may be recommended. Sometimes doctors would advise cessation of medications at least a few days before the exam.

The first steps of the procedure depend on the type of bronchoscope to be used. Both would require an IV (a catheter inserted into the veins) to deliver the medications, such as anesthesia, for the patient's comfort. If it's a rigid bronchoscope, the presence of an anesthesiologist is needed for monitoring.

Since the procedure may limit the breathing process, the patient is connected to a machine that monitors the vitals such as heart rate and blood pressure. Oxygen may be delivered through the nose or the mouth using a short tube or a cannula.

A local anesthetic is administered to the back of the throat and the nose, where the bronchoscope will pass through. The bronchoscope is then inserted into the mouth or nose, passing the vocal cords, the windpipe, and the lungs in the process.

The camera will then start taking pictures. The specialist may also opt to perform a needle aspiration or a biopsy using forceps to obtain samples of the tissue, fluid, or mucus.

The test takes about an hour to complete.

Possible risks and complications

Bronchoscopy is generally a very safe procedure, even if it is a bit uncomfortable for the patient. There could be minor bleeding lasting up to 2 days after the examination. The voice may sound hoarse and the throat may be inflamed due to the insertion of the tube. All of these, though, should disappear after a couple of days and the lung specialist can easily manage them.

More severe risks and complications can include reduced oxygen level, injury to the vocal cords, punctured lung, and excessive bleeding.

References:

  • Kraft M. Approach to the patient with respiratory disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 83.

  • Kupeli E, Karnac D, Mehta AC. Flexible bronchoscopy. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 22.

  • Reynolds HY. Respiratory structure and function: mechanisms and testing. In: Goldman L, Schafer AI, eds. Goldman’' Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 85.

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