Bronchoscopy
Dr. Ravi Gadani
MS, FMAS
Introduction
• Bronchoscopy is a technique of visualizing the inside of the airways
for diagnostic and therapeutic purposes.
• Bronchoscope)is inserted into the airways
• through the nose or mouth,
• or occasionally through a tracheostomy
• Types-
• Rigid metal tubes with attached lighting devices
• Flexible optical fiber instruments with realtime video equipment.
History
• A German, Gustav Killian – first rigid bronchoscopy in 1897- to remove
a pork bone.
• Till 1970 rigid bronchoscope was used.
• A Japanese, Shigeto Ikeda - flexible bronchoscope in 1966. The flexible
scope initially employed fiberoptic bundles requiring an external light
source for illumination.
• More recently, fiberoptic scopes have been replaced by
bronchoscopes with a charge coupled device (CCD) video chip located
at their distal extremity.
Types
• Rigid brochoscope
• Flexible brochoscope
Rigid bronchoscope- uses
• Rigid bronchoscopy is used for retrieving foreign objects.
• Massive hemoptysis, defined as loss of >600 mL of blood in 24
hours( medical emergency)
• The larger lumen of the rigid bronchoscope versus the narrow lumen
of the flexible bronchoscope allows for therapeutic approaches such
as electrocautery to help control the bleeding.
Rigid bronchoscope
Flexible bronchoscope
• A flexible bronchoscope is longer and thinner than a rigid
bronchoscope. It contains a fiberoptic system that transmits an image
from the tip of the instrument to an eyepiece or video camera at the
opposite end.
• The tip of the instrument can be oriented, allowing the practitioner to
navigate the instrument into individual lobe or segment bronchi.
Flexible bronchoscope
• Most flexible bronchoscopes also include a channel for suctioning or
instrumentation, but these are significantly smaller than those in a
rigid bronchoscope.
• Flexible bronchoscopy causes less discomfort than rigid bronchoscopy
and the procedure can be performed easily and safely under
moderate sedation.
• It is the technique of choice nowadays
Flexible bronchoscope
Uses
• Diagnostic
• To view abnormalities of the airway
• To obtain tissue specimens of the lung in a variety of disorders. Specimens
may be taken from inside the lungs by biopsy, bronchoalveolar lavage, or
endobronchial brushing.
• To evaluate a person who has bleeding in the lungs, possible lung cancer, a
chronic cough, sarcoidosis
Uses
• Therapeutic
• To remove secretions, blood, or foreign objects lodged in the airway
• Laser resection of tumors or benign tracheal and bronchial strictures
• Stent insertion to palliate extrinsic compression of the tracheobronchial
lumen from either malignant or benign disease processes
• Tracheal intubation of patients with difficult airways is often performed using
a flexible bronchoscope
Procedure – Flexible Bronchoscopy
• Bronchoscopy room.
• Antianxiety and antisecretory medications
• Sedatives such as midazolam or propofol may be used.
• A local anesthetic is often given to anesthetise the mucous
membranes of the pharynx, larynx, and trachea.
• The patient is monitored during the procedure.
Procedure – Flexible Bronchoscopy
• A flexible bronchoscope is inserted with the patient in a sitting or
supine position.
• Once the bronchoscope is inserted into the upper airway, the vocal
cords are inspected. The instrument is advanced to the trachea and
further down into the bronchial system and each area is inspected as
the bronchoscope passes.
• If an abnormality is discovered, it may be sampled, using a brush, a
needle, or forceps.
• Specimen of lung tissue (transbronchial biopsy)
Procedure – Rigid Bronchoscopy
• Under general anesthesia.
• Rigid bronchoscopes are too large to allow parallel placement of
other devices in the trachea; therefore the anesthesia apparatus is
connected to the bronchoscope and the patient is ventilated through
the bronchoscope.
Recovery
• Tolerated well. Observation is required.
• The patient is assessed for respiratory difficulty (stridor and dyspnea
resulting from laryngeal edema, laryngospasm, or bronchospasm).
• If the patient has had a transbronchial biopsy – post procedure is
done to rule out pneumothorax
Complications
• Bronchial perforation
• Bleeding
• Pneumothorax
• Laryngospasm
• Laryngeal edema
