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Bronchoscopy

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What is bronchoscopy ?

It is a test used to visualize the airways, and the lung. An instrument called bronchoscope tube, which is light weighted, flexible and a light camera at its end, is used to visualize the windpipe (trachea), voice box (larynx), airway and the lung.

It can be used for diagnosing as well for treatment (therapeutic) and palliation.

About the instrument

• It can be Flexible or Rigid.

• Rigid is used more for therapeutic purpose.

• They come in various sizes.

• The larger scopes having outer diameter of 4.9–5.5 mm and a working channel diameter of 2.0 mm, generally used for adults. This size is best suitable for needles, biopsy forceps, baskets, and better suction.

• Therapeutic bronchoscopes have the larger working channel width of ~ 2.8–3.2 mm and outer diameter of ~ 6.0–6.2 mm. The working channel of >3 mm is required for insertion of electrocautery device and lasers.

• Ultrathin bronchoscopes of outer diameter being ~ 2.8 mm and working channel width of ~ 1.2 mm are generally used in paediatric cases however are also used in cytology brushing and for suction and bronchoalveolar lavage (BAL).

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Types and newer techniques

• Virtual bronchoscopy- CT scan is done along with it.

• Endobronchial ultrasound – its done with help of ultrasound machine.

• Autofluorescence bronchoscopy – helps in detecting early cancer lesions.

• high magnification video bronchoscopy (newer techniques).

• Confocal fluorescence laser micro-endoscopy or optical coherence tomography bronchoscopy (newer techniques).

Why and when is it done?

• For identifying an infection.

• To identify reason of blood in cough (hemoptysis).

• Chronic cough

• For taking out piece of lung or lymph node (biopsy) for testing.

• Collecting sputum

• Removal of foreign body/ obstruction in the airway

• Diagnosing tumor/cancer

• To see abnormality of the vocal cords.

• Diagnosing lung abnormalities.

• For placing stent/ tube in the airway.

• For stopping of bleeding.

• To treat narrowing of the airway.

• For carrying out diagnostic procedures like bronchoalveolar lavage where fluid is put into the lungs and then removed, this helps in detecting the disease.

• Draining an abscess

• Helps in delivering laser therapy or radiation treatment in case of bronchial tumors.

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Technique

• After sedating the individual and using numbing medication for the throat the procedure starts.

• Bronchoscope, flexible or rigid, is introduced inside the mouth and progressed into the windpipe and further.

• It has a fibre-optic light at its end for better visualization of the airway.

• A small suction port is present which aspirated the fluid and de-fogs the camera hence helps in better visualization of structure.

• Flexible tubes can be bend and help in better navigation around the small structures / lesions.

• Once the procedure is complete the tube is removed and tissue/ cells samples will be send in for testing.

• Post procedure, individual would be be allowed to eat or drink for few hours until the sedation doesn’t wear off.

• Once sedation wear offs you can have ice chips or small sips of water to begin with and gradually have semi-solid food.

Chest x-ray is taken to see for signs of injury, if any they are treated before discharge.

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Preparation before the examination

• Individual is expected to fast for at least 6 to 12 hours before the procedure.

• Avoid taking blood thinning medications.

• Aspirin has to be avoided before the procedure, consult your doctor if you are taking aspirin.

• Since individual will be given anesthesia, they should be accompanied by some relative / friend in order to take them home from the hospital.

• Change into comfortable clothes/ gowns provided by hospital.

• Individual is made to lie down and his/her blood pressure, heart rate and oxygen levels are monitored before starting the procedure.

• Sedation is given and numbing mediation is sprayed in the throat (reduces gagging reflex).

Complications

• Bleeding at the site from where biopsy is done.

• Infection.

• Breathing difficulties.

• Sore throat (due to passage of the tube)• Fever (it is common after the procedure but it can also occur secondary to infection)

• Collapse of lung – in case there is injury to the lung during the procedure

• Irritation to the vocal cords

• Injury to the airway

• Collection of air between the pleura and lung (Pneumothorax)

• Heart issues, especially in individual with history of heart diseases.

• Alternation of blood pressure and heart rate (due to use of anesthesia).

• Nausea and vomiting (due to use of anesthesia)

• Muscular pain

• Heart arrest

• Injury to the teeth (more common with rigid bronchoscope)

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Alert signs

After procedure if one develops these signs, contact the doctor immediately:

• Fever >100.4°F (38°C)

• Blood in cough

• Chest pain

• Extreme change in voice (change in volume or pitch)

• Redness or swelling of the IV site

• Breathing difficulty

Contraindications

• Heart diseases, history of arrhythmias

• Low oxygen levels

• Severe repetitive coughing

• Gagging reflex

• Pulmonary hypertension (high blood pressure in blood vessels of the lungs).

• In case of narrowing of windpipe (trachea)

Advantages

• Helps to detect abnormalities which are not seen better on other imaging like X-rays or CT scans.

• Removal of fluid from lungs.

• For carrying our biopsies.

• Early detection of tumors/ cancer in suspected cases.

• Can have diagnostic as well therapeutic values.

• Removal of obstruction / foreign body to the airway.

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