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Bronchoscopy
Definition Bronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions. Alternative Names Fiberoptic bronchoscopy How the test is performed A bronchoscope is a device used to see the inside of the lungs. It can be flexible or rigid. Usually, a flexible bronchoscope is used. The flexible bronchoscope is a tube less than 1/2 inch wide and about 2 feet long. The scope is passed through your mouth or nose, and then into your lungs. Going through the nose is a good way to look at the upper airways. The mouth method allows the doctor to use a larger bronchoscope. A rigid bronchoscope requires general anesthesia. You will be asleep. If a flexible bronchoscope is used, you will be awake. The doctor will spray a numbing drug (anesthetic) in your mouth and throat. This will cause coughing at first, which will stop as the anesthetic begins to work. When the area feels thick, it is numb enough. You may get medications through a vein (intravenously) to help you relax. If the bronchoscopy is done through the nose, numbing jelly will be placed into one nostril. Once you are numb, the tube will be inserted into the lungs. Then, the doctor sends saline solution through the tube. This flushes the lungs and allows the doctor to collect samples of lung cells, fluids, and other materials inside the air sacs. This part of the procedure is called a lavage. Sometimes, tiny brushes, needles, or forceps may be passed through the bronchoscope and used to take tissue samples (biopsies) from your lungs. The pieces of lung material that are removed are so small that they are barely visible. The doctor can also place a stent in the airway or view the lungs with ultrasound during a bronchoscopy. How to prepare for the test Do not eat or drink anything 6 - 12 hours before the test. Your doctor may also want you to avoid any aspirin or ibuprofen medications before the procedure. You may be sleepy after the test, so you should arrange for transportation to and from the hospital. Many people want to rest the following day, so make arrangements for work, child care, or other obligations. Usually, the test is done as an outpatient procedure, and you will go home the same day. Some patients may need to stay overnight in the hospital. How the test will feel Local anesthesia is used to relax the throat muscles. Until the anesthetic begins to work, you may feel fluid running down the back of your throat and have the need to cough or gag. Once the anesthetic takes effect, you may have sensations of pressure or mild tugging as the tube moves through the windpipe (trachea). Although many patients feel like they might suffocate when the tube is in the throat, there is NO risk of suffocation. If you cough during the test, you will get more anesthetic. When the anesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 - 2 hours. You will not be allowed to eat or drink until your cough reflex returns. Why the test is performed You may have bronchoscopy if your health care provider suspects lung disease and an inspection of the airways or a tissue sample is needed to confirm it. The test can be used to evaluate almost any disease in pulmonary medicine, including: - Acute pulmonary eosinophilia (Loeffler syndrome)
- Aspiration pneumonia
- Atelectasis
- Bronchial adenoma
- CMV pneumonia
- Chronic pulmonary coccidioidomycosis
- Cryptococcosis
- Disseminated tuberculosis (infectious)
- Chronic pulmonary histoplasmosis
- Metastatic cancer to the lung
- Pneumonia in immunocompromised host
- Pneumonia with lung abscess
- Pulmonary actinomycosis
- Pulmonary aspergilloma (mycetoma)
- Pulmonary aspergillosis (invasive type)
- Pulmonary histiocytosis X (eosinophilic granuloma)
- Pulmonary nocardiosis
- Pulmonary tuberculosis
- Sarcoidosis
- SVC obstruction
Bronchoscopy is also recommended if you have been coughing up blood. Normal Values Normal cells and secretions are found. No foreign substances or blockages are seen. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. What abnormal results mean - Abnormality in the bronchial wall
- Enlarged (dilated) tubular vessels
- Enlarged glands or lymph nodes
- Excessive bleeding (hemorrhage)
- Infections from bacteria, viruses, fungi, parasites, or tuberculosis
- Irregular bronchial branching
- Lung cancer
- Narrowing (stenosis) of the trachea
- Swelling (inflammation)
- Tumor
- Ulceration
What the risks are The main risks from bronchoscopy are: - Bleeding from biopsy sites
- Infection
There is also a small risk of: - Arrhythmias
- Heart attack
- Low blood oxygen
- Pneumothorax
In the rare instances when general anesthesia is used, there is some risk for: - Breathing difficulties
- Muscle pain
- Change in blood pressure
- Slower heart rate
- Nausea
- Sore throat
- Vomiting
There is a small risk for: - Heart attack
- Kidney damage
When a biopsy is taken, there is a risk of hemorrhage. Some bleeding is common. The technician or nurse will monitor the amount of bleeding. There is a significant risk of choking if anything (including water) is swallowed before the anesthetic wears off. Special considerations After the procedure, your gag reflex will return. However, until it does, do not eat or drink anything. To test if the gag reflex has returned, place a spoon on the back of your tongue for a few seconds with light pressure. If you don't gag, wait 15 minutes and try it again. Make sure that you don't use any small or sharp objects to test this reflex. References Mason RJ, Broaddus VC, Murray JF, Nadel JA. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders; 2005. Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:2474. Review date: 11/12/2007 Reviewed By: Andrew Schriber, M.D., F.C.C.P., Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network.
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