Bronchoscopy - Respiratory procedures

Bronchoscopy

Bronchoscopy allows the visualisation of the bronchial tree and direct access for bronchial and transbronchial biopsies and bronchial and bronchoalveolar washings. It is performed under local anaesthetic and sedation. Flexible fibreoptic bronchoscopy is most commonly used (although rigid bronchoscopy may be required in some instances).

Topical local anaesthetic is applied to the nose and pharynx and supplemental oxygen is given through one nostril. Following sedation the flexible bronchoscope is passed through the nose, the nasopharynx and pharynx. The vocal cords are visualised and sprayed with more topical anaesthetic to minimise coughing. Once in the trachea further topical anaesthesia is administered. Each of the segments and subsegments of both lungs is examined and sampling performed depending on the indication. Radiographic screening can be used for peripheral lesions which cannot be directly visualised.

Investigations

Biopsy: Central bronchial lesions are easily biopsied, there is a small risk of haemorrhage particularly if it is a vascular lesion or carcinoid tumour. Transbronchial biopsy is used for diagnosis of diffuse parenchymal lung disease. It carries a small but significant risk of pneumothorax. It should be used with caution in ventilated patients for this reason.

Bronchial brushings: Brushings can be taken for cytology.

Bronchial/bronchoalveolar lavage: Washings can be taken for cytology (malignancy, differential cell count, e.g. eosinophilia) and microbiology (indicated in particular for Mycobacterium tuberculosis and Pneumocystis jirovecii (previously called Pneumocystis carinii), as well as unresponsive bacterial pneumonia or pneumonia in immunosuppressed patients). Appropriate staining and culture is needed.

Therapies

Aspiration of mucus plugs. Removal of foreign body.

Laser therapy for obstructing bronchial carcinoma. Brachytherapy – application of local radiotherapy

sources directly on bronchial carcinomas.

Transbronchial stenting for obstructing bronchial carcinoma.

Control of bleeding from vascular tumour. Complications include hypoxia, airways obstruction, cardiac arrhythmias (usually transient), pneumothorax, haemorrhage and transmission of infection.