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.

How the test is performed

A bronchoscope is device used to see 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 sufficiently numb. Medications may be given through an IV to help you relax.

If the bronchoscopy is done through the nose, numbing jelly will be place 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. A 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 to 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 the throat and the need to cough or gag.

Once the anesthetic takes effect, there may be sensations of pressure or mild tugging as the tube moves through the wind pipe (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, more anesthetic will be added.

When the anesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 to 2 hours. You will not be allowed to eat or drink until your cough reflex returns.

Why the test is performed

Bronchoscopy is recommended if lung disease is suspected 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's 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.

What abnormal results mean

• Abnormality in the bronchial wall
• Inflammation
• Swelling
• Ulceration
• Tumor
• Enlarged glands or lymph nodes
• Stenosis or compression of the trachea
• Dilated tubular vessels
• Irregular bronchial branching
• Hemorrhage
• Lung cancer
• Infections from bacteria, viruses, fungi, parasites, or tuberculosis

What the risks are

The main risks from bronchoscopy are:

• Infection
• Bleeding from biopsy sites

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:

• Nausea
• Vomiting
• Sore throat
• Muscle pain
• Breathing difficulties
• Depressed heart rate
• Change in blood pressure

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 there is no gagging, wait 15 minutes and attempt it again. Make sure that no small or sharp objects are used to test this reflex.

References

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000: 639-641.

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:2474.

Illustrations

Bronchoscopy

Bronchoscopy

Page Content:

Fiberoptic bronchoscopy ; fiber optics bronchoscopy