Bronchoscopy

Answer 1

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, through your windpipe (trachea), 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. The doctor may send saline solution through the tube. This washes 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 small. 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, ibuprofen, or other blood-thinning drugs 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 a bronchoscopy to help your doctor diagnose lung problems. Your doctor will be able to inspect the airways or take a biopsy sample.

Common reasons to perform a bronchoscopy are:

• Lung growth, lymph node, atelectasis, or other changes seen on an x-ray or other imaging test
• Suspected interstitial lung disease
• Coughing up blood (hemoptysis)
• Possible foreign object in the airway
• Cough that has lasted more than 3 months without any other explanation
• Infections in the lungs and bronchi
• Inhaled toxic gas or chemical

You may also have a bronchoscopy to treat a lung or airway problem, such as:

• Remove fluid or mucus plugs from your airways
• Remove a foreign object from your airways
• Widen (dilate) an airway that is blocked or narrowed
• Drain an abscess
• Treat cancer using a number of different techniques
• Wash out an airway (therapeutic lavage)

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

• Granulomas
• Infections from bacteria, viruses, fungi, parasites, or tuberculosis
  • Aspiration pneumonia
  • CMV pneumonia
  • Chronic pulmonary coccidioidomycosis
  • Cryptococcosis
  • Chronic pulmonary histoplasmosis
  • Pneumonia with lung abscess
  • Pulmonary actinomycosis
  • Pulmonary aspergilloma (mycetoma)
  • Pulmonary aspergillosis (invasive type)
  • Pulmonary histiocytosis X (eosinophilic granuloma)
  • Pulmonary nocardiosis
  • Pulmonary tuberculosis
• Inflammation of the lungs related to allergy-type reactions (hypersensitivity pneumonitis)
• Interstitial lung disease
• Lung cancer or cancer in the area between the lungs
• Narrowing (stenosis) of the trachea or bronchi
• Rheumatoid lung disease
• Sarcoidosis
• Vasculitis

What the risks are

The main risks from bronchoscopy are:

• Bleeding from biopsy sites
• Infection

There is also a small risk of:

• Arrhythmias
• Breathing difficulties
• Fever
• Heart attack
• Low blood oxygen
• Pneumothorax
• Sore throat

In the rare instances when general anesthesia is used, there is some risk for:

• Muscle pain
• Change in blood pressure
• Slower heart rate
• Nausea
• Vomiting

There is a small risk for:

• Heart attack

When a biopsy is taken, there is a risk of severe bleeding (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 numbing medicine 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

Kraft M. Approach to the patient with respiratory disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 83.

Reynolds HY. Respiratory structure and function: mechanisms and testing. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 85.

Prakash UBS. Bronchoscopy. In: Mason RJ, Murray J, VC Broaddus, Nadel J, eds. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 22.

Answer 2

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, through your windpipe (trachea), 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. The doctor may send saline solution through the tube. This washes 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 small. 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, ibuprofen, or other blood-thinning drugs 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 a bronchoscopy to help your doctor diagnose lung problems. Your doctor will be able to inspect the airways or take a biopsy sample.

Common reasons to perform a bronchoscopy are:

• Lung growth, lymph node, atelectasis, or other changes seen on an x-ray or other imaging test
• Suspected interstitial lung disease
• Coughing up blood (hemoptysis)
• Possible foreign object in the airway
• Cough that has lasted more than 3 months without any other explanation
• Infections in the lungs and bronchi
• Inhaled toxic gas or chemical

You may also have a bronchoscopy to treat a lung or airway problem, such as:

• Remove fluid or mucus plugs from your airways
• Remove a foreign object from your airways
• Widen (dilate) an airway that is blocked or narrowed
• Drain an abscess
• Treat cancer using a number of different techniques
• Wash out an airway (therapeutic lavage)

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

• Granulomas
• Infections from bacteria, viruses, fungi, parasites, or tuberculosis
  • Aspiration pneumonia
  • CMV pneumonia
  • Chronic pulmonary coccidioidomycosis
  • Cryptococcosis
  • Chronic pulmonary histoplasmosis
  • Pneumonia with lung abscess
  • Pulmonary actinomycosis
  • Pulmonary aspergilloma (mycetoma)
  • Pulmonary aspergillosis (invasive type)
  • Pulmonary histiocytosis X (eosinophilic granuloma)
  • Pulmonary nocardiosis
  • Pulmonary tuberculosis
• Inflammation of the lungs related to allergy-type reactions (hypersensitivity pneumonitis)
• Interstitial lung disease
• Lung cancer or cancer in the area between the lungs
• Narrowing (stenosis) of the trachea or bronchi
• Rheumatoid lung disease
• Sarcoidosis
• Vasculitis

What the risks are

The main risks from bronchoscopy are:

• Bleeding from biopsy sites
• Infection

There is also a small risk of:

• Arrhythmias
• Breathing difficulties
• Fever
• Heart attack
• Low blood oxygen
• Pneumothorax
• Sore throat

In the rare instances when general anesthesia is used, there is some risk for:

• Muscle pain
• Change in blood pressure
• Slower heart rate
• Nausea
• Vomiting

There is a small risk for:

• Heart attack

When a biopsy is taken, there is a risk of severe bleeding (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 numbing medicine 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

Kraft M. Approach to the patient with respiratory disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 83.

Reynolds HY. Respiratory structure and function: mechanisms and testing. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 85.

Prakash UBS. Bronchoscopy. In: Mason RJ, Murray J, VC Broaddus, Nadel J, eds. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders Elsevier; 2005:chap 22.

Reviewed By

Review Date: 04/27/2010

Allen J. Blaivas, DO, Clinical Assistant Professor of Medicine UMDNJ-NJMS, Attending Physician in the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.