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Bronchoscopy

A bronchoscopy is a test used to look inside the trachea (windpipe) and bronchi (large airways of the lungs) using an endoscopeendoscopeA thin, tube-like instrument with a light and lens used to examine or treat organs or structures in the body. (a thin, tube-like instrument with a light and lens). A bronchoscopy is also used to perform specialized procedures in the airways.

Why a bronchoscopy is done

A bronchoscopy is done to both diagnose and treat certain lung problems. It is done to:

  • remove foreign objects from the airway
  • evaluate damage to the airway caused by trauma
  • identify infection or inflammation
  • find out why a person is coughing up blood (hemoptysis)
  • find the location of bleeding within the airway and control it
  • remove fluid, mucus plugs or polyps (small cauliflower-like growths on a mucous membrane)
  • irrigate an airway
  • drain a collection of pus (abscess) or cyst (a sac with fluid or semi-solid material) in the lung
  • diagnose lung diseases or tumours
  • obtain biopsy specimens of cells for examination under a microscope or for culture (the process of growing micro-organisms, cells or tissues in a specially prepared growth media)
  • help stage lung cancer and determine if lung tumours are operable or not
  • do procedures for lung cancer, such as:
    • brachytherapy (a type of radiation therapy that uses implants to deliver radiation directly into or near a tumour)
    • laser surgery (a surgical procedure that uses a laser to make bloodless cuts in tissue)
    • photodynamic therapy (treatment with drugs that become active when exposed to light)
    • insert a small wire mesh or silicone tube (called a stent) to keep the airway open

How a bronchoscopy is done

  • Preparation for a bronchoscopy can vary but usually includes:
    • Do not eat or drink anything for 6–12 hours before the test.
    • Remove items such as dentures because the bronchoscope may be put into the mouth.
  • A bronchoscopy can often be done in a hospital operating room or endoscopy suite on an outpatient basis. The person may be drowsy and not be able to drive after the test, so they should arrange for a ride to and from the hospital. Most outpatients can go home the same day.
  • A bronchoscopy is done under a local anesthetic or under a general anesthetic in the operating room.
    • A local anesthetic is used to relax the throat muscles and numb the mouth, throat or nasal passages. If the local anesthetic is sprayed in the throat, it can taste bitter, make the person’s tongue feel thick or make them cough or gag.
  • A bronchoscope is put through the mouth or nose, through the throat, into the trachea, bronchi and then the lungs. The bronchoscope can also be inserted through an endotracheal tube (a special tube that is placed in the person’s throat to keep the breathing passages clear during surgery) or tracheostomytracheostomyA surgical procedure to create a stoma (artificial opening) in the trachea (windpipe) through the neck..
  • The person may feel pressure or like they are suffocating while the bronchoscope tube is being inserted, but there is no risk of suffocation and the person can still breathe.
  • A flexible bronchoscope is a thin, long tube that is used to examine and collect tissue from deep inside the bronchi and lungs. Its flexibility allows the endoscope to reach the farthest points in the airway.
  • A rigid bronchoscope is a hollow metal tube used for procedures that need greater access to the lungs, such as controlling bleeding or removing foreign bodies or tumours. A rigid bronchoscopy is only done under a general anesthetic. A rigid bronchoscopy is not done as often as a flexible bronchoscopy.
  • Brushings or biopsies of the bronchi and lungs can be taken through a bronchoscope.
  • During a bronchoscopy, the doctor may do an ultrasound scan of the bronchial tubes, lymph nodes next to the trachea and lung tissue. This is called endobronchial ultrasound (EBUS). It is used to identify abnormal structures and to help guide the doctor when collecting biopsy samples (transbronchial needle aspiration). The doctor can also take samples from lymph nodes in the chest (mediastinal and hilar lymph nodes).
  • A salt (saline) solution may also be put through the bronchoscopy tube to wash out the lungs (lavage) and allow the doctor to collect samples of cells, fluid and other material inside the air sacs (alveoli).
  • The person’s gag, swallowing and cough reflex usually returns a few hours after a bronchoscopy, but they cannot eat or drink anything until it does.

Potential side effects

The risks from bronchoscopy are:

  • bleeding
  • infection
  • breathing difficulties
  • low levels of oxygen in the blood
  • sore throat
  • contraction of the muscles in the bronchi (bronchospasm)
  • buildup of air in the space between the lungs and the wall of the chest (pneumothorax) that causes the lung to partially or completely collapse
  • irregular heartbeat (cardiac arrhythmia)
  • heart attack

What the results mean

A bronchoscopy can show:

  • infection or inflammation
  • narrowing (stenosis) of the trachea or bronchi
  • tumours in the bronchi or lung
  • lung diseases, such as sarcoidosis, tuberculosis or interstitial lung disease
  • fibrosis of the lung (pulmonary fibrosis)

What happens if a change or abnormality is found

The doctor will decide whether further tests, procedures, follow-up care or additional treatment is needed.

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