Sunday, June 2, 2013

About Bronchoscopy

Diagnostic Bronchoscopy Procedure

Diagnostic bronchoscopy is a procedure performed with a special endoscope (named bronchoscope) in order to look directly at the airways of the lungs. The portion of your body that is the main interest to the doctor performing the procedure is that area of the respiratory tract found below the vocal cords. Bronchoscopy is often performed in a bronchoscopy suite or endoscopy suite which is staffed by professionals with special training and advanced equipment.
Bronchoscopy suite

Health problems that lead a patient need bronchoscopy include chronic cough, Hemoptysis, or an abnormal chest xray or abnormal chest ct scan that shows a lung mass, lung nodule or unexplained shadow. Bronchoscopy might also be done to evaluate a longstanding pneumonia, or to determine the consequences of chest trauma.  The goal of a diagnostic bronchoscopy is to establish the correct cause of a problem so an appropriate treatment plan can be established. The diagnostic bronchoscopy allows the doctor to also perform other specialized procedures through the bronchoscope such as bronchoalveolar lavage (BAL), transbronchial needle aspiration (TBNA), and transbronchial biopsy.  These other specialized procedures are enabled by the bronchoscope and are discussed on another page.
Flexible Bronchoscope is in the right lung

Therapeutic Bronchoscopy

Bronchoscopy can also be used to treat or solve a problem.  When a bronchscopy procedure is used as a means to deliver a treatement it is named "Therapeutic Bronchoscopy".  For example, bronchoscopy can be used to reduce or remove an airway obstruction by a cancer, phlegm or foreign bodies, and even to help during a difficult intubation of the trachea (i.e. insertion of an endotracheal tube to permit mechanical ventilation).  Today two of the most common treatments applied during therapeutic bronchoscopy are aimed at a cancer growth that has blocked a breathing passage.  These two common treatments are laser ablation of the growth and stent insertion to open a blocked airway.

Stent placed in the left main bronchus which has a cancer growing around it.  The Stent splints open the airway.

Rigid and Flexible Bronchoscopy

There are two types of bronchoscopes: flexible fiberoptic and rigid. Flexible bronchoscopy is often performed under local anesthesia in association with conscious sedation.  Local anesthesia often includes medicines like Lidocaine that are used to numb your mouth and throat. Conscious sedation refers to those medicines (e.g. Versed, Fentanyl, propofol or a combination of a few of these) that are typically injected into a patient via an intravenous catheter and cause the patient to fall asleep.

Rigid bronchoscopes are hollow and not flexible. Rigid bronchoscopes are most often employed by a physician trying to remove a foreign body or attempting to insert additional equipment into the lower airways such as laser lights, or airway stents.  Rigid bronchoscopy is performed while a patient is under general anesthesia in the surgical operating room.