Bronchoscopy
Bronchoscopy is a diagnostic procedure in which a tube with a
tiny camera on the end is inserted through the nose or mouth into the lungs. The procedure
provides a view of the airways of the lung and allows doctors to collect lung secretions
and to biopsy for tissue specimens.
Why is a Bronchoscopy performed
During a bronchoscopy, a physician can visually examine the lower airways, including
the larynx, trachea, bronchi, and bronchioles. The procedure is used to examine the
mucosal surface of the airways for abnormalities that might be associated with a variety
of lung diseases. Its use includes the visualization of airway obstructions such as a
tumor, or the collection of specimens for the diagnosis of cancer originating in the
bronchi of the lungs (bronchogenic cancer). It can also be used to collect specimens for
culture to diagnose infectious diseases such as tuberculosis. The type of specimens
collected can include sputum, tissue samples from the bronchi or bronchioles, or cells
collected from washing the lining of the bronchi or bronchioles. The instrument used in
bronchoscopy, a bronchoscope, is a slender flexible tube containing mirrors, a light, and
an eyepiece. There are two types of bronchoscopes, a standard tube which is more rigid and
a fiberoptic tube which is more flexible. This tube contains four smaller passages, two
for light to pass through, one for seeing through and one that can accommodate medical
instruments that may be used for biopsy or suctioning, or that medication can be passed
through.
Bronchoscopy may be used for the following purposes:
- To diagnose cancer, tuberculosis, lung infection or other lung disease
- To examine an inherited deformity of the lungs
- To remove a foreign body in the lungs, such as a mucus plug, a tumor or excessive
secretions
- To allow examination of a suspected tumor, obstruction, secretion, bleeding or foreign
body in the airways
- To determine the cause of a persistent cough, or cough that includes blood in the
sputum.
How a Bronchoscopy is performed
The pulmonologist (a lung specialist trained to perform a
bronchoscopy) sprays a topical or local anesthetic in your mouth and throat. This will
cause coughing at first, which will cease as the anesthetic begins to work. When the area
feels "thick," it is sufficiently numb. Medications to relax you may be given
through an IV, making you sleepy.
If the bronchoscopy is performed via the nose, an anesthetic jelly will first be inserted
into one nostril. When it is numb, the scope will be inserted through the nostril until it
passes through the throat into the trachea and bronchi.
Usually, a flexible bronchoscope is used. The flexible tube is less than 1/2-inch wide
and about 2-feet long. As the bronchoscope is used to examine the airways of the lungs,
your doctor can obtain samples of your lung secretions to send for laboratory analysis.
Saline solution can be introduced to flush the area and collect cells that may be
analyzed by a pathologist or microbiologist. This part of the procedure is called a
"lavage" or a bronchial washing. Usually, small amounts (5-10 cc, or 1-2
teaspoons) of saline are used.
In certain circumstances, a larger volume of saline may be used. In this procedure,
called bronchoalveolar lavage, up to 300 cc of saline (20 tablespoons) are instilled into
the airway after the bronchoscope has been advanced as far as possible and a small airway
is completely blocked (temporarily) by the scope. Bronchoalveolar lavage is performed to
obtain a sample of the cells, fluids, and other materials present in the very small
airways and alveoli (air sacs).
In addition, tiny brushes, needles, or forceps can be introduced through the
bronchoscope to obtain tissue samples from your lungs. Occasionally, stenting and laser
therapies can be performed through the bronchoscope. A rigid bronchoscope is less commonly
used, and usually requires general anesthesia. |