Fiberoptic bronchoscopy

Alternative names
Bronchoscopy

Definition
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 or tissue specimens (biopsy).

How the test 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 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 performed via the nose, an anesthetic jelly will be inserted into one nostril. The scope will be inserted through the numbed 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 will obtain samples of your lung secretions to send for laboratory analysis.

Saline solution is introduced to flush the area and collect cells to 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 temporarily blocked by the scope. Bronchoalveolar lavage is performed to obtain a sample of the cells, fluids, and other materials present in the very small alveoli (air sacs).

In addition, tiny brushes, needles, or forceps may 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.

How to prepare for the test

This test may require an overnight stay in the hospital. Fasting is required for 6 to 12 hours before the test. Your doctor may want you to avoid any aspirin or ibuprofen medications before the procedure. You must sign an informed consent form. 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.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For general information regarding how you can prepare your child, see the following topics:

     
  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel

Local anesthesia is used to relax the throat muscles. Until the anesthetic begins to work, there will be a feeling of 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 trachea. Although many patients experience the feeling of suffocation when the tube is in the throat, there is NO risk of suffocation. If there is coughing during the test, more anesthetic will be added.

When the anesthetic wears off, the throat may be scratchy for several days. After the test, the cough reflex will return in 1 to 2 hours. Eating and drinking are not allowed until then.

Why the test is performed
This test is recommended if another diagnostic procedure suggests a lung disease that requires an inspection of the airways or a tissue sample for diagnosis. Bronchoscopy is also recommended if you have been coughing up blood (hemoptysis).

Normal Values

The trachea and bronchi have normal cells and secretions and no foreign bodies or obstructions.

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

Additional conditions under which the test may be performed

Bronchoscopy 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

What the risks are

The main risks from bronchoscopy are:

     
  • Infection  
  • Bleeding from biopsy sites

There is also a small risk of:

     
  • Disordered heart rhythm (arrhythmias)  
  • Heart attack  
  • Low blood oxygen (risk of hypoxemia may be greater if bronchoalveolar lavage is done)  
  • 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. However, the technician or nurse will monitor the amount of bleeding.

There is a significant risk of choking if anything (including water) is ingested 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.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.