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Bronchoscopy brän-ˈkäs-kə-pē, bräŋ-

By Noah Lechtzin, MD, MHS, Associate Professor of Medicine and Director, Adult Cystic Fibrosis Program, Johns Hopkins University School of Medicine

Bronchoscopy is a direct visual examination of the voice box (larynx) and airways through a flexible viewing tube (a bronchoscope). A bronchoscope has a camera at the end that allows a doctor to look down through the larger airways (bronchi) into the lungs.

Understanding Bronchoscopy

To view the airways directly, a doctor passes a flexible bronchoscope through a person's nostril and down into the airways. The circular inset shows the doctor's view.

A bronchoscope can be used to investigate the source of bleeding in the lungs. If a doctor suspects lung cancer, the airways can be examined and specimens can be taken from any areas that look cancerous. Bronchoscopy can be used to determine the cause of lung infections (pneumonia) if there is concern that it is caused by unusual bacteria or may be difficult to treat. Bronchoscopy is especially helpful for obtaining specimens from the lungs in people who have AIDS and other immune deficiencies. When people have been burned or have inhaled smoke, bronchoscopy helps doctors assess for burns and smoke injury of the larynx (voice box) and airways.

Bronchoscopy can help a doctor treat certain conditions. For example, the bronchoscope can also be used to remove secretions, blood, pus, and foreign bodies; to place drugs in specific areas of the lung; and as a guide over which a tube can be inserted to assist breathing (tracheal intubation).

For at least 6 hours before bronchoscopy, the person should not eat or drink. A sedative is often given to ease anxiety. Sometimes the person is given general anesthesia before bronchoscopy. The throat and nasal passage are sprayed with an anesthetic, and the bronchoscope is passed through a nostril, mouth or breathing tube and into the airways of the lungs.

Bronchoalveolar lavage is a procedure doctors can use to collect specimens from the smaller airways and alveoli that cannot be seen through the bronchoscope. After wedging the bronchoscope into a small airway, a doctor instills salt water (saline) through the instrument. The fluid is then suctioned back into the bronchoscope, bringing cells and any bacteria with it. Examination of the material under the microscope helps in diagnosing infections and cancers. The fluid can also be placed into containers containing special nutrients and left alone for a period of time to see if bacteria grow (culturing), which is a better way to diagnose infections.

Transbronchial lung biopsy involves obtaining a specimen (pieces) of lung tissue by using forceps passed through a channel in a bronchoscope. The bronchoscope is threaded into progressively smaller airways until reaching the area of concern. A doctor may use a fluoroscope (an imaging device that uses x-rays to show internal body structures on a screen) for guidance in identifying the area of concern. Such guidance can also decrease the risk of accidentally perforating the lung and causing leakage of air into the pleural space (pneumothorax). Although transbronchial lung biopsy increases the risk of complications during bronchoscopy, it provides additional diagnostic information and may make major surgery unnecessary.

Transbronchial needle aspiration is sometimes done. In this procedure, a needle is passed through the bronchoscope into the bronchial wall. The needle may be passed through the wall of a large airway under direct visualization or through the wall of a small airway using an x-ray machine for visualization. A doctor may be able to extract cells from suspicious lymph nodes to examine under a microscope. Endobronchial ultrasonography (EBUS) can be used to help guide the needle biopsy.

After bronchoscopy, the person is observed for 2 to 4 hours. If a tissue specimen was removed, a chest x-ray may be taken to check for complications, such as bleeding or pneumothorax.

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