IN THE NAME OF GOD
BRONCHOSCOPY
Mehdi hadadzadeh, MD
Cardiovascular surgeon
University of yazd
BACKGROUND
• Allows direct visualization of the airways
• Rigid and flexible instruments
• Clinical tool
– Airway anatomy
– Airway sampling
– Therapeutic
• Research tool
ORIGINS
• Until the 1980’s, only rigid instruments
were widely used
• Multiple generations of adult and pediatric
flexible bronchoscopes now
• Widely used in adult and pediatric
pulmonary medicine now
RIGID BRONCHOSCOPY
• Generally performed by ENT’s and
surgeons
• Procedure oriented
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Foreign body removal
Biopsies
Granuloma/polyp removal
Laser
Stent placement
• Visualization for future surgery
INSTRUMENTS
• Rigid bronchoscopes
– Hollow metal tube
– Glass rod telescope
FLEXIBLE BRONCHOCSOPY
• Examination of the entire respiratory
anatomy, nose to bronchi
• Able to pass through an endotracheal tube
or tracheostomy tube
Bronchoscopy
INSTRUMENTS
• Flexible instruments
– Fiberoptic bronchoscopes
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2.2mm ultrathin
2.8mm/1.2mm suction channel
3.4mm/1.2mm suction channel
4.4mm/2.0mm suction channel
4.9mm/2.2mm suction channel
5.9mm/3.0mm suction channel
Fiberoptic bronchoscope
2.8mm diameter
Pediatric videoscope
3.8mm diameter
INDICATIONS
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Atelectasis
Recurrent pneumonia
Chronic cough
Persistent/unexplained wheeze
Hemoptysis
Suspected airway compression/obstruction
Stridor
Upper airway obstruction
Suspected aspiration
Evaluation of tracheostomies
TECHNIQUE
TECHNIQUE
• Anesthesia
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Best accomplished in the operating room
May be performed bedside in an ICU setting
Continuous monitoring
Light anesthesia--allows continued spontaneous
breathing
– May be done with conscious sedation in older
individuals
TECHNIQUE
• Insertion
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Nasal
Endotracheal tube
Tracheostomy tube
Appropriate topical anesthesia and lubrication
TECHNIQUE
• Anatomical survey
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Nasal passages
Pharynx
Larynx
Trachea
Bronchi
• Examine all before any other procedures
TECHNIQUE
• Additional procedures
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Bronchoalveolar lavage
Brushings
Bronchial biopsy
Transbronchial biopsy
Laser
Others: cryotherapy, stent placement, foreign
body removal, needle biopsy
BRONCHOALVEOLAR
LAVAGE
• Small aliquots of sterile normal saline
instilled into the airway
• Removed by suctioning
• Samples distal bronchial and alveolar
surfaces
BRONCHOALVEOLAR
LAVAGE
Thoracoscopy
insertion of an endoscope, a narrowdiameter tube with a viewing mirror
or camera attachment, through a very
small incision (cut) in the chest wall
Thoracoscopy
• two or three small incisions in the chest
wall,
• often between the ribs
• examine the pleura, lungs, and mediastinum
• to obtain tissue for testing purposes
• general anesthesia
Indications
• assess lung cancer
• take a biopsy for study
• determine the cause of fluid in the chest
cavity
• introduce medications or other treatments
directly into the lungs
• treat accumulated fluid, pus (empyema), or
blood in the space around the lungs
Thoracoscopy
The risks of thoracoscopy
• Wound infection
• Bleeding
• Air leak through the lung wall, requiring a
longer hospital stay
• Pain or numbness at the incision site
• Inflammation of the lungs (pneumonia)
thoracoscopy v;s thoracotomy
• avoids many of the complications of open
chest surgery
• reduces pain,
• hospital stay
• recovery time.
Preparation
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chest X-ray
electrocardiogram (if you are over age 35)
various blood tests
arterial blood gas
pulmonary function test
fast for 12 hours before the procedure.
General anesthesia
preparations for chest surgery
Transthoracic Needle Biopsy
• to evaluate peripheral lung nodules or
masses; hilar, mediastinal, and pleural
abnormalities; and undiagnosed infiltrates
or pneumonias when bronchoscopy is
contraindicated or nondiagnostic
• diagnosis of cancer with > 95% accuracy.
Needle biopsy yields an accurate diagnosis
in benign processes only 50 to 60% of the
time.
Complications:
• hemoptysis (10 to 25%)
• pneumothorax (10 to 37%)
• parenchymal hemorrhage
• air embolism
• subcutaneous emphysema.
Mediastinoscopy
• surgical procedure to examine the inside of
the upper chest between and in front of the
lungs (mediastinum).
• replaced by other biopsy methods that use
computed tomography (CT),
echocardiography, or bronchoscopy to
guide a biopsy needle to the abnormal tissue
Indications
• Detect problems of the lungs and mediastinum, such as
sarcoidosis.
• Diagnose lung cancer or lymphoma (including Hodgkin's
disease). Mediastinoscopy is often done to check lymph nodes
in the mediastinum before considering lung removal surgery to
treat lung cancer. Mediastinoscopy can also help your doctor
recommend the best treatment (surgery, radiation,
chemotherapy) for lung cancer.
• Diagnose certain types of infection, especially those that can
affect the lungs (such as tuberculosis).
limitations
• previous mediastinoscopy or open-heart
surgery
• A history of neck problems or a neck injury
• Any physical problems of chest(congenital).
• Recently radiation therapy to the neck or
chest.
risks
• puncturing the esophagus, trachea, or blood
vessels
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• In some circumstances, this can lead to
potentially fatal bleeding.