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Bronchoscopy

Bronchoscopy is used to directly examine the interior surface of the trachea and bronchi, and it is often performed after radiographs (X-rays) to further evaluate patients with acute or chronic cough that are not resolved with standard medical therapy. Bronchoscopy can be used to obtain tissue brushings and biopsies for histological evaluation and to remove foreign bodies. Furthermore, bronchoalveolar lavage (introduction of fluid in the airways for collection) can be performed for assessment of cellular infiltrates and culture.

Uses of Bronchoscopy:

  1. Determine the cause of coughing that does not respond to standard therapy.
  2. Obtain samples from patients with bronchitis or pneumonia for microscopic evaluation and culture.
  3. Confirm and stage tracheal or bronchiolar airway collapse.
  4. Removal foreign bodies and parasitic larva from the airways.

Procedure

The patients is generally fasted for 12 hours prior to the procedure to minimize the risk of aspiration of stomach contents into the lungs during general anesthesia. After being anesthetized, the patient is intubated and anesthetic monitoring equipment is attached. The patientís heart rate and rhythm, respiratory rate, blood pressure, carbon dioxide level and oxygen saturation level are closely monitored while under anesthesia to prevent and minimize anesthesia-associated complications.

The tip of the endoscope is carefully advanced through the mouth into the trachea. As the scope is advanced down the trachea, its interior surface is evaluated for color, vascularity, rigidity, size, and position. At the bifurcation of trachea, each lobar bronchi is examined sequentially and photos and videos may be collected of normal and abnormal structures for documentation and further study. Abnormalities may include inflamed or eroded tissue, protrusion of the tracheal membrane into the tracheal lumen, parasitic infestation, polyps or nodules, scarring, and distortion of airway structure. Bronchoalveolar lavage is often performed from multiple lobes to ensure focal diseases are not missed.

Bronchoscopy generally takes between 20 and 40 minutes depending on gross findings and number of samples taken. After completion of the procedure, the endoscope is removed and the patient recovered from anesthesia. Most patients can go home on the day of the procedure.

Risks and Limitations

Bronchoscopy is generally considered a safe procedure. In addition to risks or limitations of endoscopy in general, the most common problem is that patients with severe airway or lung disease may become oxygen dependent after the procedure and require temporary hospitalization in an oxygen cage. Rarely, a patient with severe disease may develop a leak from the lung, called a tension pneumothorax, that can be life-threatening.

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