Bronchoscopy

Bronchoscopy is an invasive endoscopic examination method of the bronchial tree, which is used to assess its visual changes, sample collection or medical procedures.

Types of bronchoscopy

• According to the type of device used, we distinguish:

1. Rigid bronchoscopy - examination is performed with a rigid bronchoscope under local or general anesthesia,
2. Flexible bronchoscopy' - examination is performed with a flexible bronchoscope (fibrobronchoscope) under local anesthesia.

• according to the purpose of the examination, we distinguish:

Diagnostic bronchoscopy

Bronchoscopically, changes in the appearance of the mucous membrane of the bronchi (coloring, thickening, infiltration, changes in the vascular pattern), changes in the bronchial lumen (compression or obstruction - perhaps by a tumor), and detection of a foreign body can be evaluated. For diagnostic purposes, bronchoscopy is also used to collect material for cytological or histological examination (by excision or using a brush). Furthermore, a puncture of the enlarged lymph nodes'', which are located right next to the bronchi, and a transbronchial biopsy of the lung parenchyma are performed. A special examination method that falls into this category is bronchoalveolar lavage (BAL), when 150-300 ml of physiological solution is applied to the segmental lobe of the lung and then aspirated again.

File:Flexibles Endoscope.jpg

Flexible endoscope

Therapeutic bronchoscopy

During therapeutic bronchoscopy, a procedure is performed that serves to eliminate a disorder. It is about:

1. removal of foreign bodies,
2. sucks out excess fluid,
3. removal of coagulum' (after bleeding) or mucous plugs (formed during inflammation),
4. stoppage of bleeding (tamponade with a balloon probe or fibrin),
5. introduction of stents into the bronchi or trachea in case of obstruction caused by external pressure (metal or plastic endobronchial prostheses),
6. local tumor therapy (mostly palliative - the goal is to open the bronchus and relieve the patient of complications), this includes laser therapy, cryotherapy, induction of necrosis using alcohol, endobronchial [[brachyradiotherapy] ] (local application of a radioactive emitter to the tumor site), local application of cytostatics,
7. bronchial lavage are lavages of the entire lung followed by aspiration of the used fluid, in total about 10-20 l of physiological solution, in patients with cystic fibrosis.

Indications for bronchoscopy

Bronchoscopy is performed at

1. suspicion of neoplastic disease (e.g. based on X-ray findings),
2. hemoptysis, bleeding into the lungs,
3. inflammatory lung disease,
4. lung abscess,
5. obstruction of bronchi (e.g. mucus plugs, coagulum),
6. aspiration, foreign body in bronchus,
7. get samples (biopsy, BAL),
8. cough lasting more than 3 months, the cause of which has not been explained,
9. need for therapeutic intervention (brachytherapy, stent placement, etc.).

Contraindications of bronchoscopy

Bronchoscopy is contraindicated

1. all conditions where the patient has severe lung function impairment (one-second capacity below 1500 ml),
2. suspicion of pneumothorax or the risk of its occurrence during examination,
3. suspicion of pulmonary embolism,
4. in patients with confirmed pulmonary hypertension (high risk of bleeding).

Complications of bronchoscopy

Among the most common complications are

1. bleeding - probably the most serious, life-threatening complication,
2. pneumothorax - threatens during transbronchial biopsy of the lung parenchyma,
3. damage to the vocal cords by the device,
4. mucosa damage of the respiratory tract,
5. laryngospasm - a rare complication.

Links

Related Articles

• Endoscope
• Endoscopy
• Bronchoalveolar lavage

References

• KLENER, Paul. Internal Medicine. 3. edition. Prague : Galen, 2006. 1158 pp. ISBN 80-7262-430-X.

• CZECH, Richard. Intern. 1. edition. Prague : Triton, 2010. 855 pp. ISBN 978-80-7387-423-0.