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.

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.

Related Articles

 * Endoscope
 * Endoscopy
 * Bronchoalveolar lavage