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[edit | edit source]
- According to the type of device used, we distinguish:
- Rigid bronchoscopy - examination is performed with a rigid bronchoscope under local or general anesthesia,
- Flexible bronchoscopy' - examination is performed with a flexible bronchoscope (fibrobronchoscope) under local anesthesia.
- according to the purpose of the examination, we distinguish:
Diagnostic bronchoscopy[edit | edit source]
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[edit | edit source]
During therapeutic bronchoscopy, a procedure is performed that serves to eliminate a disorder. It is about:
- removal of foreign bodies,
- sucks out excess fluid,
- removal of coagulum' (after bleeding) or mucous plugs (formed during inflammation),
- stoppage of bleeding (tamponade with a balloon probe or fibrin),
- introduction of stents into the bronchi or trachea in case of obstruction caused by external pressure (metal or plastic endobronchial prostheses),
- 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,
- 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[edit | edit source]
Bronchoscopy is performed at
- suspicion of neoplastic disease (e.g. based on X-ray findings),
- hemoptysis, bleeding into the lungs,
- inflammatory lung disease,
- lung abscess,
- obstruction of bronchi (e.g. mucus plugs, coagulum),
- aspiration, foreign body in bronchus,
- get samples (biopsy, BAL),
- cough lasting more than 3 months, the cause of which has not been explained,
- need for therapeutic intervention (brachytherapy, stent placement, etc.).
Contraindications of bronchoscopy[edit | edit source]
Bronchoscopy is contraindicated
- all conditions where the patient has severe lung function impairment (one-second capacity below 1500 ml),
- suspicion of pneumothorax or the risk of its occurrence during examination,
- suspicion of pulmonary embolism,
- in patients with confirmed pulmonary hypertension (high risk of bleeding).
Complications of bronchoscopy[edit | edit source]
Among the most common complications are
- bleeding - probably the most serious, life-threatening complication,
- pneumothorax - threatens during transbronchial biopsy of the lung parenchyma,
- damage to the vocal cords by the device,
- mucosa damage of the respiratory tract,
- laryngospasm - a rare complication.
Links[edit | edit source]
Related Articles[edit | edit source]
References[edit | edit source]
- 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.