1.
BRONCHOSCOPY

2.
BACKGROUND
• Allows direct visualization of the airways
• Rigid and flexible instruments
• Clinical tool
– Airway anatomy
– Airway sampling
– Therapeutic
• Research tool

3.
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

4.
RIGID BRONCHOSCOPY
• Generally performed by ENT surgeons
• Procedure oriented
– Foreign body removal
– Biopsies
– Granuloma/polyp removal
– Laser
– Stent placement
• Visualization for future surgery

5.
INSTRUMENTS
• Rigid bronchoscopes
– Hollow metal tube
– Glass rod telescope

6.
FLEXIBLE BRONCHOCSOPY
• Examination of the entire respiratory
anatomy, nose to bronchi
• Able to pass through an endotracheal tube
or tracheostomy tube

7.
Bronchoscopy

8.
INSTRUMENTS
• Flexible instruments
– Fiberoptic bronchoscopes
• 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

9.
Fiberoptic bronchoscope
2.8mm diameter

10.
Pediatric videoscope
3.8mm diameter

11.
INDICATIONS
• Atelectasis
• Recurrent pneumonia
• Chronic cough
• Persistent/unexplained wheeze
• Hemoptysis
• Suspected airway compression/obstruction
• Stridor
• Upper airway obstruction
• Suspected aspiration
• Evaluation of tracheostomies

12.
TECHNIQUE

13.
TECHNIQUE
• Anesthesia
– 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

14.
TECHNIQUE
• Insertion
– Nasal
– Endotracheal tube
– Tracheostomy tube
– Appropriate topical anesthesia and lubrication

15.
TECHNIQUE
• Anatomical survey
– Nasal passages
– Pharynx
– Larynx
– Trachea
– Bronchi
• Examine all before any other procedures

16.
TECHNIQUE
• Additional procedures
– Bronchoalveolar lavage
– Brushings
– Bronchial biopsy
– Transbronchial biopsy
– Laser
– Others: cryotherapy, stent placement, foreign
body removal, needle biopsy

17.
BRONCHOALVEOLAR
LAVAGE
• Small aliquots of sterile normal saline
instilled into the airway
• Removed by suctioning
• Samples distal bronchial and alveolar
surfaces

18.
BRONCHOALVEOLAR
LAVAGE

19.
Thoracoscopy
insertion of an endoscope, a narrow-
diameter tube with a viewing mirror
or camera attachment, through a very
small incision (cut) in the chest wall

20.
• 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
Thoracoscopy

21.
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

22.
Thoracoscopy

23.
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)

24.
thoracoscopy v;s thoracotomy
• avoids many of the complications of open
chest surgery
• reduces pain,
• hospital stay
• recovery time.

25.
Preparation
• 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

26.
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

27.
• diagnosis of cancer with > 95% accuracy.
Needle biopsy yields an accurate diagnosis
in benign processes only 50 to 60% of the
time.

28.
Complications:
• hemoptysis (10 to 25%)
• pneumothorax (10 to 37%)
• parenchymal hemorrhage
• air embolism
• subcutaneous emphysema.

29.
Mediastinoscopy
• surgical procedure to examine the inside of
the upper chest between and in front of the
lungs (mediastinum).

30.
• replaced by other biopsy methods that use
computed tomography (CT),
echocardiography, or bronchoscopy to
guide a biopsy needle to the abnormal tissue

31.
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).

32.
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.

33.
risks
• puncturing the esophagus, trachea, or blood
vessels
.
• In some circumstances, this can lead to
potentially fatal bleeding.