BRONCHOSCOPY

Mehdi hadadzadeh, MD

Cardiovascular surgeon

University of yazd

IN THE NAME OF GOD

BACKGROUND

• Allows direct visualization of the airways

• Rigid and flexible instruments

• Clinical tool– Airway anatomy– Airway sampling– Therapeutic

• Research tool

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

RIGID BRONCHOSCOPY

• Generally performed by ENT’s and surgeons

• Procedure oriented– Foreign body removal– Biopsies– Granuloma/polyp removal– Laser– Stent placement

• Visualization for future surgery

INSTRUMENTS

• Rigid bronchoscopes– Hollow metal tube– Glass rod telescope

FLEXIBLE BRONCHOCSOPY

• Examination of the entire respiratory anatomy, nose to bronchi

• Able to pass through an endotracheal tube or tracheostomy tube

Bronchoscopy

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

Fiberoptic bronchoscope2.8mm diameter

Pediatric videoscope3.8mm diameter

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

TECHNIQUE

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

TECHNIQUE

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

TECHNIQUE

• Anatomical survey– Nasal passages– Pharynx– Larynx– Trachea– Bronchi

• Examine all before any other procedures

TECHNIQUE

• Additional procedures– Bronchoalveolar lavage– Brushings– Bronchial biopsy– Transbronchial biopsy– Laser– Others: cryotherapy, stent placement, foreign

body removal, needle biopsy

BRONCHOALVEOLAR LAVAGE

• Small aliquots of sterile normal saline instilled into the airway

• Removed by suctioning

• Samples distal bronchial and alveolar surfaces

BRONCHOALVEOLAR LAVAGE

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

• 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

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

Thoracoscopy

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)

thoracoscopy v;s thoracotomy

• avoids many of the complications of open chest surgery

• reduces pain,

• hospital stay

• recovery time.

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

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

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

Complications:

• hemoptysis (10 to 25%)

• pneumothorax (10 to 37%)

• parenchymal hemorrhage

• air embolism

• subcutaneous emphysema.

Mediastinoscopy

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

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

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).

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.

risks

• puncturing the esophagus, trachea, or blood vessels

.

• In some circumstances, this can lead to potentially fatal bleeding.