Alternate Names: Fiberoptic bronchoscopy

How Performed:

The pulmonologist (a lung specialist trained to perform a bronchoscopy) sprays a topical or local anesthetic in your mouth and throat. This will cause coughing at first, which will cease as the anesthetic begins to work. When the area feels "thick," it is sufficiently numb. Medications to relax you may be given through an iv., making you sleepy.

If the bronchoscopy is performed via the nose, an anesthetic jelly will first be inserted into one nostril. When it is numb, the scope will be inserted through the nostril until it passes through the throat into the trachea and bronchi. Usually, a flexible bronchoscope is used. The flexible tube is less than 1/2-inch wide and about 2-feet long. As the bronchoscope is used to examine the airways of the lungs, your doctor can obtain samples of your lung secretions to send for laboratory analysis. Other saline fluids can be introduced to flush the area and collect cells that may be analyzed by a pathologist. Tiny brushes, needles, or forceps can be introduced through the bronchoscope to obtain tissue samples from your lungs. Occasionally stenting and laser therapies can be performed through the bronchoscope. A rigid bronchoscope is rarely used.

How To Prepare:

This test may require an overnight stay in the hospital. A list of essentials is usually available from a doctor or clinic. Fasting is required for 6 to 12 hours before the test. Your doctor may want you to avoid any aspirin or ibuprofen-type medications before the procedure. You must sign an informed consent form. Arrange for transportation to and from the hospital. Many people want to rest the following day, so make arrangements for work, childcare, or other obligations.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child’s age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child’s age:

• Infant test or procedure preparation (birth to 1 year)
• Toddler test or procedure preparation (1 to 3 years)
• Preschooler test or procedure preparation (3 to 6 years)
• Schoolage test or procedure preparation (6 to 12 years)
• Adolescent test or procedure preparation (12 to 18 years)

How It Feels:

Local anesthesia is used to relax the throat muscles, so there is the feeling of fluid running down the back of the throat and the need to cough or gag until the anesthetic begins working.

Once the anesthetic takes effect, there may be sensations of pressure or mild tugging as the tube moves through the trachea. Many patients experience the feeling of suffocation when the tube is in the throat (there is no risk of suffocation). If there is coughing during the test, more anesthetic will be added.

When the anesthetic wears off, the throat may be scratchy for several days. After the test, the cough reflex will return in 1 to 2 hours, then normal eating and drinking is allowed.

Risks:

The main risks from bronchoscopy are:

• Infection
• Bleeding from biopsy sites

There is also a small risk of:

• Disordered heart rhythm (arrhythmias)
• Heart attack
• Low blood oxygen (hypoxemia)
• Pneumothorax

In the rare instances when general anesthesia is used, there is some risk for:

• Nausea
• Vomiting
• Sore throat
• Muscle pain
• Breathing difficulties
• Depressed heart rate
• Change in blood pressure

There is a small risk for:

• Heart attack
• Kidney damage

When a biopsy is taken, there is a risk of hemorrhage. Some bleeding is common; however, and the technician or nurse will monitor the amount of bleeding.

There is a significant risk of choking if anything (including water) is ingested before the anesthetic wears off.

Why Performed: This test is recommended if a chest X-ray or other diagnostic procedure suggestsa lung disease that requires an inspection of the airways of the lung or a tissue sample for diagnosis. Bronchoscopy is also recommended if you have been coughing up blood (hemoptysis).

Normal Values:

The trachea and bronchi have normal secretions and no foreign bodies or obstructions.

Abnormal Results:

• Abnormality in the bronchial wall
• Inflammation
• Swelling
• Ulceration
• Tumor
• Enlarged glands or lymph nodes
• Stenosis or compression of the trachea
• Dilated tubular vessels
• Irregular bronchial branching
• Hemorrhage
• Lung cancer
• Infections from bacteria, viruses, fungi, parasites, or tuberculosis

Additional conditions under which the test may be performed

Bronchoscopy can be used to evaluate almost any disease in pulmonary medicine, including:

• Acute pulmonary eosinophilia (Loeffler’s syndrome)
• Aspiration pneumonia
• Atelectasis
• Bronchial adenoma
• CMV pneumonia
• Coccidioidomycosis - chronic pulmonary
• Cryptococcosis
• Disseminated tuberculosis (infectious)
• Histoplasmosis - chronic pulmonary
• Metastatic cancer to the lung
• Pneumonia in immunocompromised host
• Pneumonia with lung abscess
• Pulmonary actinomycosis
• Pulmonary aspergilloma (mycetoma)
• Pulmonary aspergillosis - invasive type
• Pulmonary histiocytosis X (eosinophilic granuloma)
• Pulmonary nocardiosis
• Pulmonary tuberculosis
• Sarcoidosis
• SVC obstruction

Cost:

Special Considerations:

Your gag reflex should return before drinking or eating anything after the bronchoscopy. To test if the gag reflex has returned, place a spoon on the back of your tongue for a few seconds with light pressure. If there is no gagging, wait 15 minutes and attempt it again. Make sure that no small or sharp objects are used to test this reflex.