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bronchoscopy

Fiberoptic examination of the bronchial tree. Indications: 1) diagnostic a) *persistent cough b) hemoptysis c) suspected cancer d) lung nodule - diagnostic in 54% of peripheral pulmonary nodules (segmental bronchus or beyond) [4] e) atelectasis f) stridor g) *diffuse lung disease h) lung infection i) *low diagnostic yield in pleural effusion j) tracheobronchial foreign body aspiration (also therapeutic) 2) therapeutic a) atelectasis b) retained secretions c) tracheobronchial foreign body aspiration - sudden onset dyspnea, monophonic wheeze, history of stroke, normal chest X-ray suggests foreign body aspiration d) airway stenosis - dilation e) obstructing lesions - laser therapy - *tracheobronchial stent placement 3) staging of lung cancer 4) performance of diagnostic procedures (generally after CT of lung) a) endobronchial ultrasound - hilar lymphadenopathy - pulmonary mass lesion b) bronchial washings & bronchoalveolar lavage c) endobronchial biopsy (including hilar lymph nodes) d) transbronchial biopsy & transbronchial needle aspiration - peripheral pulmonary nodules [4] Clinical significance: - allows for the evaluation of larger airways & endobronchial biopsy of mediastinal lymph nodes & lung parenchyma - allows for removal of aspirated foreign body Complications: 1) bleeding from mucosa or lung biopsy - risk increased in patients with renal failure, thrombocytopenia & other bleeding diatheses 2) pneumothorax from lung biopsy 3) hypoxemia Management: - maximize oxygen reserves during emergency airway management with high-flow nasal cannula oxygenation [3]

Related

bronchoalveolar lavage (BAL) culture of bronchial or transtracheal aspirate/lavage lung biopsy

Specific

bronchoscopic procedure flexible bronchoscopy navigational bronchoscopy

General

respiratory endoscopy

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 737
  2. Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
  3. Badiger S et al. Optimizing oxygenation and intubation conditions during awake fibre-optic intubation using a high-flow nasal oxygen-delivery system. Br J Anaesth 2015 Aug 7 PMID: 26253608 http://bja.oxfordjournals.org/content/early/2015/08/06/bja.aev262
  4. Ost DE, Ernst A, Lei X et al. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions: Results of the AQuIRE Registry. Am J Respir Crit Care Med 2016 Jan 1; 193:68 PMID: 26367186 http://www.atsjournals.org/doi/10.1164/rccm.201507-1332OC#.VquDFxiEtRk
  5. Casal RF, Ost DE, Eapen GA. Flexible bronchoscopy. Clin Chest Med. 2013 Sep;34(3):341-52 PMID: 23993807