Modern examination methods in pulmonology

Abstract

Bronchoscopy is a procedure which can help to diagnose and treat some conditions of the airways (bronchi) and lungs. Bronchoscopy is a procedure during in which an examiner uses a viewing tube to evaluate a patient's lung and airways including the voice box and vocal cord, trachea, and many branches of bronchi. Bronchoscopy is usually performed by a pulmonologist or a thoracic surgeon. Although a bronchoscope does not allow for direct viewing and inspection of the lung tissue itself, samples of the lung tissue can be biopsied through the bronchoscope for examination in the laboratory. There are two types of bronchoscopy : A fibre-optic bronchoscope is the device usually used. This is a thin, flexible, telescope (shown in the diagram). It is about as thick as a pencil. The bronchoscope is passed through the nose or mouth, down the back of the throat, into the windpipe (trachea), and down into the bronchi. The fibre-optics allow light to shine around bends in the bronchoscope and so the doctor can see clearly inside your airways. A rigid bronchoscope (not shown in diagram) is used much less often. It is like a thin, straight telescope. It may be needed for some procedures, and in children. It requires a general anaesthetic. (A fibre-optic bronchoscopy only requires sedation.) Both types of bronchoscope have a side channel down which thin instruments can pass. For example, a thin grabbing instrument can pass down to take a small sample (biopsy) from the inside lining of a bronchus, or from structures next to a bronchus. Depending on the indication the examiner will choose between the flexible fiber optic bronchoscope and the rigid bronchoscope. For example, if a patient were coughing up large amounts of blood, a rigid bronchoscope is used since it has a large suction channel and allows for the use of instruments that can better control bleeding. The vast majority of bronchoscopies are performed using the flexible fiberoptic scope because of the improved patient comfort and reduced use of anesthesia. Bronchoscopy is used to make a diagnosis most commonly for these conditions: – persistent or unexplained cough; – blood in the sputum (coughed up mucus material from the lungs); – abnormal chest x-ray such as a mass, nodule, or inflammation in the lung; – evaluation of a possible lung infection. Bronchoscopy is used for treatment: – to remove foreign bodies in the airway; – to place a stent (a tiny tube) to open a collapsed airway due to pressure by a mass or tumor; – to remove a mass or growth that is blocking the airway. Complications of bronchoscopy are relatively rare and most often minor. It is important to realize that all procedures may involve risk or complications from both known and unforeseen causes, because individual patients vary in their anatomy and response to medications. Therefore, there is no guarantee that a procedure can be free of complications. The following is a list of potential complications: nose bleeding (epistaxis); vocal cord injury; irregular heart beats; lack of oxygen to the body's tissues; heart injury due to medications or lack of oxygen; bleeding from the site of biopsy; punctured lung (pneumothorax); damage to teeth (from rigid bronchoscopy); complications from pre-medications or general anesthesia.