Health Encyclopedia

Bronchoscopy

Definition

Bronchoscopy is a test to view the airways and diagnose lung disease. It may also be used during the treatment of some lung conditions.

Alternative Names

Fiberoptic bronchoscopy

How the test is performed

A bronchoscope is a device used to see the inside of the lungs. It can be flexible or rigid. Usually, a flexible bronchoscope is used. The flexible bronchoscope is a tube less than 1/2 inch wide and about 2 feet long.

The scope is passed through your mouth or nose, and then into your lungs. Going through the nose is a good way to look at the upper airways. The mouth method allows the doctor to use a larger bronchoscope.

A rigid bronchoscope requires general anesthesia. You will be asleep. If a flexible bronchoscope is used, you will be awake. The doctor will spray a numbing drug (anesthetic) in your mouth and throat. This will cause coughing at first, which will stop as the anesthetic begins to work. When the area feels thick, it is numb enough. You may get medications through a vein (intravenously) to help you relax.

If the bronchoscopy is done through the nose, numbing jelly will be placed into one nostril.

Once you are numb, the tube will be inserted into the lungs. Then, the doctor sends saline solution through the tube. This flushes the lungs and allows the doctor to collect samples of lung cells, fluids, and other materials inside the air sacs. This part of the procedure is called a lavage.

Sometimes, tiny brushes, needles, or forceps may be passed through the bronchoscope and used to take tissue samples (biopsies) from your lungs. The pieces of lung material that are removed are so small that they are barely visible. The doctor can also place a stent in the airway or view the lungs with ultrasound during a bronchoscopy.

How to prepare for the test

Do not eat or drink anything 6 - 12 hours before the test. Your doctor may also want you to avoid any aspirin or ibuprofen medications before the procedure.

You may be sleepy after the test, so you should arrange for transportation to and from the hospital.

Many people want to rest the following day, so make arrangements for work, child care, or other obligations. Usually, the test is done as an outpatient procedure, and you will go home the same day. Some patients may need to stay overnight in the hospital.

How the test will feel

Local anesthesia is used to relax the throat muscles. Until the anesthetic begins to work, you may feel fluid running down the back of your throat and have the need to cough or gag.

Once the anesthetic takes effect, you may have sensations of pressure or mild tugging as the tube moves through the windpipe (trachea). Although many patients feel like they might suffocate when the tube is in the throat, there is NO risk of suffocation. If you cough during the test, you will get more anesthetic.

When the anesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 - 2 hours. You will not be allowed to eat or drink until your cough reflex returns.

Why the test is performed

You may have bronchoscopy if your health care provider suspects lung disease and an inspection of the airways or a tissue sample is needed to confirm it. The test can be used to evaluate almost any disease in pulmonary medicine, including:

Acute pulmonary eosinophilia (Loeffler syndrome)
Aspiration pneumonia
Atelectasis
Bronchial adenoma
CMV pneumonia
Chronic pulmonary coccidioidomycosis
Cryptococcosis
Disseminated tuberculosis (infectious)
Chronic pulmonary histoplasmosis
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

Bronchoscopy is also recommended if you have been coughing up blood.

Normal Values

Normal cells and secretions are found. No foreign substances or blockages are seen.

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Abnormality in the bronchial wall
Enlarged (dilated) tubular vessels
Enlarged glands or lymph nodes
Excessive bleeding (hemorrhage)
Infections from bacteria, viruses, fungi, parasites, or tuberculosis
Irregular bronchial branching
Lung cancer
Narrowing (stenosis) of the trachea
Swelling (inflammation)
Tumor
Ulceration

What the risks are

The main risks from bronchoscopy are:

Bleeding from biopsy sites
Infection

There is also a small risk of:

Arrhythmias
Heart attack
Low blood oxygen
Pneumothorax

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

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

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. The technician or nurse will monitor the amount of bleeding.

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

Special considerations

After the procedure, your gag reflex will return. However, until it does, do not eat or drink anything.

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 you don't gag, wait 15 minutes and try it again. Make sure that you don't use any small or sharp objects to test this reflex.

References

Mason RJ, Broaddus VC, Murray JF, Nadel JA. Textbook of Respiratory Medicine. 4th ed. Philadelphia, Pa: Saunders; 2005.

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005:2474.

Review Date:11/12/2007
Reviewed By:Andrew Schriber, M.D., F.C.C.P., Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network.

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