bronchoscopy
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Introduction
Fiberoptic examination of the bronchial tree.
Indications
- diagnostic
- persistent cough
- hemoptysis
- suspected cancer
- lung nodule
- diagnostic in 54% of peripheral pulmonary nodules (segmental bronchus or beyond)[4]
- atelectasis
- stridor
- diffuse lung disease
- lung infection
- low diagnostic yield in pleural effusion
- tracheobronchial foreign body aspiration (also therapeutic)
- therapeutic
- atelectasis
- retained secretions
- tracheobronchial foreign body aspiration
- sudden onset dyspnea, monophonic wheeze, history of stroke, normal chest X-ray suggests foreign body aspiration
- airway stenosis - dilation
- obstructing lesions
- laser therapy
- tracheobronchial stent placement
- staging of lung cancer
- performance of diagnostic procedures (generally after CT of lung)
- endobronchial ultrasound
- bronchial washings & bronchoalveolar lavage
- endobronchial biopsy (including hilar lymph nodes)
- 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
- bleeding from mucosa or lung biopsy
- risk increased in patients with renal failure, thrombocytopenia & other bleeding diatheses
- pneumothorax from lung biopsy
- hypoxemia
Management
- maximize oxygen reserves during emergency airway management with high-flow nasal cannula oxygenation[3]
More general terms
More specific terms
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 737
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, 17. American College of Physicians, Philadelphia 2012, 2015
- ↑ 3.0 3.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26253608 <Internet> http://bja.oxfordjournals.org/content/early/2015/08/06/bja.aev262
- ↑ 4.0 4.1 4.2 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26367186 <Internet> http://www.atsjournals.org/doi/10.1164/rccm.201507-1332OC#.VquDFxiEtRk
- ↑ Casal RF, Ost DE, Eapen GA. Flexible bronchoscopy. Clin Chest Med. 2013 Sep;34(3):341-52 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23993807