Bronchoscopy

Bronchoscopy is a procedure used to look inside the lungs' airways, called the bronchi and bronchioles. The airways carry air from the trachea, or windpipe, to the lungs.

During the procedure, your doctor passes a thin, flexible tube called a bronchoscope through your nose (or sometimes your mouth), down your throat, and into the airways. If you have a breathing tube, the bronchoscope can be passed through it to your airways.

At the bronchoscope's tip are a light and a mini-camera, so the doctor can see your windpipe and airways. You will be given medicine to make you relaxed and sleepy during the procedure.

If there's a lot of bleeding in your lungs or a large object stuck in your throat, your doctor may use a bronchoscope with a rigid tube. The rigid tube, which is passed through the mouth, is wider. This allows your doctor to see inside it more easily, treat bleeding, and remove stuck objects.

A rigid bronchoscopy is usually done in a hospital operating room while you're under general anesthesia. Anesthesia is used so you will sleep through the procedure and not feel any pain.

Overview

Bronchoscopy is usually done to find the cause of a lung problem. Your doctor may take samples of mucus or tissue from your lungs during the procedure to test in a lab.

Bronchoscopy may show a tumor, signs of an infection, excess mucus in the airways, the site of bleeding, or something blocking the airway, like a piece of food.

Sometimes bronchoscopy is used to treat lung problems. It may be done to insert a stent in an airway. An airway stent is a small tube that holds the airway open. It's used when a tumor or other condition blocks an airway.

In children, the procedure is most often used to remove something blocking the airway. In some cases, it's used to find out what's causing a cough that has lasted for at least a few weeks.

Outlook

Bronchoscopy is usually a safe procedure. You may be hoarse and have a sore throat after the procedure. There's a slight risk of minor bleeding or developing a fever or pneumonia.

A rare but more serious risk is a pneumothorax, or collapsed lung. In this condition, air collects in the space around the lungs, which causes them to collapse. This problem is easily treated.

Scientists are studying new methods of bronchoscopy, including virtual bronchoscopy. This is a kind of computed tomography (CT) scan. A CT scan uses special x-ray equipment to take clear, detailed pictures of the inside of your body. During the scan, you lie on a table that slides through the center of a tunnel-shaped x-ray machine. X-ray tubes in the scanner rotate around you and take pictures of your lungs.

Virtual bronchoscopy is still not used often.

Who Needs Bronchoscopy?

The most common reason why your doctor may decide to do a bronchoscopy is if you have an abnormal chest x ray or computed tomography (CT) scan. These tests may show a tumor, a collapsed lung, or signs of an infection.

A chest x ray takes a picture of the heart and lungs. A CT scan uses special x-ray equipment to take pictures of the inside of your body.

Other reasons for bronchoscopy include if you're coughing up blood or if you have a cough that has lasted more than a few weeks.

The procedure also can be done to remove something that's stuck in an airway (like a piece of food), to place medicine in the lung to treat a lung problem, or to insert a stent (small tube) in an airway to hold it open when a tumor or other condition causes a blockage.

Bronchoscopy also can be used to check for swelling in the upper airways and vocal cords of people who were burned around the throat area or inhaled smoke from a fire.

In children, the procedure is most often used to remove something blocking an airway. In some cases, it's used to find out what's causing a cough that has lasted for at least a few weeks.

What To Expect Before Bronchoscopy

Your doctor will do the bronchoscopy in a special clinic or in the hospital. To prepare for the procedure, tell your doctor:

• What medicines you're taking, including prescription and over-the-counter medicines. It's helpful to give your doctor a list of the medicines you take.
• About any previous bleeding problems.
• About any allergies to medicines or latex.

Arrange for someone to drive you home from the clinic or hospital. The medicine you'll receive before the procedure will make you sleepy.

Avoid eating or drinking for 4 to 8 hours before the procedure. Your doctor will let you know the right amount of time.

What To Expect During Bronchoscopy

Your doctor will do the procedure in an exam room at a special clinic or in the hospital. The bronchoscopy itself usually lasts about 30 minutes. But the entire procedure, including preparation and recovery time, takes about 4 hours.

Your doctor will give you medicine through an intravenous (IV) line in your bloodstream or by mouth to make you sleepy and relaxed.

Your doctor also will squirt or spray a liquid medicine into your nose and throat to make them numb. This helps prevent coughing and gagging when the bronchoscope (long, thin tube) is inserted.

Then, your doctor will insert the bronchoscope through your nose or mouth and into your airways. As the tube enters your mouth, you may gag a little. Once it enters your throat, that feeling will go away.

Your doctor will look at your vocal cords and airways through the bronchoscope (which has a light and a mini-camera at its tip).

He or she may take a sample of lung fluid or tissue for further testing. A chest x ray may be used to help find the exact area to take the sample.

Samples can be taken through these methods:

• Bronchoalveolar lavage. The doctor passes a small amount of salt water (a saline solution) through the bronchoscope and into part of your lung and then suctions it back out. The fluid picks up cells and bacteria from the airway, which your doctor can study.
• Transbronchial lung biopsy. The doctor inserts forceps into the bronchoscope and takes a small sample of tissue from inside the lung.
• Transbronchial needle aspiration. The doctor inserts a needle into the bronchoscope and removes cells from the lymph nodes in your lungs. These nodes are small, bean-shaped masses. They trap bacteria and cancer cells and help fight infection.

You may feel short of breath during bronchoscopy, but enough air is getting to your lungs. Your doctor will check your oxygen level. If the level drops, you'll be given oxygen.

If there's a lot of bleeding in your lungs or a large object stuck in your throat, your doctor may use a bronchoscope with a rigid tube. The rigid tube, which is passed through the mouth, is wider. This allows your doctor to see inside it more easily, treat bleeding, and remove stuck objects.

A rigid bronchoscopy is usually done in a hospital operating room while you're under general anesthesia. Anesthesia is used so you will sleep through the procedure and not feel any pain.

After the procedure is done, your doctor will remove the bronchoscope.

What To Expect After Bronchoscopy

After bronchoscopy, you'll need to stay at the clinic or hospital for up to a few hours. If your doctor uses a bronchoscope with a rigid tube, there's a longer recovery time. While you're at the hospital or clinic:

• You may have a chest x ray if your doctor took a sample of tissue from your lung. This test will check for a pneumothorax and bleeding. A pneumothorax is a condition in which air or gas collects in the space around the lungs. This can cause the lung(s) to collapse. The condition is easily treated.
• A health care provider will check your breathing and blood pressure.
• You can't eat or drink until the numbness in your throat wears off. This takes 1 to 2 hours.

After recovery, you'll need to have someone take you home. You'll be too sleepy to drive.

If samples of tissue or fluid were taken during the procedure, they'll be tested in a lab. Ask your doctor when you'll receive the lab results.

Recovery and Recuperation

Ask your doctor when you can return to your normal activities, such as driving, working, and physical activity. For the first few days, you may have a sore throat, cough, and hoarseness. Call your doctor right away if you:

• Develop a fever
• Have chest pain
• Have trouble breathing
• Cough up more than a few tablespoons of blood

What Does Bronchoscopy Show?

Bronchoscopy may show a tumor, signs of an infection, excess mucus in the airways, the site of bleeding, or something blocking your airway.

Your doctor will use the procedure results to decide how to treat any lung problems that were found. Other tests may be needed.

What Are the Risks of Bronchoscopy?

Bronchoscopy is usually a safe procedure. However, there's small risk for problems. The risks include:

• A drop in your oxygen level during the procedure. The doctor will give you oxygen if this happens.
• A slight risk of minor bleeding and developing a fever or pneumonia.

A rare but more serious side effect is a pneumothorax. A pneumothorax is a condition in which air or gas collects in the space around the lungs. This can cause the lung(s) to collapse.

This condition is easily treated and may go away on its own. If it interferes with breathing, a tube may need to be placed in the space around the lungs to remove the air.

A chest x ray may be done after bronchoscopy to check for problems.

Key Points

• Bronchoscopy is a procedure used to look inside the lungs' airways.
• During this procedure, your doctor inserts a bronchoscope (a thin, flexible tube) through your nose or mouth, down your throat, and into your airways. At the tube's tip are a light and a mini-camera, so the doctor can see your windpipe and airways.
• This procedure is usually done to find out the cause of a lung condition, such as a tumor. Sometimes it's done to treat a lung problem.
• Your doctor may decide to do a bronchoscopy if you have an abnormal chest x ray or computed tomography (CT) scan. This is the most common reason for bronchoscopy. Chest x rays and CT scans can show tumors, pneumothorax (collapsed lung), or signs of infection.
• Bronchoscopy also can be done to remove something stuck in the airway or to place medicine in the lung to treat a lung problem. It can be used to check for swelling in the upper airways and vocal cords of people who were burned around the throat area or inhaled smoke from a fire.
• In children, bronchoscopy is used to remove something blocking the airway. In some cases, it's used to find out what's causing a cough that has lasted for at least a few weeks.
• Bronchoscopy is done in a special clinic or hospital. Your doctor will give you medicine to numb your nose and throat and make you sleepy and relaxed. Then, your doctor will insert the bronchoscope and look at your lungs. He or she may take a sample of lung fluid or tissue for further testing, or he or she may insert a stent (small tube) to hold the airway open as part of the procedure.
• If there's a lot of bleeding in your lungs or a large object stuck in your throat, your doctor may use a bronchoscope with a rigid tube. A rigid bronchoscopy is usually done in a hospital operating room while you're under general anesthesia. Anesthesia is used so you will sleep through the procedure and not feel any pain.
• The bronchoscopy itself usually takes about 30 minutes. But the entire procedure, including preparation and recovery time, takes about 4 hours.
• Bronchoscopy can show a tumor, signs of an infection, excess mucus in the airways, the site of bleeding, or something blocking the airway, like a piece of food.
• Bronchoscopy is usually a safe procedure. However, there's a small risk for problems. These problems may include a drop in your oxygen level during the procedure, minor bleeding, or developing a fever or pneumonia.
• A more serious risk is a pneumothorax, or collapsed lung. In this condition, air collects in the space around the lungs, which causes them to collapse. The condition is easily treated.
• For a few days after the procedure, you may be hoarse and have a sore throat. Call your doctor right away if you have chest pain, trouble breathing, or cough up more than a few tablespoons of blood.