Bronchoscopy is an endoscopic examination method, which is used to investigate the lower respiratory tract, i.e. the windpipe and bronchi.


There are two types of bronchoscopes. One is a rigid tube (rigid bronchoscopes) and the other has a form of a flexible tube (flexible bronchoscope). Either way, the principle of the examination is similar. The endoscopic device is inserted through the oral cavity and nasopharynx into the larynx and deeper into the respiratory tract. The end of the device is equipped with a miniature video camera and light source. In addition, the endoscopic device allows the examiner to use little tools to take a tissue sample for histological examination. These tools can also be used to extract aspirated solid objects.




Scheme of bronchoscopy



The patient should fast and avoid smoking for about 6-8 hours before the examination. It is also advisable to do basic blood tests and check the patient’s blood clotting parameters.


Bronchoscopy can be performed by both the local and general anesthesia. Local anesthesia means application of a spray anesthetic on mucous membranes of the upper airways to decrease the irritation caused by the endoscope. The local anesthetic can be combined with other drugs such as anxiolytic agents to sedate the patient. Bronchoscopy under general anesthesia is performed less often.


The bronchoscopy is great in examining unknown diseases of the lower respiratory tract, interstitial lung diseases and lung tumors. Bronchi-infiltrating tumor tissue can be seen thanks to the camera and small sample from any suspicious lesion can be taken by special bioptic forceps for histological examination that confirms the diagnosis.


Bronchoscopy is also valuable for possibility to perform the bronchoalveolar lavage (BAL). When the endoscopic instrument reaches the smallest bronchi, it can release a small amount of saline. The fluid is quickly suck in back into the device and sample of the fluid can be sent for cytological examination – examination of cells present in the obtained fluid.


Bronchoscopy can be used for removal of aspirated solid foreign objects out of the lower airways. The inhaled objects should be removed as they can cause shortness of breath (sometimes even death by suffocation) or they may become a source of severe purulent pneumonia.


The examination is painless, but it may be worse tolerated by some people. The insertion and presence of the device in the respiratory tract may irritate the airways and cause cough and feeling of breathlessness. After examination, the patient may suffer from hoarseness for a while. Therefore, bronchoscopy should be cautiously indicated and it is not an examination of first choice.


When properly indicated, the bronchoscopy is a great examination that allows confirming many diseases of respiratory tract by visualization of bronchi and the possibility to obtain samples for histological and cytological examination. In case of aspiration of a solid object, the bronchoscopy may be the only therapeutic solution available.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources