Test Overview

Bronchoscopy is a procedure that allows your
doctor to look at your airway through a thin viewing instrument called a
bronchoscope. During a bronchoscopy, your doctor will examine your throat,
larynx,
trachea, and lower airways.

Bronchoscopy
may be done to diagnose problems with the airway, the lungs, or with the
lymph nodes in the chest, or to treat problems such as
an object or growth in the airway.

There are two types of
bronchoscopy.

  • Flexible bronchoscopy.
    It uses a long, thin, lighted tube to look at your airway. The flexible
    bronchoscope is used more often than the rigid bronchoscope because it usually
    does not require
    general anesthesia, is more comfortable for the
    person, and offers a better view of the smaller airways. It also allows the
    doctor to remove small samples of tissue (biopsy).
  • Rigid bronchoscopy. This is usually done with general anesthesia and uses a
    straight, hollow metal tube. It is used:

    • When there is bleeding in the airway that
      could block the flexible scope’s view.
    • To remove large tissue
      samples for biopsy.
    • To clear the airway of objects (such as a piece
      of food) that cannot be removed using a flexible bronchoscope.

Special procedures, such as widening (dilating) the airway
or destroying a growth using a
laser, are usually done with a rigid
bronchoscope.

Why It Is Done

Bronchoscopy
may be used to:

  • Find the cause of airway problems, such as
    bleeding, trouble breathing, or a long-term (chronic) cough.
  • Take
    tissue samples when other tests, such as a chest
    X-ray or
    CT scan, show problems with the lung or with
    lymph nodes in the chest.
  • Diagnose lung diseases by collecting tissue or mucus (sputum) samples for examination.
  • Diagnose
    and determine the extent of
    lung cancer.
  • Remove objects blocking the
    airway.
  • Check and treat
    growths in the airway.
  • Control bleeding.
  • Treat areas of
    the airway that have narrowed and are causing problems.
  • Treat cancer of the airway using radioactive materials
    (brachytherapy).

How To Prepare

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have
regarding the need for the procedure, its risks, how it will be done, or what
the results will mean. To help you understand the importance of this procedure,
fill out the
medical test information form (What is a PDF document?).

Before you have a
bronchoscopy, tell your doctor if you:

  • Are taking any medicines.
  • Are
    allergic to any medicines, including
    anesthetics.
  • Take a blood thinner, or if you have had bleeding problems.
  • Are or might be pregnant.

Your doctor will tell you how soon before the biopsy to stop eating and drinking. Follow the instructions exactly about when to stop eating and drinking, or your test may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.

Your doctor may order other tests before your bronchoscopy,
such as a
complete blood count (CBC), clotting factors,
arterial blood gas (ABG), or
lung function tests.

Arrange to have
someone drive you home after the procedure.

How It Is Done

You may be asked to remove dentures,
eyeglasses or contact lenses, hearing aids, wigs, makeup, and jewelry before
the bronchoscopy procedure. You will empty your bladder before the procedure.
You will need to take off all or most of your clothes (you may be allowed to
keep on your underwear if it does not interfere with the procedure). You will
be given a cloth or paper covering to use during the procedure.

The procedure is done by a
thoracic surgeon or a pulmonologist and an assistant. Your heart rate, blood
pressure, and oxygen level will be checked during the procedure.

A chest X-ray may be done before and after the bronchoscopy.

Flexible bronchoscopy

During this procedure, you
will lie on your back on a table with your shoulders and neck supported by a
pillow, or you will recline in a chair that resembles a dentist’s chair.
Sometimes the procedure is done while you are sitting upright.

You
will be given a
sedative to help you relax. You may have an
intravenous line (IV) placed in a vein. You will
remain awake but sleepy during the procedure.

Before the
procedure, your doctor usually sprays a
local anesthetic into your nose and mouth. This numbs
your throat and reduces your gag reflex during the procedure. If the
bronchoscope is to be inserted through your nose, your doctor may also place an
anesthetic ointment in your nose to numb your nasal passages.

Your
doctor gently and slowly inserts the thin bronchoscope through your mouth (or
nose) and advances it to the vocal cords. Then more anesthetic is sprayed
through the bronchoscope to numb the vocal cords. You may be asked to take a
deep breath so the scope can pass your vocal cords. It is important to avoid
trying to talk while the bronchoscope is in your airway.

An X-ray
machine (fluoroscope) may be placed above you to provide a picture that helps your doctor see
any devices, such as
forceps to collect a biopsy sample, that are being
moved into your lung. The bronchoscope is then moved down your larger breathing
tubes (bronchi) to examine the lower airways.

If your doctor
collects sputum or tissue samples for biopsy, a tiny biopsy tool or brush will
be used through the scope. A salt (saline) fluid may be used to wash your
airway, then the samples are collected and sent to the lab to be
studied.

Finally, small biopsy forceps may be used to remove a
sample of lung tissue. This is called a transbronchial biopsy.

Rigid bronchoscopy

This procedure is usually
performed under
general anesthesia. You will lie on your back on a
table with your shoulders and neck supported by a pillow.

You will
be given a sedative to help you relax. You will have an
intravenous line (IV) placed in a vein. Once you are asleep, your head will be carefully
positioned with your neck extended. A tube
(endotracheal) will be placed in your windpipe (trachea) and a machine will
help you breathe. Your doctor then slowly and gently inserts
the bronchoscope through your mouth and into your windpipe.

If
your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or
a brush will be inserted through the scope. A salt (saline) fluid may be used
to wash your airway, then the samples are collected and sent to the lab for
biopsy.

Recovery after bronchoscopy

Bronchoscopy by either procedure usually takes about 30 to 60 minutes.
You will be in recovery for 1 to 3 hours after the procedure. Following the
procedure:

  • Do not eat or drink anything for 1 to 2 hours,
    until you are able to swallow without choking. After that, you may resume your
    normal diet, starting with sips of water.
  • Spit out your saliva
    until you are able to swallow without choking.
  • Do not drive for at
    least 8 hours after the procedure.
  • Do not smoke for at least 24 hours.

How It Feels

If you have general anesthesia, you will
feel nothing during the procedure. Oxygen is usually given through a small tube
placed in your nose if you are awake during the procedure.

You may
be able to feel pressure in your airway as the bronchoscope is moved from place
to place. You may gag or cough during bronchoscopy. Your airway will not be
blocked, but if you feel discomfort let your doctor know.

After
the procedure, you may feel tired for a day or so and have general muscle
aches. If a local anesthetic is used, you may have a bitter taste in your
mouth. Your mouth may feel very dry for several hours after the procedure. You
may also have a sore throat and some hoarseness for a few days. Sucking on
throat lozenges or gargling with warm salt water may help soothe your sore
throat.

The anesthesia will make it hard to swallow. You will need to avoid eating or drinking for 1 to 2 hours after the procedure.

If a biopsy sample was taken, it is normal to spit up a
small amount of blood after the procedure.

Risks

Bronchoscopy is generally a safe procedure.
Although complications are rare, your doctor will discuss any risks with you.
Complications that may occur include:

  • Spasms of the bronchial tubes, which can impair
    breathing.
  • Irregular heart rhythms
    (arrhythmias).
  • Infections, such as
    pneumonia. These can usually can be treated with
    antibiotics.
  • Ongoing hoarseness.

If a biopsy was done during bronchoscopy, complications
that may occur include:

  • A tear in the lung from the biopsy forceps used
    to collect a tissue sample. This will allow air to flow into the pleural space,
    producing a partial collapse of the lung (pneumothorax).
  • Bleeding caused by the
    biopsy forceps used to collect the tissue.
  • An infection from the
    biopsy procedure.
  • A very small chance of death.

After the procedure

Call your doctor immediately
if you:

  • Cough up more than
    2 Tbsp (30 mL) of
    blood.
  • Have trouble breathing.
  • Have a fever for more
    than 24 hours. A mild fever [lower than
    100°F (38°C)] may be present
    right after the procedure, but this is not a concern.

Results

Bronchoscopy is a procedure that allows
your doctor to look at your airway through a thin viewing instrument called a
bronchoscope. Your doctor may discuss your results with you soon after the
procedure. Test results on any biopsy samples are usually available in 2 to 4
days.

Bronchoscopy
Normal:

The large airway leading to the lungs and
the breathing tubes in the lungs appear normal. There are no objects, thick
secretions, or growths.

Abnormal:

An object, thick secretions, or growths are
blocking your airway.

Tissue sample shows a lung infection or
disease, such as
tuberculosis or
lung cancer.

What Affects the Test

Reasons you may not be able to
have the test or why the results may not be helpful include:

  • A problem that limits your ability to extend
    your neck.
  • A
    biopsy sample that is too small for a
    diagnosis.

Also, a biopsy collects tissue from such a small area, so
there is a chance that a cancer may be missed.

What To Think About

  • Before a final diagnosis is made, the results
    of a bronchoscopy will be considered along with your medical history, physical
    examination, and the results of other tests including a chest
    X-ray or a
    computed tomography (CT) scan. A lung biopsy may be
    needed when all of these other results are inconclusive.

  • A needle biopsy with a CT
    scan is commonly used because it can diagnose many lung problems. A
    bronchoscopy may be a better option when the problem is close to the airway.
    Your doctor will determine the best method for you.
  • Virtual
    bronchoscopy uses a CT scan to provide a picture of the throat and airways. It does not require the placement of a bronchoscope down the throat.
  • Bronchoscopy
    methods that use ultrasound and other technologies can help diagnose and treat
    more problems than standard bronchoscopy. But these methods may not be
    available everywhere.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders.
  • Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
  • Pagana KD, Pagana TJ (2014). Mosby’s Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby.

Credits

ByHealthwise Staff
Primary Medical Reviewer Adam Husney, MD – Family Medicine
E. Gregory Thompson, MD – Internal Medicine
Specialist Medical Reviewer David C. Stuesse, MD – Cardiac and Thoracic Surgery

Current as ofMarch 25, 2017