A thin, flexible viewing tube (bronchoscope) is passed through the nose (or less often, the mouth) and into the lungs. Fiberoptic cables permit direct visualization of the vocal cords (larynx), upper airways (trachea), and lower airways (bronchi). In addition, various instruments may be passed through the scope to obtain fluid or tissue samples for laboratory examination. Less commonly, a rigid bronchoscope is used, primarily for the removal of large foreign bodies caught in the airways.
Purpose of the Bronchoscopy
- To visually inspect the airways for tumors, obstruction, narrowing (stricture), inflammation, bleeding, or a foreign body
- To help diagnose lung diseases, such as inflammatory conditions, infection, or cancer
- To visualize the larynx and identify possible vocal cord paralysis
- Used therapeutically to remove foreign bodies, tumors, or excessive secretions from the airways
Who Performs Bronchoscopy
- A pulmonary specialist (pulmonologist) or a surgeon performs this procedure at your bedside or in an endoscopy room.
- Rigid bronchoscopy must be done in an operating room.
Special Concerns about Bronchoscopy
- While this procedure may be uncomfortable, you will be able to breathe throughout, since the bronchoscope does not block your airways. If needed, extra oxygen may be administered through a special mask or tube.
- Chest x-rays and certain blood tests, such as coagulation studies, may be needed before bronchoscopy is done.
- If rigid bronchoscopy is performed, heavy sedation or general anesthesia is required.
Before the Bronchoscopy
- Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, voltaren or naproxen). You may be instructed to discontinue them before the test. Also mention any herbs or supplements that you take.
- If you are taking blood thinners (e.g., warfarin), your doctor will make special arrangements before the procedure.
- Tell your doctor if you’ve ever had an allergic reaction to anesthetic medication.
- Do not eat 6 hours or drink 4 hours before the test.
- If you wear dentures, glasses, or contact lenses, remove them before the test.
- Immediately before the test, an intravenous (IV) needle or catheter is inserted into a vein in your arm or hand, so that you may be given medications during the test. You may receive a mild sedative to relax you and a drug called atropine to help dry up your saliva.
What You Experience during Bronchoscopy
- You will either lie down on a table or bed, or sit upright in a chair. Remain relaxed, breathing through your nose.
- A topical anesthetic (lidocaine) is applied to the inside of one nostril to minimize discomfort when the scope is inserted. Lidocaine may also be sprayed on the back of your throat to suppress the gag reflex. (If the scope is to be passed through your mouth, a plastic mouthpiece is inserted to protect your teeth and prevent you from biting down on it.)
- Once the lidocaine has taken effect, the doctor inserts the scope into your nose or mouth. When the instrument reaches a certain point, lidocaine is sprayed through it to anesthetize your larynx and trachea and prevent coughing.
- The doctor closely inspects your larynx, trachea, and bronchi through the scope, looking for any abnormalities.
- If appropriate, a tiny brush or other instruments may be passed through the scope to remove samples of tissue or cells from suspicious areas. A suction instrument may be used to remove a foreign object or mucus blockage. (These procedures are painless.) To take deeper samples, the doctor may use fluoroscopy to guide the progress of the instruments.
- If an infection is suspected or there is a buildup of mucus, the doctor may flush saline solution into the lung and suck it back out (bronchoalveolar lavage). This procedure both removes secretions and obtains fluid specimens that will be analyzed for infectious organisms or other abnormalities.
- The procedure takes 30 to 60 minutes.
Risks and Complications of Bronchoscopy
- You may experience temporary hoarseness, loss of voice, a sore throat, or mild fever.
- Less common complications include reduced oxygen concentration in the blood (hypoxemia), aspiration of foreign contents into the lungs, bleeding, infection, and narrowing of the airways (bronchospasm or laryngospasm).
- Rarely, more severe complications such as pneumothorax (leakage of air outside the lungs and into the pleural cavity, resulting in a collapsed lung) and cardiac arrest may occur. Emergency equipment is kept readily available.
- There is also a slight risk of abnormal heart rhythm (arrhythmia), heart attack and low blood oxygen levels (hypoxemia).
- Risks associated with general anesthesia include nausea and vomiting, sore throat, muscle pain, breathing difficulties, slow heart rate, low or high blood pressure and kidney damage.
- In general, rigid bronchoscopy carries a higher risk of trauma and complications than flexible bronchoscopy.
After the Bronchoscopy
- You will lie down with your head slightly elevated. Your vital signs will be monitored until the sedation wears off, and you will be observed for any complications.
- If a deep biopsy was obtained, a chest x-ray may be performed to ensure that the biopsy did not cause a pneumothorax.
- Flexible bronchoscopy does not usually necessitate an overnight hospital stay. Due to the sedation, you should arrange for someone to drive you home after the procedure. (If you received a general anesthetic, you are more likely to require brief hospitalization.)
- Do not eat or drink until your gag reflex returns, usually in a few hours.
- If a biopsy was performed, there may be a small amount of blood in your sputum, but this should subside within 24 hours.
- If a sore throat develops, lozenges or a warm saline gargle may provide some relief.
- Contact your doctor immediately if you begin coughing up large amounts of blood, develop a high fever, have breathing difficulties, or experience any pain.
- During the visual inspection of your airways, the doctor will note any abnormalities, such as inflammation, narrowing, blood, secretions, or tumors. In some cases, this examination is sufficient to provide a definitive diagnosis.
- If tissue, cell, or fluid samples were taken, specimen containers may be sent to several different laboratories for examination. For example, biopsied tissue may be inspected under a microscope for the presence of unusual cells, or may be cultured for infectious organisms.
- If a definitive diagnosis can be made, appropriate treatment will be initiated.
- If a definitive diagnosis cannot be made, additional tests, such as a lung biopsy, may be needed.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media