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Rebecca Dezube

, MD, MHS, Johns Hopkins University

Last full review/revision May 2021| Content last modified May 2021

Bronchoscopy is a direct visual examination of the voice box (larynx) and airways through a viewing tube (a bronchoscope).

A bronchoscope has a camera at the end that allows a doctor to look down through the larger airways (bronchi) into the lungs. Doctors can also pass small tools through the bronchoscope to allow them to take samples of lung or airway tissue to help diagnose lung disorders and to treat some lung disorders. Bronchoscopes may be flexible or rigid. Most bronchoscopy procedures, particularly those for diagnosis, are done in an outpatient setting using a flexible bronchoscope. Sometimes the person is sedated before the procedure, and sometimes a topical (nasal and/or inhaled) anaesthetic is used.

Some diagnostic and therapeutic procedures require the use of a rigid bronchoscope and are done under general anesthesia in a hospital. For example, removing a foreign object, controlling bleeding, or widening an airway may be best done through a rigid metal bronchoscope in an operating room.

(See also Medical History and Physical Examination for Lung Disorders and Respiratory System.)

Understanding Flexible Bronchoscopy

To view the airways directly, a doctor passes a flexible bronchoscope through a person's nostril or into the mouth and down into the airways. The circular inset shows the doctor's view.

Understanding Flexible Bronchoscopy

A bronchoscope can be used to

  • Assess the airways and voice box (larynx) for injury in people who have been burned or may have inhaled smoke
  • Determine the cause of lung infections (such as pneumonia) if there is concern that the cause is unusual bacteria or may be difficult to treat (for example, in people who have AIDS or other immune system deficiencies)
  • Examine airways and take tissue specimens from areas that may be cancerous
  • Investigate a source of bleeding in the lungs

Bronchoscopy can help doctors treat certain conditions. For example, the bronchoscope can be used to

  • Be a guide over which a tube can be inserted to assist breathing (tracheal intubation)
  • Place drugs in specific areas of the lung
  • Remove secretions, blood, pus, and foreign bodies

For at least 6 hours before bronchoscopy, the person should not eat or drink. Sedation is often given to people having flexible bronchoscopy, and general anesthesia is usually given to those undergoing rigid bronchoscopy. In flexible bronchoscopy, the throat and nasal passage are sprayed with an anesthetic, and the bronchoscope is passed through a nostril, mouth, or breathing tube and into the airways of the lungs.

After bronchoscopy, the person is observed for 2 to 4 hours. If a tissue specimen was removed, a chest x-ray may be taken to check for complications, such as bleeding or pneumothorax (air in the chest but outside the lungs).

Procedures Done With Bronchoscopy

Sometimes, as part of a bronchoscope examination, doctors do additional procedures to collect specimens for examination in a laboratory.

Bronchoalveolar lavage is a procedure doctors can use to collect specimens from the smaller airways and air sacs (alveoli) that cannot be seen through the bronchoscope. After wedging the bronchoscope into a small airway, a doctor administers salt water (saline) through the instrument. The fluid is then suctioned back into the bronchoscope, bringing cells and any bacteria with it. Examination of the material under the microscope helps in diagnosing infections and cancers. The fluid can also be placed into containers containing special nutrients and left alone for a period of time to see if bacteria grow (culturing), which is a better way to diagnose infections.

Transbronchial lung biopsy involves obtaining a specimen (pieces) of lung tissue by using forceps passed through a channel in a bronchoscope. The bronchoscope is threaded into progressively smaller airways until reaching the area of concern. A doctor may use a fluoroscope (an imaging device that uses x-rays to show internal body structures on a screen) for guidance in identifying the area of concern. Such guidance can also decrease the risk of accidentally perforating the lung and causing leakage of air into the pleural space (pneumothorax). Although transbronchial lung biopsy increases the risk of complications during bronchoscopy, it provides additional diagnostic information and may make major surgery unnecessary.

Transbronchial needle aspiration is sometimes done. In this procedure, a needle is passed through the bronchoscope into the bronchial wall. The needle may be passed through the wall of a large airway under direct visualization or through the wall of a small airway using an x-ray machine for visualization. A doctor may be able to extract cells from suspicious lymph nodes to examine under a microscope. Endobronchial ultrasonography (EBUS) can be used to help guide the needle biopsy.

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