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Bronchoscopy
Bronchoscopy = endoscopic procedure that allows direct visualisation of the upper airways, trachea, and proximal bronchi. Can also be used for diagnostic sampling and therapeutic interventions.
⚙️ Procedure
- 🍽️ Patients are usually fasted beforehand; check clotting profile and reverse coagulopathy if present
- 🪛 Rigid bronchoscopy: performed under general anaesthesia (useful for obstruction, foreign bodies, massive haemoptysis)
- 🧵 Flexible bronchoscopy: done under local anaesthesia + sedation; scope usually passed through the nose
- 📉 Constant monitoring (O₂ sats, HR, BP, ECG) required
- ⚠️ Recognised complications: pneumothorax, hypoxia, epistaxis
📋 Indications
- 🫁 Investigation of suspected lesion on CXR/CT
- 🔬 Endobronchial biopsy of suspicious tissue
- 💧 Bronchoalveolar lavage (BAL) – e.g. infection, malignancy, interstitial lung disease
- 💉 Investigation of haemoptysis + therapeutic control of bleeding
- 🧽 Removal of foreign bodies, mucus plugs, or obstructing material
🚫 Contraindications
- ❌ Severe/refractory hypoxaemia or inability to maintain oxygenation during procedure
- ⚠️ Relative cautions: unstable angina, uncontrolled hypercarbia, superior vena cava obstruction, unstable asthma, uraemia, pulmonary hypertension, advanced age
⚠️ Complications
- 📉 Serious complications are rare (~1 in 500,000)
- 🤕 Fever, sore throat, hoarse voice for up to 48 hrs
- ⚡ Allergic responses, bronchospasm
- 💨 Pneumothorax (may occur hours after procedure)
- 🩸 Bleeding: epistaxis, haemoptysis
- ❤️ Arrhythmias, hypoxic episodes, rarely death
📌 Exam Pearl: Flexible bronchoscopy is most commonly used for diagnosis (biopsy, lavage), while rigid bronchoscopy is reserved for therapeutic interventions (foreign body removal, massive haemoptysis).
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