The doctor can use the bronchoscope to examine the lungs and airways. In addition, the method helps in the treatment, for example, to extract viscous mucus. During lung reflection, the doctor introduces a bronchoscope into the airway via the mouth or nose. Modern bronchoscopes consist of a soft, flexible tube with a diameter of two to six millimeters. At the top of the tube sits a camera with the light source. This camera sends its images in real time to a monitor on which the doctor examines the patient’s airways.
In addition, the bronchoscope can inject and aspirate liquid and thereby perform a so-called bronchial lavage. In addition, very small pliers or brushes can be advanced through the tube and tissue samples taken. These biopsy specimens will be examined later by the doctor under a microscope. In addition, a miniature ultrasound head can image the environment of the airways.
For what reasons does the doctor perform a bronchoscopy?
A bronchoscopy may be necessary for both treatment and diagnosis, for example, if there is suspicion of lung cancer in the room or if treatment is to be scheduled for a known lung tumor. Doctors can also use this method to introduce radioactive substances into the lungs in order to irradiate tumors locally. Restrictions of the respiratory tract can be clarified by bronchoscopy. Similarly, the doctor can investigate reduced ventilation of partial areas of the lung, so-called atelectasis. With the lung reflection and bronchial lavage cells and germs can also be extracted from the lungs.
Doctors also use lung plasmas to look for and remove foreign bodies. In ventilated patients, the position of the breathing tube can also be corrected with it. In addition, secretions such as mucus plugs can be washed away with the bronchoscope and inserted so-called stents, which seemed to the airways from the inside and keep them open.
How is an examination with the bronchoscope going?
On the day of the examination, the patient comes sober. He receives a spray that stuns the throat and suppresses the gagging. Then, the patient is virtually always injected with a short narcotic into the vein, so that he feels nothing at all from the examination. If necessary, sedatives are also used.
The doctor introduces the bronchoscope through the mouth or nose into the trachea. Afterward, he examines the mucous membrane of the airways, which can be imagined as a “bronchial tree” with more and more ramifications. The doctor examines all bronchi to a maximum of the third or fourth diversion. This usually takes 10 to 15 minutes. The airways themselves are insensitive to pain.
If a bronchial lavage is needed, the doctor injects about 20-100 milliliters of sterile fluid into the lower respiratory tract and then sucks it off. It extracts bacteria and cells from the surface of the respiratory tract and subsequently examines them in the laboratory.
After the examination, the patient should abstain from eating and drinking for about two hours until the anesthetic of the throat has subsided. Otherwise, there is a risk of swallowing. If the patient has been given tranquilizers or anesthesia, they are not allowed to drive the same day.
What other types of bronchoscopy are there?
In addition to the lung reflection with a flexible tube, there is still the investigation with a rigid tube. This tube can, for example, better remove foreign matter from the lungs. Even if a tumor severely restricts the airways, rigid bronchoscopy has advantages. Sometimes the doctor can remove tumors directly using laser devices or argon bombers. Argon beamer is coagulation devices that transfer energy via argon gas and soil the tissue two to three millimeters deep. The doctor uses them to destroy tissue and stop bleeding. If he has to use stents to stretch a constriction, it works better with the rigid bronchoscope.
Is a bronchoscopy dangerous?
The bronchoscope may cause nosebleeds or sore throat with difficulty swallowing, hoarseness or coughing, and very rarely injure the larynx. Even short-term fever sometimes occurs afterwards, especially in lavages. Severe incidents are very rare in bronchoscopy.
Removing the tissue samples may cause slight bleeding. Therefore, one should expect in the first two days that you abhustet blood to a small extent. Every now and then, the bleeding is so severe that they have to be breastfed by the endoscope.
In some cases, injury to the alveoli causes the lungs to leak and form a so-called pneumothorax. This means that air flows into space between the lungs and the surrounding lung cavity and causes the feeling of being short of air. Then, if necessary, the application of a chest tube is necessary: This plastic tube through the chest wall conveys the infiltrated air to the outside.
Possible exclusion reasons
Bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute