Modern Diagnostic and therapeutic value of bronchoscopy and pleuroscopy.

By MOKWE SOPURUCHI

 Bronchoscopy is a medical technique of visualizing the

inside of airways (bronchi) for diagnostic and therapeutic purposes. An instrument called the bronchoscope is used for this procedure and is introduced through the nose, mouth or occasionally through a tracheostomy.

Bronchoscopy procedure;
Patient preparation;
Stop any fluid intake 6-12hrs earlier. Collect information about patient illness, allergies,

medications (anticoagulants and aspirin should be stopped) Patient is advised not to talk during procedure as it can lead to sore throat afterwards

conducting the exam.

Local anesthesia is given inside nose and mouth

(lignocaine 100mg by cricothyroid puncture) Patient is lying in supine position with head extended. During the procedure monitoring of HR, BP, oxygen level is done. Bronchoscope is inserted through the mouth or nose or tracheostomy.

Types
Rigid bronchoscopy Flexible bronchoscopy

 Rigid bronchoscopy is used for retrieving foreign

object. The larger lumen allows for its use for therapeutic approaches like electocautery to stop bleeding

Rigid bronchoscpy

Indications for rigid bronchoscopy ;

1) 2) 3) 4) 5) 6) 7)

Bleeding or hemorrhage Foreign body extraction Deeper biopsy specimen Dilation of tracheal or bronchial strictures Relief of airway obstruction Insertion of stents Pediatric bronchoscopy

CONTRA-INDICATIONS; 1) Uncontrolled coagulopathy 2) Extreme ventilatory and oxygenation demands. 3) Tooth infections.

Tissue biopsy .
Flexible bronchoscopy.

 The flexible (fibreoptic) bronchoscope is longer and

thinner than a rigid bronchoscope. It contains a fiber-optic system at the tip of the device. Because it is flexible and easier to use it allows the practitioner to navigate into individual lobe or segmental bronchi. It causes less discomfort than the former and can be performed easily and safely under moderate sedation. It is the technique of choice nowadays.

Indications;
Hemoptysis, lung cancer staging, suspected tracheo-

esophageal fistulas, evaluation for rejection in lung

transplant patient, bronchopulmonary lavage,

aspiration, evaluation of airway in burn patients etc.

Clots in left lower lobe

A: Primary mesothelioma; B: Metastasitic tumor; C: Tuberculous pleurisy; D: Pyothorax; E: Hepatic hydrothorax; F: Nonspecific inflammation.

Absolute contraindications
Untreatable life threatening

Relative contra-indications
Uncooperative patient Recent MI High grade tracheal

arrhytmias Inability to adequately oxygenate patient during procedure Acute respiratory failure with hypercapnea

obstruction Uncorrectable coagulopathy.

Diagnostic value of bronchoscopy

To view abnormalities of the bronchi
To obtain tissue specimens of the lung in a variety of

disorders. Specimens may be taken from inside the lungs by biopsy broncheoalveolar lavage, or endobronchial brushing. To evaluate a person who has bleeding in the lungs, possible lung cancer, a chronic cough, sarcoidosis.

Therapeutic value;
To remove secretions, blood, or foreign objects lodged in

the airway Laser resection of tumors or benign tracheal and bronchial strictures Stent insertion to palliate extrinsic compression of the tracheobronchial lumen from either malignant or benign disease processes Bronchoscopy is also employed in percutaneous tracheostomy Tracheal intubation of patients with difficult airways is often performed using a flexible bronchoscope

THORACOSCOPY

 Thoracoscopy is the introduction of an endoscope into

the pleural space for the purpose of diagnosis or

treatment.

 Thoracoscopy is used to evaluate exudative effusions

and various pleural and lung lesions when noninvasive testing is inconclusive. The diagnostic accuracy for malignant and tuberculous disease of the pleura is 95%. The procedure is also used for pleurodesis in patients with recurrent malignant effusions and to break up loculations in patients with empyema.

 Complications: Complications are similar to those of

thoracentesis. Postprocedural fever is common (16%); pleural tears causing air leak, subcutaneous emphysema, or both are less common (2% each). Hemorrhage, lung perforation, and gas embolism are serious but rare.

Video-assisted thoracoscopic

surgery (VATS) is a surgical

operation involving thoracoscopy, usually performed by a thoracic

surgeon using general or

local/regional anaesthesia with additional sedation as necessary

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