What can be seen on bronchoscopy. Bronchoscopy of the lungs - what is it? Inflammatory processes in the lungs

For patients, the name and description of the study sounds intimidating, and they wonder, lung bronchoscopy - what is it? This is a complex procedure with great diagnostic and therapeutic possibilities. Bronchoscopy carries some risks, but if performed correctly, they are minimal, so the procedure can be considered safe. It is carried out in almost the same conditions as the real operation, with the same precautions.

Bronchoscopy is done in cases where it is necessary to determine the degree of damage to the bronchial tree in various diseases of the lungs and bronchi, for the diagnosis of diseases and endoscopic operations. Bronchoscopy is prescribed:

• with a common pathological process on x-ray of the lungs;
• if you suspect a tumor of the trachea or bronchi;
• for differential diagnosis of bronchial asthma and COPD;
• to determine the causes of inflammation of the bronchi, recurrent pneumonia, hemoptysis;
• to remove a foreign body from the bronchi;
• for the diagnosis of anomalies in the structure of the bronchial tree;
• as part of preparation for lung surgery.

Also, bronchoscopy allows you to enter solutions and aerosols of drugs, evaluate the effectiveness of surgical treatment, perform endoscopic operations, if necessary, it is used in resuscitation.

Bronchoscopy carries a lot of risk - its consequences can be dangerous for the patient's health. This manipulation requires local or general anesthesia, which is not easily tolerated by all patients. If the procedure is carried out incorrectly, a gag reflex is possible, damage to the bronchial mucosa up to bleeding. It is possible to stop breathing during the procedure. After bronchoscopy, if the patient does not comply with the rules for conducting the study, bleeding and a sharp deterioration in the condition are possible.

Bronchoscopy should not be performed if:

• there is a stenosis (narrowing) of the larynx or bronchi;
• during an attack of bronchial asthma or exacerbation of COPD;
• with severe respiratory failure;
• after a recent heart attack or stroke;
• with aneurysm or coarctation of the upper aorta;
• with blood clotting disorders;
• with intolerance to drugs for anesthesia;
• with severe mental illness.

Old age can also be a contraindication to bronchoscopy - many older people do not tolerate drugs used for anesthesia.

Conducting bronchoscopy is a complex and lengthy process that requires compliance with certain rules, high qualification of the doctor, proper preparation of the patient, caution during the procedure and medical supervision after it.

Usually, before bronchoscopy, an X-ray of the lungs is done, which shows pathological changes - lesions spread throughout the lungs, increased pulmonary pattern, the appearance of areas of atelectasis or emphysema. Based on the results of radiography, the question of the need for bronchoscopy is decided.

Before prescribing a bronchoscopy, the doctor will refer the patient to other studies - ECG, coagulography, biochemical blood test. These studies are needed in order to find out whether it is safe for the patient to perform bronchoscopy. The doctor will conduct a preliminary conversation, finding out what chronic diseases the patient suffers from. It is especially important to learn about the presence of heart disease, blood clotting disorders, allergic and autoimmune diseases, and the tolerance of various drugs.

After the indications and contraindications are taken into account, the doctor prescribes a bronchoscopy. Sleeping pills can be taken at night before the study, as manipulation is associated with stress, and lack of sleep can aggravate it. You need to eat 8 hours before the procedure, you can not smoke on the day of the study. On the morning of the procedure or the evening before, if bronchoscopy is scheduled for the morning, it is necessary to clear the intestines. Let's say taking laxatives or administering a cleansing enema. Immediately before the procedure, you must go to the toilet. For the procedure, you need to take a towel or napkins with you.

Patients suffering from bronchial asthma should carry an inhaler with them. In case of pathology of the cardiovascular system, if bronchoscopy is not contraindicated, the following drugs must be prescribed before it:

• antiarrhythmics;
• antihypertensive drugs;
• beta-blockers;
• antiplatelet agents and anticoagulants;
• sedatives.

This treatment technique reduces the risk of possible complications from the cardiovascular system.

Bronchoscopy is a complex manipulation, it can only be carried out in a room specially equipped for this purpose, subject to aseptic and antiseptic conditions, as in an operating room. The doctor conducting the study must be highly qualified in order to prevent damage to the bronchi during manipulation. Algorithm for performing bronchoscopy:

1. Premedication.

The patient is given atropine, aminophylline and salbutamol - in the form of aerosols or subcutaneous injections. They dilate the bronchi and help maintain a constant width of their lumen. If necessary, sedatives are administered (appointed a few hours before the start of the manipulation).

1. Anesthesia.

Depending on the type of bronchoscopy and the characteristics of the patient's psyche, either local anesthesia or general anesthesia is used. General anesthesia is prescribed for children, patients with unstable mentality and intolerance to drugs for local anesthesia. It is also used for bronchoscopy with a rigid bronchoscope. For local anesthesia, a solution of lidocaine in the form of a spray is used, which is sprayed in turn on the nasal cavity, nasopharynx, larynx, trachea and bronchi as the bronchoscope advances. Side effects of anesthesia - a feeling of nasal congestion, difficulty swallowing, hoarseness, numbness of the palate and tongue. Local anesthesia suppresses cough and gag reflexes, which can interfere with bronchoscopy. Local anesthesia is prescribed if a soft bronchoscope is used, the patient is able to endure the procedure without general anesthesia or, on the contrary, will not be able to endure general anesthesia (old age, severe diseases of the cardiovascular system).

1. Manipulation.

After premedication and the introduction of anesthesia, you can proceed to the endoscopic examination of the bronchi. The patient should sit or lie on his back, the endoscope is inserted through the nostril with general anesthesia or a pronounced gag reflex, or through the mouth if there are no obstacles. The tubes of the endoscope are thin enough so that they do not interfere with breathing. During the manipulation, the doctor sees the image on the monitor.

Bronchoscopy allows you to examine the larynx, glottis, trachea, bronchi of large and medium diameter.

Small bronchi, bronchioles and alveoli remain inaccessible. If necessary, instruments for endoscopic operations can be inserted through a bronchoscope and foreign bodies, tumors can be removed, a biopsy taken, bleeding stopped, and the bronchial lumen expanded.

1. postoperative period.

It is advisable to stay in the hospital under the supervision of medical personnel for 2 hours after the bronchoscopy.

If the preparation of the patient was carried out correctly, then after bronchoscopy there are no negative effects, the postoperative period proceeds without complications, and the next day the patient is ready to return to his normal life.

After bronchoscopy, it is necessary to remain under the supervision of medical personnel. In the postoperative period, slight hemoptysis may be observed, it is considered normal. In patients with bronchial asthma, an attack is possible, so it is necessary to have an inhaler with you. Non-intense pressing pains in the heart may occur if the patient suffers from diseases of the cardiovascular system.

After local anesthesia, speech, swallowing and sensitivity disorders persist, this can last for 2-3 hours after the operation. Until these residual effects have passed, it is not recommended to eat and drink water - this can lead to pieces of food entering the respiratory tract. Sedative drugs that are used during bronchoscopy slow down the reaction, so for 8 hours you should not drive and do any work that is risky to life and health, requiring concentration and increased attention. It is also necessary to refrain from smoking during the day.

If bronchoscopy was performed under general anesthesia, then after removing the patient from this state, he needs to stay in the hospital for at least a day in order to avoid the negative consequences of anesthesia - a sudden drop in blood pressure, an asthmatic attack and other manifestations. If the patient's condition allows, he is discharged from the hospital the next day. However, orthostatic hypotension, dizziness, and weakness may still occur, which will last for several days. It is advisable at this time to refrain from any activity associated with a risk to life.

If one or more of the following symptoms occur after a bronchoscopy, call an ambulance immediately:

• hemoptysis after bronchoscopy lasts more than 5 hours, does not weaken or intensifies;
• feeling pain in the chest;
• wheezing appeared, breathing is difficult;
• nausea, vomiting;
• after the procedure, the temperature increased, chills began.

The symptoms listed above are signs of infection or bleeding in the bronchi. It is necessary to see a doctor in time so that these complications do not become life-threatening.

There are 2 types of bronchoscopy, differing in the equipment used - bronchoscopy with a hard or soft bronchoscope. Each of them has its advantages and disadvantages, and its indications when it is necessary to carry out each of them.

A solid bronchoscope reveals pathologies of large bronchi - the middle ones remain inaccessible to it. It allows you to expand the lumen of the bronchi, remove large foreign bodies, and can be used for resuscitation during drowning. Also, a soft one can be inserted through a rigid bronchoscope if necessary.

A rigid bronchoscope is used to install stents that prevent the bronchi from collapsing, remove large tumors, scars, foreign bodies, flush the bronchi with drug solutions, and remove fluid from the bronchi during drowning. Its use requires mandatory general anesthesia. The rigid bronchoscope is not suitable for children.

A soft bronchoscope (fibrobronchoscopy) allows penetration into smaller bronchi than a hard one, does not injure the bronchial mucosa, and can be used in pediatrics. It is used for visualization of the lower bronchi, biopsy, removal of small foreign bodies, detailed examination of the mucous membrane of the bronchi and trachea. This procedure can be performed under local anesthesia; general anesthesia is not necessary. A soft bronchoscope can, if necessary, be inserted through a hard bronchoscope to examine those parts of the bronchi that remain inaccessible to a hard bronchoscope.

After performing bronchoscopy, the doctor fills out the protocol of manipulation - a document that describes in detail the indications for prescribing bronchoscopy in this patient, the features of the manipulation, the results and the adverse reactions that have occurred.

The results of a bronchoscopy are essential to making a diagnosis or confirming it, so the correct description of the results when a diagnostic procedure is performed is of the utmost importance.

In tuberculosis, the bronchi and glottis are edematous, narrowed, often only a soft bronchoscope can pass through them without injuring them. Dense infiltrates and small areas of pale pink edema are observed on the walls of the bronchi. In the later stages of tuberculosis, these areas bleed, fistulas may be observed.

With endobronchitis - inflammation of the bronchial mucosa - various changes in the mucosa are observed. It may be thin, pink or red, bleed easily on contact, edematous with poorly visible vessels, or hypertrophied, enlarged, narrowing the lumen of the bronchi and obstructing breathing. In the purulent form of the disease, pus is actively secreted upon contact of the bronchoscope with the mucosa, may be on its surface or accumulate in the lower sections of the bronchi.

Cystic fibrosis (pathology of the external secretion glands) is manifested by a narrowing of the lumen of the larynx, trachea and bronchi, swelling and bleeding of the mucosa. A characteristic symptom is the accumulation of thick, viscous sputum that clogs the lumen of small, and sometimes medium and even large bronchi. Such sputum clots cannot come out on their own and turn off parts of the lungs from breathing. Bronchoscopy allows you to remove them.

Bronchiectasis - the formation of "pockets" on the walls of the bronchi - is manifested by the expansion of the lumen of some parts of the bronchi, which has the shape of a bag or spindle. The mucosa next to bronchiectasis is thin, edematous, easily damaged and bleeds. Inside bronchiectasis, sputum or pus may accumulate.

In bronchial asthma, there are signs of degenerative endobronchitis (thinning of the mucosa), abundant secretion of a light secret without admixture of pus, bulging of individual sections of the mucosa into the lumen of the bronchi. The mucosa itself has a bluish or reddish tint.

A foreign body is clearly visible with bronchoscopy, it blocks the lumen of the bronchus, if it is for a long time, it is covered with fibrin fibers. The mucosa around the foreign body is edematous, inflamed, hypertrophied during a long stay, and can bleed easily.

Congenital anomalies of the bronchial tree. At the same time, areas of expansion or narrowing of the bronchi, thinning or curvature of their walls, fistulas, various cavities filled with mucous secretions, pus or air are visible.

Cancer tumors manifest themselves in different ways depending on the specifics of the neoplasm. Exophytic tumors have a wide base, clear boundaries, irregular contours, healthy mucosal color or redness. The surface of the tumor is covered with erosions, foci of necrosis, and other pathological formations. Around the tumor unchanged or hyperemic mucosa. A tumor with infiltrating growth, on the contrary, almost does not protrude into the lumen of the bronchus. It is located on the wall in the form of a small thickening, its boundaries can be clear or blurry. The surface is smooth or rough, but always covered with a purulent coating and small erosions. The color may be bluish or not differ from a healthy mucosa. The mucosa around the tumor is edematous, the cartilaginous base of the bronchus and the vascular pattern are not visible, the lumen is narrowed. If the tumor grows outside the bronchus, then the mucosa remains unchanged, but the lumen of the bronchus narrows, its wall becomes hard and edematous, a protrusion of the bronchus wall into the lumen may appear.

Conducting bronchoscopy in children is associated with various negative consequences, therefore, it should be carried out strictly according to the indications, which include:

• the presence of a foreign body in the bronchi;
• congenital anomalies of the bronchial tree;
• atelectasis - loss of breath from the area or the whole lung;
• tuberculosis;
• cystic fibrosis;
• lung abscesses;
• bronchial conduction disorders of unknown etiology.

This bronchoscopy is performed only with a soft bronchoscope, sometimes, if the child is very agitated, general anesthesia is required. In the office, there must be a laying for artificial ventilation of the lungs in case of edema. After the procedure, antibiotics are required, since the risk of developing infectious complications in children is much higher than in adults.

Possible Complications

With a properly performed bronchoscopy, complications rarely develop, but nevertheless they are possible. The most common complication is swelling and spasm of the airways. In this case, breathing is sharply hampered up to an asthmatic attack or respiratory arrest. If you experience difficulty breathing after a bronchoscopy and it does not go away or gets worse, you should immediately tell your doctor about it, as this may be a sign of edema.

Infection of the respiratory tract occurs if there are foci of inflammation - sinusitis, tonsillitis, laryngitis, accumulations of pus in bronchiectasis. Bronchoscopy can promote infection from the upper sections to the lower ones. Infectious lesions are possible if the rules for processing a surgical instrument are violated, but this is a rarer case.

Bleeding from bronchial vessels is possible if the mucosa is damaged by a bronchoscope. This happens with severe inflammation of the mucosa, if it is damaged by a foreign body during its extraction, and also if the bronchoscopy procedure is violated - too sharp movements of the bronchoscope, an attempt to advance the bronchoscope into smaller bronchi that do not correspond to its diameter, or a change in the patient's posture during manipulation. When bleeding, a large amount of sputum with blood (pink or red, foamy) is separated, the patient's condition deteriorates rapidly. Normally, hemoptysis after bronchoscopy stops within 2 hours, usually faster. A longer hemoptysis, and even more so its intensification, is a dangerous symptom.

A diagnostic method, the essence of which is to examine with a bronchoscope the inner surface of the respiratory tract throughout their entire length, starting from the throat, vocal cords, larynx and trachea up to the bronchial tree itself. This procedure allows you to identify various pathologies of the respiratory tract from the narrowing of the bronchi to a malignant tumor in the lungs. There is little pleasant in bronchoscopy, but on the other hand, do you remember such a diagnostic event that the patient would go to, like on a holiday? That's the same. Therefore, if you were sent for bronchoscopy, you need to clench your teeth (that is, on the contrary, unclench) and ...

Types of bronchoscopy

Types of bronchoscopy are determined by the technological features of the device by which it is actually produced - a bronchoscope, which can be either rigid or provide for the possibility of bending. Hence the name of the procedure:

Rigid bronchoscopy

It is used in case of contact with the respiratory tract of any foreign small objects such as bones, crusts of bread, etc. or in heavy bleeding from the lungs or some other part of the respiratory tract. This type of bronchoscopy requires general anesthesia.

Flexible bronchoscopy

Flexible lung bronchoscopy A flexible bronchoscope is called a bronchofibroscope. This method does not require general anesthesia, which makes it more convenient for both the doctor and the patient. It would seem that if it is possible to do bronchoscopy without anesthesia, why complicate your life with hard bronchoscopy. It is reasonable, but still the latter is still used in medicine purely for the purposes indicated above: removal of foreign objects and examination of the respiratory tract in conditions of heavy bleeding. Flexible bronchoscopy allows for a fairly wide range of manipulations from a banal study of the inner surface of the mucous membranes of the respiratory tract to tissue sampling for biopsy.

Indications for bronchoscopy

Bronchoscopy is a universal method: it can not only detect the disease, but also treat it.

Diagnostic purposes

• confirmation or initial diagnosis in a number of respiratory diseases, including very serious ones (malignant neoplasms localized in the larynx, pharynx, bronchi and trachea, pulmonary tuberculosis, respiratory tract diseases with concomitant purulent inflammation (abscess, gangrene), bronchial asthma, cough with blood, etc.);
• to clarify the preliminary diagnosis when a suspicious spot or obscuration of unclear etiology is found on the radiograph;
• control examination after surgical removal of a section of the lung or bronchus.

Therapeutic goals

The therapeutic functions of bronchoscopy consist in removing foreign objects from the lumen of the respiratory tract, cleaning the airways from bronchial mucus and transporting drugs to the site of their direct action.

Contraindications for bronchoscopy

Bronchoscopy also has a number of contraindications. Among them are high blood pressure, neuropsychiatric diseases (schizophrenia, epilepsy), the period of exacerbation of bronchial asthma, post-infarction or post-stroke condition.

Preparation for bronchoscopy

First of all, it is necessary to consult with the doctor about all the nuances of the upcoming procedure, about the risks and "bonuses", as well as to "test the ground" for the probable result of the procedure. The doctor should know the names of all the drugs you are taking (if any, of course, there are any), have information about the presence of drugs in your history, incl. and for anesthesia, do you have any deviations in terms of blood clotting, are you expecting a baby.

If before the procedure the doctor sent you for a blood test (including a "gas" and acidity test) and recommended tests for the functional state of your lungs - you should take this for granted, there is nothing suspicious here, this is a common practice before bronchoscopy.

On the eve of the procedure, 8-10 hours before it, you must refuse to eat.

How is a bronchoscopy done?

Before a bronchoscopy, you need to get rid of all your “devices” used in everyday life: you need to remove false teeth, glasses or contact lenses, jewelry, hearing aids, wigs, etc. Bronchoscopy also requires minimizing the wardrobe, in a word, clothes also need to be removed. It is also recommended to go to the toilet.

Conducting bronchoscopy With flexible bronchoscopy, as already mentioned, anesthesia is not used: it is enough to introduce a local anesthetic in the form of a spray into the nose and mouth, as well as an intravenous sedative. For a patient lying on his back, the doctor inserts a bronchoscope (possibly intranasal) into the mouth and feeds it forward to the vocal cords. The vocal cords are already anesthetized by spraying an anesthetic through a bronchoscope. All this time, an image of the distance traveled is displayed on the monitor. Then the device moves even lower towards the bronchi. At this stage, if the goal is to clear the bronchi of mucus, a saline solution is sprayed.

With rigid bronchoscopy, the doctor begins to insert the device only after the general anesthesia has worked.

Everything about everything usually takes half an hour or an hour. The procedure is invasive, so it requires some rehabilitation after itself. For 2 hours, you need to forget about water and food, do not sit at the wheel of your “iron horse” (at least for 8 hours), delete cigarettes from your life for a day (in general, it is advisable not to return to them at all) .

General anesthesia deprives the patient of the opportunity to feel all the "hardships and hardships" that fall on him during the procedure. Local anesthesia with flexible bronchoscopy also relieves discomfort as much as possible. The only thing is that with the “body movements” of the bronchoscope, there is a chance to feel discomfort in the airways, and also go into a fit of coughing. At the end of the event, as a rule, the sensations are comparable to those after unloading a couple of wagons of bricks: weakness and soreness in the muscles. Local anesthesia has a side effect in the form of an unpleasant taste and dry mouth, as well as a temporary change in voice (you can speak in falsetto or, on the contrary, hoarsely, in the spirit of Sherlock Holmes of All Russia - Vasily Livanov). To avoid these troubles, you can gargle with warm salted water or dissolve a tablet for throat irritation. If red blood dots are found in saliva, you should not worry: after a biopsy, this is the norm.

Bronchoscopy results

The result of the procedure will be summed up after 2-4 days, when the results of the biopsy are ready. If bronchoscopy has revealed the complete absence of problems in your respiratory tract and dispelled suspicions of malignant neoplasms, foreign bodies, blockage of the bronchi with mucus, etc. You will go home with peace of mind. If some small objects are found in your airways, an excessively thick bronchial secretion that clogs them, or, God forbid, a biopsy indicates the presence of serious problems (lung infection, tuberculosis, etc.), your communication with the doctor will continue .

Bronchoscopy of the lungs is an instrumental examination of the mucous membranes of the trachea and bronchi using a special device - a bronchoscope. With this type of intervention, it is possible to identify or eliminate any pathology, flush the airways, or introduce a medicinal substance.

Bronchoscopy of the lungs is a pulmonological method for studying the bronchial tree, showing even minimal problems that threaten the patient's health.

This medical procedure is needed to:

• assess the internal condition of the bronchi and trachea;
• take a sample of a suspicious tissue area for the purpose of histological examination;
• remove a foreign body from the trachea.

Indications for carrying out

Indications for the procedure:

• detection of tumors that are benign;
• diagnosis of bronchial cancer;
• detection of stagnant processes in the respiratory organs (remedial bronchoscopy is required);
• suspicion of infection and inflammation;
• establishing the causes of bloody discharge when coughing;
• a feeling of shortness of breath, incomplete inhalation and exhalation (when heart disease and asthma are excluded);
• excessive secretion of sputum that has an unpleasant odor;
• pronounced symptoms of chronic cough.

Contraindications

Contraindications for research:

• narrowing of a pathological nature, in which the endoscope is not able to penetrate the trachea and bronchi;
• the patient has asthma or diseases of the vascular, cardiac system;
• mental problems;
• respiratory failure;
• hypertension (high blood pressure);
• pregnancy.

Advantages and disadvantages

Advantages and disadvantages of the procedure:

Does it hurt or not?

Bronchoscopy of the lungs does not cause pain, however, the introduction of the device is accompanied by:

• numbness of the palatine part;
• lump in the throat;
• difficulty in swallowing.

Unpleasant bronchoscopy can be at the initial stage of the procedure, then the negative sensations disappear.

What reveals?

This method of examination reveals:

• neoplasms of various etiologies;
• bronchial deformities;
• tuberculosis;
• stenosis of the branches of the respiratory throat;
• decreased tone of the large bronchi.

Briefly about what bronchoscopy shows and determines, the Health-saving channel tells.

Research types

Types of bronchoscopy differ depending on the type of device used, as well as the purpose of the procedure.

Depending on the device

Depending on the bronchoscope, there are:

Fibrobronchoscopy (FBS) is a study using a flexible endoscope and is used when there are no direct indications for the use of another type of instrument. The thin tubes of the device make it easy to move into the lower parts of the bronchi.

Bronchoscopy of the lungs with a rigid device has another name - rigid. It is used to examine large bronchi and is widely used for resuscitation purposes.

Depending on the purpose of the

Depending on the purpose of the bronchoscopy, there are:

• diagnostic;
• medical;
• virtual.

Diagnostic bronchoscopy

The purpose of the examination is to examine the respiratory organs to identify certain lesions that can confirm the preliminary diagnosis of the doctor.

Diagnostic bronchoscopy is:

1. Fluorescent. It involves the introduction of a special acid to the patient, after which the light system of the device can determine the red zone (indicating the presence of a tumor).
2. Autofluorescent. It is also used to detect various tumors. A special light system causes a green glow of the bronchus (its submucosal layer).

Therapeutic bronchoscopy

The need for therapeutic bronchoscopy may arise when:

• lavage of the respiratory tract from blood clots or sputum is required;
• the patient suffers from a severe form of pneumonia, in which the introduction of an antibiotic into a specific bronchus is recommended;
• you have to stop bleeding in the lungs;
• it is necessary to get rid of pus if the accumulation is located near the bronchus.

Virtual Bronchoscopy

Features of virtual bronchoscopy:

• represents an alternative study - CT of the bronchi;
• x-ray sections and a special program allows you to see the smallest details and pathologies;
• this method does not involve external intervention.

Preparation for the procedure

Preparation for bronchoscopy includes:

• preliminary analyses;
• consultation with a doctor;
• diet and sedatives.

What research needs to be done?

Before the procedure, you must do:

• radiography;
• electrocardiography;
• take blood tests: general and biochemical, coagulation test;
• determine the level of gases in the blood.

Consultation with a doctor

With the results obtained, it is necessary to seek advice from the attending therapist. He will tell you if additional examinations are required from specialists of a narrow profile, and will also answer all questions about the procedure. If no contraindications are found, the specialist will refer the patient for lung bronchoscopy.

Proper diet and sedatives

The following rules will help prevent negative consequences for the patient:

1. There should be eight hours before the procedure. It is important not to eat heavy foods and those that cause bloating. You also need to limit yourself to fluid intake.
2. In order for the patient to fully relax, the specialist will prescribe him sedatives and sleeping pills.

What should be done immediately before bronchoscopy?

Immediately before the procedure you need:

• calm down and set yourself up in a positive way;
• empty the bladder;
• take a towel for examination - after completion of the study, a short cough with blood is likely to occur;
• refrain from smoking;
• in the morning, before visiting the clinic, cleanse the intestines (with an enema or replace with glycerin suppositories).

How is a bronchoscopy done?

If the manipulation takes place without the use of general anesthesia, the procedure involves the following algorithm of actions:

1. The patient undresses to the waist and lies down on the couch, or remains in a sitting position on a chair, he is explained the rules of conduct during the procedure, and how it goes.
2. An injection with a special drug is injected into the shoulder area, which has an overwhelming effect on salivation.
3. A sedative is introduced.
4. Drugs are sprayed into the mouth area, with the help of which the bronchi expand.
5. Local anesthesia of the root of the tongue is done and the apparatus itself (its outer part) is processed with the same solution.
6. The bronchoscope tube is passed through the mouth or nose at the moment the patient takes a deep breath and they begin to look at the respiratory organs.
7. Endoscopy is done strictly according to the scheme, first they study the glottis and larynx. When there is a need for a biopsy, material is taken for research.

After the completion of bronchoscopy, the patient is given a protocol of the completed examination with photographs.

Anesthesia general or local?

Most cases of bronchoscopy require only local anesthesia.

The need for general anesthesia may be due to the peculiarity of the mental state of the patient or his age. This type of anesthesiology is used to examine children and patients who are under stress, shock.

How long does the procedure take?

Bronchoscopy of the lungs takes no more than half an hour. The duration depends on the purpose of its implementation, but as practice shows, this is a fairly quick study.

How is a bronchoscopy done for children?

For children, bronchoscopy is done as follows:

1. The child is reassured and explained in detail how to behave.
2. The baby's nasal cavity is thoroughly cleaned.
3. Anesthesia (narcosis) is administered.
4. The procedure is carried out in a dream using a small diameter bronchoscope.

Consequences and possible complications

Consequences and possible complications can be as follows:

• opening of bleeding;
• allergic reactions to the anesthetic drug that was used during the procedure;
• bronchospasm;
• increased arrhythmia;
• for children - a decrease in blood pressure, in addition, anaphylactic shock is possible.

Deciphering the results

The results of the study may be as follows:

Disease	Endoscopic picture
Polyp on the vocal cords	A neoplasm that does not allow the ligaments to fully close. Has different lengths.
Tuberculosis	Muddy and viscous sputum on the walls of the bronchi. The mucous membrane is thickened and inflamed.
Foreign body present	Visualized at the level of the junction of the pharynx and esophagus. It can be pieces of food, small toys (in children).
Malignant education	The narrowing of the lumen, the growth of the bronchus on the mucous membrane, a few blood clots. The tumor is irregular
Bronchitis (chronic)	In the lumen - a small amount of mucus, which has a thick consistency.

Alternative to bronchoscopy

An alternative to bronchoscopy, computed tomography of the lungs, also has advantages and disadvantages.

Bronchoscopy- a technique for endoscopic visualization of the state of the tracheobronchial tree using an optical device - a rigid or flexible bronchoscope. In pulmonology, bronchoscopy is performed according to diagnostic and therapeutic indications. Diagnostic bronchoscopy is aimed at identifying a tumor or inflammatory process, malformations of the bronchial tree, finding out the causes of hemoptysis, taking a biopsy and sputum for research, etc. Therapeutic bronchoscopy is performed to remove foreign bodies, sanitize the bronchi, administer drugs, remove bronchial adenomas, elimination of obstructive bronchial obstruction, etc.

Based on the type of endoscope used, a distinction is made between flexible and rigid (rigid) bronchoscopy. Rigid bronchoscopy uses a rigid tube and usually general anesthesia. With the help of this variant of bronchoscopy, foreign bodies are removed from the respiratory tract, the bronchial tree is examined in case of severe bleeding. Conducting flexible bronchoscopy using a flexible fiberoptic bronchoscope allows you to examine the distal bronchi and perform a greater amount of therapeutic and diagnostic manipulations using local anesthesia. The price of bronchoscopy varies depending on the type of study (rigid, flexible), goals and additional manipulations. Before planning a bronchoscopy, a lung x-ray, ECG, coagulogram is required.

Indications

Diagnostic bronchoscopy is carried out with a clarifying purpose for radiologically determined lung tumors with endobronchial or peribronchial growth, tracheal formations, tuberculosis, bronchial stenosis, bronchiectasis, bronchitis, anomalies in the development of the tracheobronchial tree, purulent destructive processes (abscess, lung gangrene). Bronchoscopy may be prescribed based on clinical symptoms: persistent unmotivated cough, copious or fetid sputum, bleeding or hemoptysis, shortness of breath.

During diagnostic bronchoscopy, not only a visual examination of the internal lumen of the tracheobronchial tree is performed, but also a collection of diagnostic material - a pathological secretion, a piece of a tumor, washings from the bronchi, transbronchial lung biopsy, etc. Material samples obtained during bronchoscopy are examined by cytological, bacteriological, histological methods.

Modern pulmonology uses bronchoscopy for therapeutic purposes for bronchoalveolar lavage and tracheal aspiration, performing endoscopic operations - extracting foreign bodies from the lumen of the airways, stopping bleeding, removing tumors in the lumen of the bronchus, expanding and endoprosthesis replacement of stenotic areas of the trachea / bronchus with a stent, transbronchial drainage of a lung abscess , elimination of postoperative atelectasis and hypoventilation of the lungs, etc. The price of therapeutic, surgical and diagnostic bronchoscopy may be different in one institution. Control bronchoscopy is performed after resection of the lungs and bronchi, endoscopic removal of tumors.

Contraindications

Restrictions on bronchoscopy may be associated with the severity of the background pathology - high arterial hypertension, arrhythmia, epilepsy, schizophrenia, recent myocardial infarction, TBI, stroke, coagulation disorders, coronary artery disease, pulmonary heart failure. Rigid bronchoscopy cannot technically be feasible in case of ankylosis of the lower jaw, damage to the cervical vertebrae, severe stenosis of the larynx or trachea.

Methodology

To avoid accidental aspiration of gastric contents into the respiratory tract during coughing and vomiting, bronchoscopy is performed after an 8- to 10-hour fasting period. Before bronchoscopy, removable dentures should be removed, loosen the tight collar of clothing.

When performing flexible bronchoscopy, the oropharynx and nasal passages are anesthetized with an aerosol lidocaine spray to reduce the cough reflex and discomfort when passing the fibrobronchoscope through the nose. 5-7 minutes after anesthesia, the endoscopist begins the bronchoscopy itself. During the bronchoscopy, the patient usually sits in a chair. A flexible fiber bronchoscope equipped with a video camera and illumination is inserted through the nasal passage or mouth and advanced into the respiratory tract under the control of optics. Upon reaching the bronchi, there is a strong urge to cough. The patient should be aware that due to the small diameter of the fibroendoscope (smaller than the bronchial lumen), asphyxial complications of bronchoscopy are excluded.

During bronchoscopy, the surface of the trachea and bronchi is sequentially examined, paying attention to the condition of the mucosa (color, severity of the vascular pattern and folds), the mobility of the walls of the bronchi, the nature of the secret. Normally, bronchoscopy shows a pale pink or slightly yellowish mucosa with a matte surface and moderately pronounced folds. When examining the trachea and large bronchi, the vascular pattern is clearly visible, the contours of the cartilage rings and intercartilaginous spaces are clearly defined. The walls of the bronchi and trachea (especially in the membranous part) are mobile during breathing.

With inflammation of the bronchial mucosa during bronchoscopy, there is hyperemia and swelling of the walls, wear of the folds and vascular pattern, accumulation of mucous, purulent or mucopurulent secrets inside the bronchi. Atrophic changes in the bronchi during bronchoscopy are characterized by increased folding, thinning of the mucosa through which the vessels are visible, expansion and gaping of the bronchi. Identification of malignant lung tumors during bronchoscopy is possible on the basis of direct (in the case of endobronchial growth) or indirect (in the case of peribronchial growth) signs. With peribronchial localization of tumors, the lumen is deformed, the mobility of the bronchus wall, the local pattern of blood vessels and folding change.

An experienced bronchologist, who knows the endoscopic features of the norm and pathology, may suspect specific signs of a particular deviation during bronchoscopy. After examination and necessary manipulations (diagnostic, sanitation, surgical), bronchoscopy ends with the removal of the endoscope. Eating is allowed after the disappearance of sensations of numbness of the nasopharyngeal mucosa.

Complications

Hoarseness and nasal voice, urge to cough persist for several hours after bronchoscopy. If liquids or food are taken early, they may enter the trachea. When biopsy or removal of endobronchial tumors, there is a possibility of bleeding. If a transbronchial lung biopsy is performed during bronchoscopy, there is a risk of developing mediastinal emphysema or pneumothorax. In patients with initial pulmonary heart failure during bronchoscopy, hypoxia and arrhythmias may develop. With bronchial asthma, there is a risk of laryngospasm or bronchospasm.

In the case of correct identification of risks, the option of bronchoscopy and anesthesia, as well as the high professionalism of the bronchologist, there are practically no complications. However, in a number of non-standard situations, bronchoscopy may require emergency surgical or resuscitation care.

The cost of bronchoscopy in Moscow

The price of the procedure is formed taking into account the study option (flexible, rigid). If it is necessary to carry out rehabilitation measures, medical manipulations or perform a biopsy, the cost of the technique increases. The price of bronchoscopy in Moscow is affected by the type of clinic (public, private), the reputation and convenience of the location of the medical organization, the qualifications of the endoscopist and the urgency of the study. The pricing does not take into account the cost of a preliminary examination, so the patient will have to pay separately for the ECG, X-ray of the lungs and coagulogram. Some private clinics offer discounts for overnight procedures.

People who know firsthand what serious respiratory pathologies are, have encountered bronchoscopy at least once in their lives and already know what awaits them. But those who go for such an examination for the first time would really like to know everything about lung bronchoscopy - what it is, how the procedure goes, and what to expect after it.

Bronchoscopy of the lungs is a diagnostic method that allows you to visualize the internal state of the trachea and bronchi. Bronchoscopy is an invasive penetrating examination method. A bronchoscopic tube is inserted through the upper part of the windpipe into the airways. The further course of the intervention depends on the tasks.

The bronchoscope has a fiber that conducts light and a camera that transmits a clear image to the monitor screen. Thanks to modern equipment, it is possible to obtain results with almost 100% accuracy. This is important for patients with various pulmonary diseases. In addition, bronchoscopy in tuberculosis is of great importance for differential diagnosis.

Types of lung bronchoscopy

Flexible lung bronchoscopy is performed using thin tubes of a fiberoptic bronchoscope. They have a small diameter, so they can easily move into the lower sections of the bronchi, while maintaining the integrity of the mucosa. This examination is also suitable for the smallest.

Rigid therapeutic bronchoscopy is performed using rigid surgical bronchoscopes. They do not allow you to examine the small branches of the windpipe, but such equipment can be widely used for therapeutic purposes:

• fight against pulmonary hemorrhage;
• elimination of stenoses in the lower airways;
• removal of large unnatural objects from the windpipe;
• removal of sputum from the lower respiratory tract;
• removal of neoplasms of various etiologies and scar tissue.

Young children, patients with mental disabilities or severely panicked patients undergo video bronchoscopy in their sleep. This means carrying out under general anesthesia. In which cases such an operation is prescribed, the pulmonologist decides, based on the available history and concomitant symptoms.

Indications and contraindications for surgery

Diagnostic bronchoscopy is appropriate in such cases:

• excruciating cough of unclear etiology;
• violations of the frequency and depth of breathing of unknown origin;
• if there is blood in the sputum;
• frequent inflammation of the bronchi or lungs;
• the assumption that an object is stuck in the windpipe or a tumor is present;
• with sarcoidosis;
• cystic fibrosis;
• emphysema;
• bleeding from the respiratory tract.

Bronchoscopy for tuberculosis can be used as an element of the general differential diagnosis, and to determine the exact side of pulmonary bleeding provoked by this pathology. A study in cancer (bronchogenic carcinoma) of the lung allows you to control the growth of the neoplasm.

For therapeutic purposes, endoscopic intervention is performed in the following cases:

• foreign body in the airways;
• coma;
• a set of measures aimed at stopping blood loss;
• tumors that blocked the lumen of the airways;
• the need to administer drugs directly into the respiratory tract.

Sanitary bronchoscopy begins with the removal of contents from the lower respiratory tract using suction. After washing, 20 ml of the sanitizing mixture is injected, followed by its suction. At the end of the procedure, a mucolytic and/or antibacterial agent is administered.

• allergic reaction to anesthesia;
• persistent hypertension;
• diseases associated with severe pathologies of the heart;
• recent acute cerebrovascular accident or acute lack of blood supply to the heart muscle;
• chronic violation of the maintenance of normal blood gas composition;
• aortic aneurysm;
• severe mental illness;
• stenosis of the larynx.

When it is necessary and whether it is possible in the case of a particular patient to carry out bronchoscopy, the attending physician decides. If therapeutic and diagnostic bronchoscopy is performed in emergency conditions, then some contraindications may not be taken into account.

Preparing for the operation

Bronchoscopy of the lungs requires careful preparation for the procedure. How to prepare in the best way, the doctor should explain to the patient. First of all, the patient is prescribed a series of examinations, and the bronchoscopy procedure can be performed when the tests are ready.

Required minimum:

• general clinical blood test;
• complex analysis of blood coagulation parameters;
• study of arterial blood for gas composition;
• electrocardiogram;
• chest x-ray.

If the technique of bronchoscopy requires the use of premedication before the procedure, then the patient must be ascertained for allergies to certain drugs.

You can eat the last meal 8-12 hours before the scheduled manipulation. Moreover, for dinner you can not eat poorly digestible food, as well as the one that causes flatulence. The night before, you should clean the intestines with a classic enema or pharmacy microclysters. On the day of the study, you should stop smoking. You should enter the diagnostic room with an empty bladder.

How is a bronchoscopy performed?

Therapeutic or diagnostic bronchoscopy should be performed in a specially equipped room under sterile conditions.
Examination of the mucous membrane of the respiratory tract under local anesthesia is performed according to the following algorithm:

1. The patient is given an injection of Atropine in the shoulder area. This active substance inhibits salivation.
2. A bronchodilator drug from the group of selective β₂-adrenergic agonists is sprayed into the oral cavity.
3. An anesthetic is applied to the back third of the tongue, facing the pharynx, or slightly lower by spraying and splashing. The same tool is applied to the outer part of the bronchoscope.
4. The bronchoscope tube is gently inserted into the oral cavity and then advanced. A tube is usually inserted after a mouthpiece is inserted into the patient's mouth, which is necessary so that the patient does not damage the bronchoscope with his teeth.
5. If during the manipulation the patient lies, then a laryngoscope can be inserted into his oral cavity and larynx, which facilitates the introduction of a bronchoscope.

The diagnostician performs the necessary manipulation quickly enough and the entire diagnostic procedure does not last long so as not to cause severe hypoxia. If therapeutic manipulations are performed, then the duration increases. So, bronchoscopy for pneumonia can last 30 minutes.

Bronchoscopy with biopsy is considered a fairly painless procedure. The biopsy is taken with special forceps. Since the mucosa of the branches of the respiratory throat is practically devoid of pain receptors, during the manipulation the patient experiences only slight discomfort behind the sternum. If the method of conducting under anesthesia is used, then after an intravenous injection, the person falls asleep and does not feel anything during the procedure.

Is anesthesia used?

Many endoscopists believe that in some pathologies it is better not to suppress the natural reflex activity of the airways. They only anesthetize the root of the tongue, the cartilage above the entrance to the larynx, and the inner surface of the upper windpipe. In adult practice, local anesthesia is used for flexible bronchoscopy.

Bronchoscopy under anesthesia is predominantly performed using a rigid bronchoscope. Conducting a study in a dream is more often used in pediatric practice. Under the influence of anesthetic substances, protective reflex spasms are eliminated, the lumen of the branches of the windpipe expands, which makes it possible to carry out endoscopic examination in the best way.

Features of the conduct in children

In pediatrics, research is allowed from a very early age, but on condition that there is a flexible fiber bronchoscope of small diameter.

Pediatrics has its own characteristics in endoscopic examination of the lower respiratory tract:

• the introduction of the baby into a medical sleep is required;
• bronchoscopy is carried out using a special children's bronchoscope;
• in babies during the diagnosis, the risk of developing bronchospasm is increased, so the room must be equipped with everything necessary for mechanical ventilation;
• after bronchoscopy, antibiotics are mandatory.

The duration of the bronchoscopy depends on the tasks. On average, such manipulation takes from a quarter of an hour to half an hour.

Features of manipulation in tuberculosis

If tuberculosis is diagnosed, then bronchoscopy occupies an important place in the management of such patients. How long each such procedure lasts depends on the tasks pursued, and they can be as follows:

• determine the sensitivity of mycobacteria to the selected anti-tuberculosis drugs;
• drain the cavity with cavernous tuberculosis;
• locally introduce anti-tuberculosis drugs;
• dissect fibrous tissue in the branches of the windpipe;
• stop the bleeding;
• examine the condition of the suture material after lung resection;
• evaluate the condition of the branches of the windpipe, which causes this lung disease, before surgery.

Bronchoscopy in tuberculosis is indispensable in assessing the improvements from the chosen treatment tactics.

How is asthma research done?

Conducting bronchoscopy in bronchial asthma causes controversy among specialists, since the visualized changes in the mucous membrane in this pathology are nonspecific. They can easily be confused with other diseases of the lower respiratory tract with reversible and irreversible processes.

If moderate or severe asthma worsens, then at any age, it is optimal to use a rigid injection bronchoscope and anesthesia with muscle relaxants against the background of continuous mechanical ventilation. The therapeutic tactics and tools used during the procedure depend on the stage of the pathological process and how severe the respiratory failure is.

What can a lung bronchoscopy reveal?

During an endoscopic examination, it is possible to carefully examine the mucous membrane and identify signs of various pathologies:

• neoplasms of various nature;
• pathologies associated with inflammatory processes;
• decreased tone of large bronchi;
• stenosis of the branches of the respiratory throat;
• frequent attacks of suffocation on the background of bronchial asthma.

If pathologies requiring urgent intervention have been diagnosed, then a therapeutic effect will be immediately provided during bronchoscopy. Usually the results of bronchoscopy are known on the same day. But if a bronchoscopy with a biopsy was performed, then it was necessary to send the material for histological examination, so the answer will have to wait a few days.

Rehabilitation after the study

Regardless of whether the manipulation was associated with treatment or diagnosis, after the procedure, doctors recommend adhering to the following rules:

• after the procedure, you should not rush home, but it is better to stay under the supervision of a specialist for some time (2-4 hours);
• you can drink and eat only 2-3 hours after the manipulation;
• after the procedure, it is better not to smoke in the next day, as this impairs the recovery of the mucosa;
• if sedation was carried out, then in the next 8 hours it is better to refrain from driving vehicles;
• for 2-3 days to avoid physical overwork.

In addition, it is important to monitor your well-being. If there is pain behind the sternum, a feverish condition, or coughing up blood, then you should urgently go to the hospital.

Possible Complications

Bronchoscopy most often passes without consequences, but possible harm to the health of the patient is not excluded. The development of complications usually occurs if the procedure is performed by an inexperienced endoscopist.

Possible consequences and complications:

• an acute condition that occurs when the muscles of the bronchi contract and narrow their lumen;
• sudden involuntary contraction of the muscles of the larynx;
• accumulation of air or gases in the pleural cavity;
• bleeding after a biopsy;
• inflammation of the lungs, provoked by infection of the bronchioles;
• violation of the frequency, rhythm and sequence of excitation and contraction of the heart;
• increased individual sensitivity.

If bronchoscopy is diagnostic, CT or MRI can be used as an alternative. But there is nothing to replace the medical manipulation of such a plan. To avoid serious consequences, you can agree to such a procedure only in a trusted medical institution.