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Value of Bronchoscopy and Thoracoscopy in Respiratory Medicine
Value of Bronchoscopy and Thoracoscopy in Respiratory Medicine
By MOKWE SOPURUCHI
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
(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
object. The larger lumen allows for its use for therapeutic approaches like electocautery to stop bleeding
Rigid bronchoscpy
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.
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-
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
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
treatment.
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.
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