Bronchoscopy Dr Mazen Qusaibaty MD DIS Head Pulmonary
Bronchoscopy Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Email: Qusaibaty@gmail. com 1
Familial Antecedents Personnel Interrogatory Main Symptoms Secondary Diagnosis Vital Physical examination Signs Main Laboratory Complementary examination Radiology Procedures 2
Bronchoscopy
5 Types of Bronchoscopy 1. Flexible 2. Rigid
6 Bronchoscopy • Bronchoscopy is an endoscopic technique • Visualizing the inside of the airways for diagnostic and therapeutic purposes
7 Bronchoscopy • An instrument (bronchoscope) is inserted into the airways • Usually through the nose or mouth, or occasionally through a tracheostomy
Indications Diagnostic indications Therapeutic indications 8
1. Evaluation of pneumonia or infiltrate of unclear etiology • Immunocompromised patients ¶Long term steroid use ¶Patients on chemotherapy ¶HIV ¶Transplant recipients 9
10 1. Evaluation of pneumonia or infiltrate of unclear etiology • To rule out opportunistic infections ¶(PCP or fungal infections)
11 1. Evaluation of pneumonia or infiltrate of unclear etiology • Incomplete resolution of presumed pneumonia, despite treatment • (Cryptogenic Organizing Pneumonia)
12 1. Evaluation of pneumonia or infiltrate of unclear etiology • Suspected lung transplant Infection • Or • Rejection
13 2. Persistent Atelectasis • Malignant endobronchial obstruction • Remove any obstructing lesion (eg, mucus plug, foreign body)
3. Centrally located lung masses or nodules 14
4. Peripheral lung mass or nodules 15
16 4. Peripheral lung mass or nodules • Flexible bronchoscopy with ¶Fluoroscopic guidance ¶Electromagnetic navigation guidance ¶Endobronchial ultrasound (EBUS)
Fluoroscopic guidance 17
Electromagnetic navigation guidance 18
Endobronchial ultrasound (EBUS) 19
20 • Radial probe ultrasound guidance can be used to access and obtain diagnostic tissue from the peripheral lung nodules.
Endobronchial ultrasound (EBUS) 21
22
23 5. Mediastinal lymphadenopathy or masses (Transbronchial needle aspiration (TBNA)
24 6. Hemoptysis • Localize the cause of bleeding to direct appropriate therapy ¶Laser ¶Balloon Tamponade ¶Angiographic Embolization
25 7. Tracheobronchomalacia
8. Airway lacerations that follow blunt chest trauma
9. Cough 27
10. Tracheoesophageal fistula 28
11. Bronchopleural fistula 29
12. Evaluate complications or placement of artificial airways 30
Therapeutic indications
1. Mucus impaction
2. Foreign body removal
3. Endotracheal tube placement
4. Laser or argon plasma coagulation
5. Photodynamic therapy A photosensitizer drug (usually a hematoporphyrin derivative) is administered intravenously, which accumulates selectively within the neoplastic tissue
Photodynamic therapy light at a wavelength of 600 to 800 nm to activate the photosensitizers in the target lesion, leading to the death of the neoplastic tissue.
6. Electrocoagulation electrical current
7. Cryotherapy liquid nitrogen
8. Balloon dilation
09. Brachytherapy catheter placement Local radiotherapy
10. Tracheobronchial stents
Contraindications
44 Contraindications • Severe refractory hypoxia with inability to maintain adequate oxygenation during the procedure • Malfunctioning equipment
45 Contraindications • Exacerbation of Asthma • Exacerbation of chronic obstructive pulmonary disease • Severe pulmonary hypertension • Current or recent myocardial ischemia • Poorly controlled heart failure • Life-threatening cardiac arrhythmias
46 Contraindications • Hose on anticoagulants • or • Who have a coagulopathy
47 Contraindications • Patients with Renal Insufficiency • Occasionally Those With Superior Vena Cava Syndrome.
48 Rigid Bronchoscopy
Rigid bronchoscopy 49
• Rigid bronchoscopy is used for retrieving foreign objects • it allows protection of the airway and controlling the foreign body during recovery 50 Rigid bronchoscopy
51 Massive hemoptysis • Massive hemoptysis, defined as loss of >600 m. L of blood in 24 hours ¶Is a medical emergency ¶Should be addressed with initiation of intravenous fluids ¶Examination with rigid bronchoscopy
52 Rigid Bronchoscopy • The larger lumen of the rigid bronchoscope ¶Allows for therapeutic approaches such as electrocautery to help control the bleeding.
Foreign body removal 53
Familial Antecedents Personnel Interrogatory Main Symptoms Secondary Diagnosis Vital Physical examination Signs Main Laboratory Complementary examination Radiology Procedures 54
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