Name of the Procedure:

Bronchoscopy, rigid or flexible, with fluoroscopic guidance; transbronchial needle aspiration biopsy(s) of trachea, main stem, and/or lobar bronchus(i).

Summary

A bronchoscopy is a medical procedure where a thin, flexible or rigid tube called a bronchoscope is used to examine the airways and lungs. In some cases, fluoroscopic guidance (a type of real-time X-ray) is used. This procedure often includes a transbronchial needle aspiration biopsy, where samples of tissue are taken from the trachea, main stem, and/or lobar bronchi for further analysis.

Purpose

This procedure addresses conditions affecting the airways and lungs such as infections, tumors, or inflammatory conditions. The primary goal is to diagnose the underlying issue by obtaining tissue samples that can be analyzed for abnormalities.

Indications

• Persistent cough
• Unexplained lung infections
• Suspicious areas on imaging tests (e.g., X-ray, CT scan)
• Difficulty breathing
• Abnormal respiratory sounds
• Hemoptysis (coughing up blood)

Preparation

• Fasting for at least 6 hours before the procedure.
• Adjustments in medications, particularly anticoagulants or antiplatelet agents.
• Pre-procedure assessments such as blood tests, chest X-rays, and electrocardiograms (ECGs).

Procedure Description

1. The patient is given anesthesia or sedation.
2. A bronchoscope is inserted through the nose or mouth and down into the lungs.
3. Fluoroscopic guidance is used to navigate and precisely locate the target areas.
4. A needle is passed through the bronchoscope to collect tissue samples from the trachea, main stem, and/or lobar bronchi.
5. The bronchoscope is slowly withdrawn.
6. The collected samples are sent to a laboratory for analysis.

Duration

The procedure typically takes 30 minutes to 1 hour.

Setting

• Hospital
• Outpatient clinic
• Surgical center

Personnel

• Pulmonologist or thoracic surgeon
• Nurses
• Anesthesiologist or sedation nurse
• Radiology technician (for fluoroscopy)

Risks and Complications

• Bleeding
• Infection
• Pneumothorax (collapsed lung)
• Reaction to anesthesia
• Sore throat or hoarseness

Benefits

• Accurate diagnosis of lung conditions.
• Early detection of potential issues.
• Facilitation of appropriate and timely treatment.

Recovery

• Observation for a few hours post-procedure to monitor for complications.
• Rest and limited physical activity for the remainder of the day.
• Follow-up appointment to discuss biopsy results and further treatment.
• Possible sore throat and mild cough, which should subside in a few days.

Alternatives

• CT-guided lung biopsy: An imaging-guided method to obtain lung tissue samples, often less invasive.
• Sputum cytology: Analysis of mucus from the lungs, though it may be less definitive.
• Thoracentesis: Collection of fluid from the pleural space around the lungs, useful if pleural effusion is present.

Patient Experience

• The patient might feel drowsy from the sedation or anesthesia.
• Mild discomfort in the throat and chest.
• Pain management with over-the-counter analgesics.
• Comfort measures including warm saline gargles for throat soreness.