Name of the Procedure:

Bronchoscopy, Rigid or Flexible, Including Fluoroscopic Guidance, when Performed; with Transbronchial Lung Biopsy(s), Each Additional Lobe (List separately in addition to code for primary procedure).

Summary

A bronchoscopy is a medical procedure that uses a thin, flexible or rigid tube (bronchoscope) to view the airways and lungs. When combined with fluoroscopic guidance and transbronchial lung biopsies, it allows doctors to obtain tissue samples from different lobes of the lung for diagnostic purposes.

Purpose

This procedure is used to diagnose various lung conditions, including infections, tumors, and inflammatory diseases. The goal is to obtain tissue samples (biopsies) from the lungs for further examination under a microscope, aiding in accurate diagnosis and treatment planning.

Indications

• Persistent cough with unknown origin
• Abnormal chest X-rays or CT scans
• Suspected lung infections
• Difficulty breathing or shortness of breath
• Lung cancer diagnosis or staging
• Evaluation of lung transplant rejections

Preparation

• Patients may need to fast for 6-12 hours before the procedure.
• Adjustments to medications, especially blood thinners, may be required.
• Pre-procedure blood tests and imaging studies, such as chest X-rays or CT scans, are often necessary.
• Consent forms will be signed after discussing potential risks and benefits.

Procedure Description

1. The patient is positioned safely and comfortably.
2. IV sedation or general anesthesia is administered to ensure the patient is relaxed and pain-free.
3. The bronchoscope is inserted through the mouth or nose and navigated down the throat into the lungs.
4. Fluoroscopic guidance (real-time X-ray) is used to accurately position the bronchoscope in different lobes of the lung.
5. Special tools are passed through the bronchoscope to collect tissue samples from various lung areas.
6. The procedure typically involves taking tissue samples from additional lung lobes as needed.
7. Once sufficient samples are collected, the bronchoscope is carefully removed.

Duration

The procedure usually takes between 30 to 60 minutes, depending on the complexity and the number of biopsies required.

Setting

Bronchoscopies are typically performed in a hospital’s endoscopy suite or a specialized outpatient clinic with appropriate imaging facilities.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist or Nurse Anesthetist
• Radiologic Technologist (for fluoroscopic guidance)
• Registered Nurse and other support staff

Risks and Complications

• Common: Sore throat, coughing, minor bleeding
• Rare: Pneumothorax (collapsed lung), significant bleeding, infection, allergic reactions to sedation
• Management: Close monitoring, supportive care, and immediate intervention if complications arise

Benefits

• Accurate diagnosis of lung conditions
• Ability to collect tissue samples from multiple lung lobes
• Aid in the planning of appropriate treatments
• Rapid results, often within a few days

Recovery

• Patients are typically monitored for a few hours post-procedure.
• Mild sore throat and cough are common and temporary.
• Avoid strenuous activity for 24 hours.
• Follow-up appointments may be scheduled to discuss biopsy results.
• Pain relievers may be recommended for discomfort.

Alternatives

• Non-invasive imaging studies (e.g., CT scan, MRI)
• Needle biopsy depends on the location and size of the lesion.
• Pros: Less invasive.
• Cons: May not provide comprehensive tissue samples, leading to less accurate diagnoses.

Patient Experience

• During the procedure: Patients are usually under sedation or anesthesia, so they won't feel or remember much.
• Post-procedure: Mild discomfort, such as a sore throat and cough, can be managed with pain relievers.
• Supportive care: Fluids, rest, and following medical advice aid in a smooth recovery.