Bronchoscopy 1 Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health – Dr Mazen Qusaibaty MD, DIS / Head Pulmonary and Internist Department Ibnalnafisse Hospital Ministry of Syrian health –

2Diagnosis Interrogatory Antecedents Familial Personnel Symptoms Main Secondary Physical examination Signs Vital Main Complementaryexamination Laboratory Radiology Procedures

Bronchoscopy

1.Flexible 2.Rigid 5

Bronchoscopy Bronchoscopy is an endoscopic technique Visualizing the inside of the airways for diagnostic and therapeutic purposes 6

Bronchoscopy An instrument (bronchoscope) is inserted into the airways Usually through the nose or mouth, or occasionally through a tracheostomy7

Indications Diagnostic indications Therapeutic indications8

Immunocompromised patients Immunocompromised patients   Long term steroid use   Patients on chemotherapy   HIV   Transplant recipients 9

To rule out opportunistic infections   (PCP or fungal infections)10

Incomplete resolution of presumed pneumonia, despite treatment (Cryptogenic Organizing Pneumonia)11

Suspected lung transplant Infection Or Rejection 12

Malignant endobronchial obstruction Remove any obstructing lesion (eg, mucus plug, foreign body)13

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4. Peripheral lung mass or nodules 15

16 Flexible bronchoscopy with   Fluoroscopic guidance   Electromagnetic navigation guidance   Endobronchial ultrasound (EBUS)

17 Fluoroscopic guidance

18 Electromagnetic navigation guidance

19 Endobronchial ultrasound (EBUS)

Radial probe ultrasound guidance can be used to access and obtain diagnostic tissue from the peripheral lung nodules. Radial probe ultrasound guidance can be used to access and obtain diagnostic tissue from the peripheral lung nodules.20

21 Endobronchial ultrasound (EBUS)

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5. Mediastinal lymphadenopathy or masses (Transbronchial needle aspiration (TBNA)23

6. Hemoptysis Localize the cause of bleeding to direct appropriate therapy   Laser   Balloon Tamponade   Angiographic Embolization 24

7. Tracheobronchomalacia 7. Tracheobronchomalacia 25

8.Airway lacerations that follow blunt chest trauma

9. Cough 27

10.Tracheoesophageal fistula 28

11. Bronchopleural fistula 29

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Therapeutic indications

1. Mucus impaction

2. Foreign body removal 2. Foreign body removal

3. Endotracheal tube placement

4. Laser or argon plasma coagulation 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

Severe refractory hypoxia with inability to maintain adequate oxygenation during the procedure Severe refractory hypoxia with inability to maintain adequate oxygenation during the procedure Malfunctioning equipment Malfunctioning equipment44

Exacerbation of Asthma Exacerbation of Asthma Exacerbation of chronic obstructive pulmonary disease Exacerbation of chronic obstructive pulmonary disease Severe pulmonary hypertension Severe pulmonary hypertension Current or recent myocardial ischemia Current or recent myocardial ischemia Poorly controlled heart failure Poorly controlled heart failure Life-threatening cardiac arrhythmias Life-threatening cardiac arrhythmias45

Hose on anticoagulants or Who have a coagulopathy46

Patients with Renal Insufficiency Occasionally Those With Superior Vena Cava Syndrome.47

Rigid Bronchoscopy 48

49 Rigid bronchoscopy

Rigid bronchoscopy is used for retrieving foreign objects Rigid bronchoscopy is used for retrieving foreign objects it allows protection of the airway and controlling the foreign body during recovery 50 Rigid bronchoscopy

Massive hemoptysis Massive hemoptysis, defined as loss of >600 mL of blood in 24 hours   Is a medical emergency   Should be addressed with initiation of intravenous fluids   Examination with rigid bronchoscopy51

The larger lumen of the rigid bronchoscope   Allows for therapeutic approaches such as electrocautery to help control the bleeding.52

53 Foreign body removal

54Diagnosis Interrogatory Antecedents Familial Personnel Symptoms Main Secondary Physical examination Signs Vital Main Complementaryexamination Laboratory Radiology Procedures