Fiberoptic bronchoscopy

The diagnosis of SCLC is usually made using fiberoptic bronchoscopy. The value of fiberoptic bronchoscopy was established in the 1980s (8,9). Ninety-three percent of SCLC cases are diagnosed by fiberoptic bronchoscopy while fine needle aspiration or mediastinoscopy diagnose the rest. The majority of time, the diagnosis of SCLC is made cytologically. Unfortunately, this limits the amount of tissue available for further studies,... 

Fiberoptic bronchoscopy is often done after intratracheal injection of 2.5% cocaine solution and lidocaine spray. Acute myocardial infarction after fiberoptic bronchoscopy with intratracheal cocaine has been reported (48). 

A 73-year-old man with a history of breathlessness, cough, and weight loss had some ill-defined peripheral shadow in the upper zones of a chest X-ray. He had fiberoptic bronchoscopy with cocaine and lidocaine and 5 minutes later became distressed, with dyspnea, chest pain, and tachycardia. Electrocardiography showed an evolving anterior myocardial infarction. Coronary angiography showed a stenosis of less than 25% in the proximal left anterior descending artery with coronary artery spasm. He made an uneventful recovery. 

The primary tumor is assessed with chest x-rays and fiberoptic bronchoscopy, whereas lymphatic spread is usually assessed by mediastinoscopy, gallium-67 citrate scanning, and CT and/or PET scans. If the history and physical examination or other routine clinical studies (e.g., complete blood cell count and liver function tests) suggest the possibility of metastatic disease, then special scans (e.g., bone, brain, or liver) or biopsies (e.g., bone marrow or liver) may be necessary for... 

Haidl P, Kemper P, Butnarasu SJ et al (2001) Does the inhalation off L-menthol solution in the premedication for fiberoptic bronchoscopy affect coughing and the sensation of dyspnoea Pneu-mologie 55 115-119... 

The most commonly used diagnostic modalities to find the cause of the hemoptysis and to identify the pulmonary lobes in which the bleeding is localized are conventional radiography, fiberoptic bronchoscopy and CT. Knowledge of the localization of the bleeding is of importance for the interventionalist in order to facilitate the subsequent embolization procedure. 

CT offers the possibility to demonstrate both airway and vascular pathology (e.g. bronchiectasis, bronchogenic carcinoma, aneurysmal disease of the thoracic aorta), and has been reported to be the modality of first choice in patients with hemoptysis [18]. In patients who have a non-diagnostic fiberoptic bronchoscopy, CT can provide a diagnosis in half of the cases, while in patients with non-conclusive chest radiography this rate varies from 39% to 88% [16, 17]. Localization of the bleeding site can be achieved in 63%-100% of all cases [7, 15]. Current multidetector CT scanners also allow visualization of bronchial and non-bronchial systemic artery anatomy, and may thus be of help for the interventionalist to plan the procedure [8,13,19, 20]. 

Hsiao El, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB (2001) Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR Am J Roentgenol 177 861-867... 

Immunologic Allergic reactions to lido-caine for fiberoptic bronchoscopy have been reviewed [57 ]. The authors concluded that lidocaine is safe in bronchoscopy, provided that care is taken to limit the dose. In suspected local anesthetic allergy they suggested patch testing before the use of any topical anesthesia. 

Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) contributed significant insights into the pathogenesis of IPF and other ILDs but practical value is limited (2,147). Increases in polymorphonuclear leukocytes, mast cells, alveolar macrophages, and myriad cytokines are noted in BAL fluid from patients with IPF lymphocyte numbers are usually normal (147). However, BAL cell profiles in IPF do not predict prognosis or therapeutic responsiveness (147). We do not believe BAL cell counts have a role to stage or follow IPF. 

Figure 2 Diagnostic approach to blood and marrow transplant recipients with pulmonary complications. Abbreviations FOB, fiberoptic bronchoscopy HRCT, high-resolution computed tomography of the chest PFT, pulmonary function test VATS, video-assisted thoracoscopic surgery.

Fourrier F, Fourrier L, Lestavel P, et al. Acute lobar atelectasis in ICU patients comparative randomized study of fiberoptic bronchoscopy versus respiratory therapy. Intensive Care Med 1994 20 S40. 

Figure 6 Patients already receiving antimicrobial therapy. (A) When pneumonia develops as a superinfection in a patient who has been receiving antimicrobial agents for several days before the appearance of new infiltrates and fiberoptic bronchoscopy is performed immediately without any modifications of the treatment, bacteria responsible for the new infection are then mostly resistant to the antibiotics given previously and culture results will not be modified. (B) In contrast, when fiberoptic bronchoscopy is done after the introduction of new antimicrobial agents, bacteria responsible for the infection are then frequently sensitive to the new antibiotics given and culture results are negative in a high number of cases.

However, conditions placing the patient at risk for fiberoptic comphca-tions are limitations for using invasive diagnostic techniques in nonventilated patients, because performance of bronchoscopy may paradoxically be more dangerous in this setting than in patients receiving mechanical ventilation. Our personal bias would be to use a policy based only on chnical evaluation and results of sputum analysis to select treatment in critically ill patients... 

Bartlett JG, Alexander J, Mayhew J, Sollivan-Sigler N, GorbachSL. Should fiberoptic bronchoscopy aspirates be cultured Am Rev Respir Dis 1976 114 73-78. 

Trouillet JL, Guiguet M, Gibert C, et al. Fiberoptic bronchoscopy in ventilated patients evaluation of cardiopulmonary risk under midazolam sedation. Chest 1990 97 927-933. 

Wimberley N, Ealing LJ, Bartlett JG. A fiberoptic bronchoscopy technique to obtain uncontaminated lower airway secretions for bacterial culture. Am Rev Respir Dis 1979 119 337-343. 

For intubated infants, flexible flberoptic bronchoscopy may not always be feasible. Modifications of fiberoptic bronchoscopy techniques have been performed with moderate success. A styletted intracatheter wedged blindly by way of the endotracheal tube and blind wedging of a double catheter system through the endotracheal tube to obtain lower respiratory tract secretions have been described (68). 

Starobin D, Fink G, Shitrit D, Izbicki G, Bendayan D, Bakal I, Kramer MR (2003) The role of fiberoptic bronchoscopy evaluating transplant recipients with suspected pulmonary infections analysis of 168 cases in a multiorgan transplantation center. Transplant Proc 35 659-660... 

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