3/9/2012
Bronchoscopy
Dr. William Bekemeyer
Western Montana Clinic
Pulmonology
70 year old male, former smoker with COPD.
On meds; recent hemoptysis. Purulent sputum & hoarseness
• Exam
– Clear lungs
– Raspy voice
1
3/9/2012
CXR
Bronchoscopy
• Clear 58 year old man with history of ABPA, complains of recurrence of Aspergillus
bronchitis
• Exam
– Crackles & Wheezes
CT
• Mucoid impaction
Bronchoscopy
2
3/9/2012
74 year old male smoker with chest pain & dyspnea
• CXR
– Pneumothorax
– Rt. Upper lobe mass
• Chest tube placed and bronchoscopy done
79 year old female for persistent cough failed anti‐reflux therapy from ENT & no sputum
• Exam
– Rales both bases
3
3/9/2012
CXR
• Chronically elevated right diaphragm, otherwise clear
Bronchoscopy
51 year old female with non‐productive cough for 1 year; never smoked
• Exam
– Normal CXR
• Normal
Bronchoscopy
• Normal
4
3/9/2012
60 year old female with history of asthma sinusitis, chronic reflux & atopy
• Exam: – Rhonchi
– Wheezes inpiratory & expiratory CXR
Bronchoscopy
• Clear
Excisional Biopsy Fibroepithelial Polyp
Repeat Bronchoscopy
3 months, no recurrence
63 year old female with history of coughing up “slugs”
• Exam
– Diffuse Rhonchi
• Lab
– Eosinophilia
– Elevated IgE
5
3/9/2012
CXR
Bronchoscopy
• Clear
• Suspect ABPA, culture was negative
62 year old female with OSA & mild pulmonary hypertension presents with cough, wheezing, and sputum. Unresponsive to outpatient antibiotics & steroids; recently some hemoptysis.
• Exam
– Diffuse wheezes
CXR: Unremarkable
6
3/9/2012
• Bronchoscopy
– Recurrent symptoms for 2 months
• Ultimately, repeat Broncoscopy finds sunflower shell in RLL bronchus
62 year old female, S/P treatment of nonsmall
cell cancer RUL with nice response to chemo & radiation but persistent cough.
• Exam
– Hyper pigmentation from radiation
– Rales RUL
7
3/9/2012
CXR & CT
• No Evidence of Tumor
Bronchoscopy
• Purulent secretions & no evidence of tumor though quite a bit of scar & inflammation. 71 year old male smoker with hoarseness & hemoptysis.
• Exam
– Hoarse
– Clear chest
CXR
• Normal
Bronchoscopy
• Dx Right Vocal Cord Cancer
8
3/9/2012
45 year old female; 20 years S/P LU lobectomy
for trauma has 2 years of non‐productive cough
• Exam
– Normal except thoracotomy scar – Near continuous cough
CXR
Bronchoscopy
• Evidence of prior surgery, otherwise normal
76 year old male with cough for 2 years after laryngectomy for cancer.
• Exam
– COPD changes
– Hoarse
9
3/9/2012
CXR
• Bronchoscopy
• COPD changes
68 year old female; 1 year S/P, right upper lobectomy for cancer. Presents with fatigue, weight loss, and night sweats
• Exam
– Decreased breath sounds right upper chest, well healed thoracotomy scar
CXR
• Bronchoscopy
• Air in Right pleural space
10
3/9/2012
60 year old female with wheeze on exertion cough, minimal; sputum; some hoarseness
• Exam
– Upper airway inspiratory ‐ expiratory wheeze
CXR
Bronchoscopy
• Normal
Indications for Bronchoscopy
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Mass for dx or staging
Suspected sarcoid with low Dlco
Chronic Cough
Foreign Body
Recurrent infection in same lobe
Pulmonary infiltrate for culture
Hemoptysis not otherwise explained
Unexplained wheeze especially if localized
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3/9/2012
Indications (cont’d)
• Persistent radiographic abnormality (atelectasis)
• Miscellaneous
– Smoke Inhalation
– Chest trauma
– Tracheo‐esophageal fistula
– Endotracheal tube placement/confirmation
– Tracheobronchomalacia
– Hoarseness/vocal cord paralysis
• Suspected retained secretions/mucous plugging
Contradictions / Complications
• Bronchospasm; Tachycardia; Vagalbradyardia; Hypoxemia; recent MI; active CHF; Hypertension; Bradycardia; Tachycardia; Laryagospasm bleeding, etc. 12