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Name
Bronchoscopy
Short Description
Bronchoscopy
Affected Animals: Animals with respiratory tract diseases that
cannot be diagnosed with x-rays or ultrasound, or those that do not
respond to symptomatic treatment for their problems, are potential
candidates for bronchoscopy.
Overview: Bronchoscopy is a diagnostic procedure for
patients with respiratory tract disease. It can be used to identify
structural abnormalities, abnormal airway secretions, foreign
bodies, and mass lesions including certain tumors. Additional
procedures combined with bronchoscopy can allow for identification
of inflammation or infection in the respiratory tract. Specialized
equipment and expertise is required for performing bronchoscopy and
for monitoring the patients during the procedure.
Bronchoscopy does not always identify the cause of an individual
animal's problem, but at least it can rule out many potential
explanations for it.
Description:Very heavy sedation or general
anesthesia is necessary for bronchoscopy in small animal patients.
Injectable anesthetic drugs are used so that it is not necessary to
use an endotracheal tube for the inhalation of gas anesthesia during
the procedure. Without such a tube, there is more room for the
bronchoscope to be inserted into the trachea and the bronchi. Oxygen
can be delivered during the procedure through a small catheter
inserted down into the trachea or through the bronchoscope itself.
In larger patients, gas anesthesia may be used, as the bronchoscope
can pass through larger endotracheal tubes while still allowing for
the delivery of oxygen and gas anesthetic agents to the patient.
Patients are monitored with an electrocardiogram and with pulse
oximetry during the procedure.
Once the patient is anesthetized, the bronchoscope is passed into
the trachea from the oral cavity. In most cases, bronchoscopy is
done with flexible fiberoptic endoscopes. Many times, these are
attached to a small camera that can record findings during the
procedure. Rigid bronchoscopes are also available, but they are not
commonly used in small animal patients.
Bronchoscopy is used to visually inspect the airway for any evidence
of collapse, compression, or dilation. Mass lesions can be seen if
present within the lining of the trachea or bronchi. Abnormal
discharges such as excessive mucus, blood, or pus may also be seen.
If a foreign object has been inhaled, it may be seen if the scope
can reach the point where it is lodged.
The procedure is useful not only for visualization of abnormalities,
but also for obtaining samples. With bronchoscopy, biopsies can be
taken if lesions requiring biopsy are seen, and samples of abnormal
discharges can be collected and submitted for microscopic analysis
and culture. Flushing sterile saline through the endoscope often
facilitates sample collection. Special brushes may be passed through
the endoscope for collecting samples as well. If airway foreign
bodies are seen, special grasping forceps may allow for their
removal without surgical intervention.
Prognosis: The prognosis depends primarily on the diagnosis
and on the presence of other factors affecting the patient. Since
complications due to the procedure are rare, the prognosis for an
animal undergoing bronchoscopy is usually good with respect to the
procedure itself.
Potential problems that can arise during the procedure include
anesthesia-related complications, including death. Heart arrhythmia
and bleeding may occur. Oxygen levels may drop temporarily but can
usually be corrected quickly by supplying additional oxygen. Fever,
infection, and abnormalities in the lungs that can be seen on chest
x-rays can develop, but these complications occur infrequently.
PreprocedureCare:
Prior to bronchoscopy, animals need to be prohibited from eating
because the procedure is performed under anesthesia. In emergency
situations this may not be possible, particularly when bronchoscopy
is needed to attempt removal of an airway foreign body. Since it is
not usually a first-line diagnostic tool, prior evaluation almost
always includes chest x-rays.
PostprocedureCare:
Following bronchoscopy, animals are usually given oxygen to breathe
until they are awake. Because the procedure is usually short in
duration, and since the injectable or gas anesthetic agents also
tend to be short acting, most patients that are stable at the time
the procedure is performed can be released the same day. For those
that are seriously ill, hospitalization is usually required for
ongoing treatment of their illness, not because of the procedure
itself.
Prevention: Many complications can be avoided by careful
patient selection. Critically ill patients with serious heart
disease or metabolic conditions that need to be stabilized first are
not good candidates for anesthesia; bronchoscopy is therefore not
recommended for them. Animals in severe respiratory distress are not
good candidates; however bronchoscopy may be indicated in these
patients when an airway foreign body or some other type of
structural airway disease is suspected that absolutely requires
bronchoscopy for an accurate diagnosis or prompt therapeutic
intervention. Patients with severe bleeding disorders, or with very
low
