The role of bronchoscopy in the diagnosis of airway disease

Abstract

Endoscopy of the airway is a valuable tool for the evaluation and management of airway disease. It can be used to evaluate many different bronchopulmonary diseases including airway foreign bodies, tumors, infectious and inflammatory conditions, airway stenosis, and bronchopulmonary hemorrhage. Traditionally, options for evaluation were limited to flexible and rigid bronchoscopy. Recently, more sophisticated technology has led to the development of endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB). These technological advances, combined with increasing provider experience have resulted in a higher diagnostic yield with endoscopic biopsies. This review will focus on the role of bronchoscopy, including EBUS, ENB, and rigid bronchoscopy in the diagnosis of bronchopulmonary diseases. In addition, it will cover the anesthetic considerations, equipment, diagnostic yield, and potential complications.

Keywords: Bronchoscopy; diagnosis; electromagnetic fields; endosonography; lung disease.

Figure 1

Examples of airway pathology identified by flexible bronchoscopy. Upper left: airway foreign body upper right: granular cell tumor of the trachea. Lower left: tracheobronchial airway injury with avulsion of the right mainstem bronchus lower right: obstructing bronchopulmonary carcinoid tumor in the left mainstem bronchus.

Figure 2

ENB peripheral navigation screenshot. The CT guided planned pathway is used to navigate to the left upper lobe nodule to allow for tissue sampling. ENB, electromagnetic navigational bronchoscopy.