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Indications for bronchoscopy

 

Bronchoscopy is probably an underused procedure, usually because its diagnostic potential is underrated. In some appropriate instances the investigation is not thought of and therefore not undertaken. In others the supposed danger and discomfort are greatly exaggerated. Long discussions may take place on the advisability of bronchoscopy, so wasting much time and effort. In fact, contraindications are few. Modern techniques of anaesthesia, either local or general, and of ventilation make the procedure so safe that a patient must be gravely ill, or have quite gross reduction in respiratory reserve, before bronchoscopy becomes dangerous. Clearly, in the immediately hopeless case, investigations would be inhuman; a similar argument applies to great age and frailty. Certain patients, with advanced superior vena caval obstruction, and therefore urgently needing radiotherapy, should have their bronchoscopy delayed until after treatment has started and there has been some subsidence of neck swelling: bronchoscopy before radiation can sometimes lead to trouble from postoperative laryngeal oedema, or excessive bleeding when a biopsy is attempted.

Bronchoscopy, a safe and invaluable investigation, should be performed very readily. If this policy is followed many unsuspected diagnoses will be made, suspected diagnoses confirmed, much time saved and distress often avoided. To illustrate this wide scope of bronchoscopy is the aim of the following discussion of indications. The patient’s history The patient’s present symptom, or symptoms, together with the story of the illness, are of paramount diagnostic importance and must be listened to with the utmost care. The clinician should he prepared to undertake bronchoscopy on the history alone It is not sufficiently well known that gross pathology (for example tumour or radiolucent foreign body) can be present in a large airway Without producing any physical signs or radiological change (Plates 145, 150, 153, 174 & 217). Nevertheless the discerning physician will often be suspicious on first hearing the patient’s story. One suggestive symptom alone should lead to action, but multiple symptoms strengthen the indication for bronchoscopy. In particular, so much information may be obtained bronchoscopically in cases of bronchial carcinoma that this examination should be carried out in all patients where there is the slightest suspicion of the disease, particularly if they are, or have been, heavy smokers. Individual symptoms are discussed further in the following sections. .

Haemoptysis

The patient’s history The patient’s present symptom, or symptoms, together with the story of the illness, are of paramount diagnostic importance and must be listened to with the utmost care. The clinician should he prepared to undertake bronchoscopy on the history alone It is not sufficiently well known that gross pathology (for example tumour or radiolucent foreign body) can be present in a large airway Without producing any physical signs or radiological change (Plates 145, 150, 153, 174 & 217). Nevertheless the discerning physician will often be suspicious on first hearing the patient’s story. One suggestive symptom alone should lead to action, but multiple symptoms strengthen the indication for bronchoscopy. In particular, so much information may be obtained bronchoscopically in cases of bronchial carcinoma that this examination should be carried out in all patients where there is the slightest suspicion of the disease, particularly if they are, or have been, heavy smokers. Individual symptoms are discussed further in the following sections. .

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