RespiratoryTier 2Topic

Bronchoscopy

What it is

Direct endoscopic visualisation of the tracheobronchial tree - diagnostic (biopsy, lavage, brushings) and therapeutic (foreign body removal, stenting, bleeding control)
Flexible bronchoscopy is standard; rigid bronchoscopy is reserved for specific indications (massive haemoptysis, large airway obstruction, foreign body, stent placement) given better airway control and a larger working channel

Sampling techniques

Bronchoalveolar lavage (BAL) - samples the distal airways/alveoli; used for infection (including PCP, unusual organisms), malignancy cytology, and ILD workup (cell differential pattern)
Endobronchial/transbronchial biopsy - tissue diagnosis of visible lesions or diffuse parenchymal disease
Brushings/washings - adjunct cytological sampling

Indications

Indications: unexplained haemoptysis, suspected endobronchial malignancy, unexplained persistent infiltrate, suspected TB when sputum is unobtainable/negative, ILD characterisation

Risks and preparation

Risks: bleeding (higher with biopsy, anticoagulation), pneumothorax (with transbronchial biopsy), hypoxaemia during the procedure, and rarely respiratory arrest
Conscious sedation is typically used; anticoagulation/antiplatelets are usually held before biopsy per standard peri-procedural bleeding-risk protocols

Uses

Haemoptysis workup, lung cancer diagnosis, interstitial lung disease workup, pulmonary infection in the immunocompromised

Place among biopsy options

Complements but does not replace CT-guided or surgical biopsy for peripheral lesions beyond bronchoscopic reach (EBUS extends reach to central/mediastinal targets)

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