(Flexible Bronchoscopy, Fiberoptic Bronchoscopy, FOB, Rigid Bronchoscopy)

Procedure overview

What is bronchoscopy?

Bronchoscopy is a procedure that allows the doctor to directly visualize the interior passageways of the lower respiratory tract through a bronchoscope (a long, narrow, fiberoptic, lighted tube inserted through the nose or mouth). With the bronchoscope, the doctor can see the larynx (voice box), trachea (windpipe), bronchi (large airways to the lungs), and bronchioles (smaller branches of the bronchi).

There are two types of bronchoscopies, characterized by the type of bronchoscope used: flexible or rigid. The type of bronchoscope used will determine the extent to which the bronchioles of the lung are visualized.

With a flexible bronchoscope, the doctor is able to visualize not only the tissue of the larger airways (trachea and bronchi), but also that of the smaller sections (bronchioles) as well. The design of the flexible bronchoscope is advantageous because it can be maneuvered into the smaller bronchioles, yielding more information about their condition than can be determined with a rigid bronchoscope.

In addition, the flexible, fiberoptic bronchoscope has interior channels which increase the capabilities of treatment options, such as delivering oxygen, suctioning secretions, obtaining tissue samples (biopsy), instilling medications, and laser therapy.

A rigid bronchoscope is a straight, metal, lighted tube capable of visualizing only the larger airways, thus limiting the diagnostic and therapeutic options available. However, certain conditions may warrant its use, such as aspiration of a large amount of secretions and/or blood, controlling significant bleeding, or removal of foreign objects and/or lesions (diseased tissue) within the bronchi. Generally, the rigid bronchoscope has been replaced by the flexible bronchoscope because it has less risk of traumatizing the tissue, improved patient tolerance, and provides better access to smaller areas of the lung tissue.

Other related procedures that may be used to diagnose lung problems include chest X-ray, computed tomography (CT scan) of the chest, bronchography, chest fluoroscopy, chest ultrasound, lung scan, lung biopsy, mediastinoscopy, positron emission tomography (PET scan) of the chest, and pulmonary angiogram. Please see these procedures for additional information.

Anatomy of the respiratory system

The respiratory system is made up of the organs involved in the interchanges of gases, and consists of the:

  • Nose

  • Pharynx

  • Larynx

  • Trachea

  • Bronchi

  • Lungs

The upper respiratory tract includes the:

  • Nose

  • Nasal cavity

  • Ethmoidal air cells

  • Frontal sinuses

  • Maxillary sinus

  • Larynx

  • Trachea

The lower respiratory tract includes the lungs, bronchi, and alveoli.

What are the functions of the lungs?

The lungs take in oxygen, which cells need to live and carry out their normal functions. The lungs also get rid of carbon dioxide, a waste product of the body's cells

The lungs are a pair of cone-shaped organs made up of spongy, pinkish-gray tissue. They take up most of the space in the chest, or the thorax (the part of the body between the base of the neck and diaphragm).

The lungs are enveloped in a membrane called the pleura.

The lungs are separated from each other by the mediastinum, an area that contains the following:

  • The heart and its large vessels

  • Trachea (windpipe)

  • Esophagus

  • Thymus

  • Lymph nodes

The right lung has three sections, called lobes. The left lung has two lobes. When you breathe, the air enters the body through the nose or the mouth. It then travels down the throat through the larynx (voice box) and trachea (windpipe) and goes into the lungs through tubes called main-stem bronchi.

One main-stem bronchus leads to the right lung and one to the left lung. In the lungs, the main-stem bronchi divide into smaller bronchi and then into even smaller tubes called bronchioles. Bronchioles end in tiny air sacs called alveoli.

Reasons for the procedure

A bronchoscopy may be performed for diagnostic and/or therapeutic reasons. Diagnostic indications may include, but are not limited to, the following:

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