Bronchoscopic and Thoracoscopic indications, findings and complications at Ain Shams University Hospital

Abstract

Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes (Balfour et al., 2003). There are three types of bronchoscopy: rigid, flexible and virtual bronchoscopy; flexible bronchoscopy is the most commonly performed type of bronchoscopy (Adwan et al., 2008), causes less discomfort for the patient than rigid bronchoscopy and the procedure can be performed easily and safely under moderate sedation. It is the technique of choice nowadays for most bronchoscopic procedures (Make et al., 2001). The first therapeutic rigid bronchoscopy (RB) was performed in 1897 by Professor Gustav Killian at the Department of Otolaryngology, Freiburg University, Germany (Ayers and Beamis Jr., 2001). Meanwhile, fiberoptic bronchoscopy (FOB) has widespread diagnostic and therapeutic indications. Procedure complications are not rare and they do occur since its introduction, in 1964 by Ikeda, the flexible fiberoptic bronchoscope has substantially advanced diagnostic and therapeutic possibilities in pulmonary medicine and has replaced the rigid or open tube bronchoscope in many situations (Taylor et al., 1999). The age of included patients in this study was between 2 months to 75 years old, with mean age 45 + 20.25 years. There was a highly significant relationship between the sex and the indication of bronchoscopy, the most common indication in males was lung mass (19.7%) and the most common indication in females was haemoptysis (18.2%). The most common indication for fiberoptic bronchoscopy was haemoptysis in 135 cases (23.2%), and then lung mass in113 cases (19.4%). The most common indication for rigid bronchoscopy was lung mass (34 cases; 16.7%), then haemoptysis (28 cases; 13.7%). The only indication in this study for thoracoscopy was undiagnosed pleural effusion (64 cases). The most common finding in cases of haemoptysis was endobronchial lesion in 25.8%, then normal findings in 22.7% and congested mucosa in 12.9%. The most common finding in cases of lung mass was endobronchial lesion in 41.2%, then broadened spur in 16.5%. The most common findings in cases of chronic cough were normal findings in 36.4%, then pus trickling from bronchi in 27.3%, tracheal mass in 18.2% and broadened spur in 9%. The most common finding in cases of undiagnosed pleural effusion was pleural nodules in 46.4%, then pleural plaques in 12.5%, thickened pleura and pleural adhesions with the same percentage in 8.9%.