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Bronchoscopy is another tool for monitoring and diagnosis. The bronchoscope is a thin, long instrument equipped with a light and camera. It is inserted into a sedated patient's airways and lungs to examine for abnormalities and rule out infection and rejection.

Bronchoscopy is performed by your transplant pulmonologist, usually in the bronchoscopy suite located adjacent to the pulmonary function laboratory at Fairfax Inova Hospital. There are two types of bronchoscopy procedures.

  • Surveillance bronchoscopy is performed on a routine basis following transplantation to ensure there are no underlying problems with your new lungs. We generally will schedule you for a bronchoscopy between 7 and 10 days after your transplant and again at 1 month, 3 months, 6 months and possibly 9 and 12 months following transplantation.
  • A clinically-indicated bronchoscopy is performed when a patient's condition changes and the physician needs to know what is happening in the lungs. Symptoms that may necessitate a bronchoscopy include shortness of breath, a drop in lung function numbers, a change on a patient's X-ray or unexplained fever.

Depending on timing, a clinically-indicated bronchoscopy may replace the next routinely-scheduled bronchoscopy.

Before a bronchoscopy
Do not eat or drink anything prior to your bronchoscopy without first talking with your physician. You may take your medications with sips of water. Bring your medicine with you to take after the procedure.

Consult with your pulmonologist prior to your procedure if you take a blood thinner or medication for blood pressure or diabetes.

Arrange for a family member or friend to accompany you to your appointment and to remain in the waiting area during the procedure. You can return home after your bronchoscopy but will be drowsy and unable to drive.

The procedure
Before the procedure, intravenous sedation and a local anesthesia are administered in the nose and upper airways.The bronchoscope is passed through the nose. The upper airways are closely examined.

Next the vocal cords are examined. Additional local anesthetic is applied to the cords to minimize discomfort. Bronchoscopy is generally not a painful procedure, but patients often experience excess coughing due to irritation from the bronchoscope or the sterile fluids used to flush the lungs and airways.

The trachea is entered and both sides of the lung are inspected in detail. The physician uses the bronchoscope to suction away any secretions present. Sterile fluid is brought into the lung and then suctioned out into a collection container.

The specimens collected are called bronchial washings or bronchoalveolar lavage. These fluids are sent to the microbiology laboratory to check for viruses, bacteria or fungi which may require treatment and for abnormal cells (cytology).

Close attention is paid to the bronchial anastomosis, which is the hook-up between the native bronchus and the donor bronchus. The physician looks for scar tissue or stricture formation.

A biopsy (tissue sample) of the lung is usually obtained, especially if rejection is suspected. The physician passes a biopsy forceps through the bronchoscope into the lung and collects tiny snips of lung tissue by opening and closing the forceps. The physician uses fluoroscopic (X-ray) guidance to ensure that the forceps are properly positioned.

Complications from biopsies may include bleeding and a pneumothorax (also known as a collapsed lung). Bleeding is controlled through suctioning or by passing medication such as epinephrine through the bronchoscope to constrict the bleeding vessel(s). You may cough up a little blood for up to 24 hours.

A pneumothorax is trapped air between the lung and the chest wall. Depending on the size of the pneumothorax, a chest tube may be inserted to evacuate the air. You may also develop a low fever. Contact your transplant coordinator if your symptoms worsen or persist for more than 24 hours.

Biopsy results
Lung tissue biopsies are graded on a scale of 0-4. Zero (0) means no rejection. Four (4) means severe rejection. Your pulmonologist will review the biopsy with a pathologist and evaluate all of your symptoms to determine the best course of treatment for you. Biopsy results are usually available the next day.