Sample Report Fiberoptic Bronchoscopy
Title of Procedure
1. Fiberoptic bronchoscopy.
2. Endobronchial and transbronchial biopsies with fluoroscopy.
Description of Procedure: The patient was premedicated with Versed. Approximately 4 mg was given prior to introduction of the scope. A total of 9 mg was given before and during the procedure for sedation. Some tendency toward obstructive apnea was noted both before and during the procedure with the patient in supine posture.
The fiberoptic scope was introduced via the right naris. The naris was tight and a very small amount of bleeding ensued from the middle turbinate. The scope was passed into the hypopharynx. The vocal cords, false cords, arytenoid region, hypopharyngeal region toward the esophagus, and the epiglottis were visualized. All of these were relatively unremarkable. Some landmarks were present around the region of the arytenoids but no erythema or clear edema, and no distortion. Vocal cords appeared to move relatively normally, although the patient would not phonate following sedation.
The trachea was inspected and found to be normal. The main carina was sharp. The right bronchial tree was inspected, and three normal segments into the right upper lobe were found. The right middle lobe had two segments; the more medial one was stenotic, with circumferential narrowing and suggestion of possible submucosal disease with overlying normal-appearing mucosa. A very small amount of increased mucus was present in this area. The right lower lobe, including superior segment, anterolateral and basal segments, was also inspected to the subsegmental level, revealing no abnormality. The left upper lobe with lingula and the left lower lobe with superior segment likewise were inspected to the subsegmental level, revealing no abnormalities.
Using fluoroscopic control, a brush was placed into the right middle lobe into the three available orifices. The more stenotic and medial of these came closest to approximating the right heart border where the lesion had been seen on CT. The lesion itself was not clearly visible on fluoroscopy. Although an accentuated density at the right hilum was noted, it was not felt to be the lesion seen on CT. Consequently, biopsies were not clarified a great deal by fluoroscopic localization of the lesion.
Biopsies were taken from the medial and stenotic portion of the right middle lobe, approximating the right heart border on at least one occasion. Approximately four pieces of tissue were removed, plus two fairly significant endobronchial biopsies from the region of the narrowed orifice into the right middle lobe and its associated carina.
Specimens included dry and wet brush slides, plus biopsies in formalin. Chief differential diagnosis of neoplasm was done. After the procedure, the patient was given 0.3 mg of Romazicon to aid in recovery from Versed. Fluoroscopy has been used after transbronchial biopsies to ensure no pneumothorax at that time. Subsequent chest x-ray was ordered.
1. Fiberoptic bronchoscopy.
2. Endobronchial and transbronchial biopsies with fluoroscopy.
Description of Procedure: The patient was premedicated with Versed. Approximately 4 mg was given prior to introduction of the scope. A total of 9 mg was given before and during the procedure for sedation. Some tendency toward obstructive apnea was noted both before and during the procedure with the patient in supine posture.
The fiberoptic scope was introduced via the right naris. The naris was tight and a very small amount of bleeding ensued from the middle turbinate. The scope was passed into the hypopharynx. The vocal cords, false cords, arytenoid region, hypopharyngeal region toward the esophagus, and the epiglottis were visualized. All of these were relatively unremarkable. Some landmarks were present around the region of the arytenoids but no erythema or clear edema, and no distortion. Vocal cords appeared to move relatively normally, although the patient would not phonate following sedation.
The trachea was inspected and found to be normal. The main carina was sharp. The right bronchial tree was inspected, and three normal segments into the right upper lobe were found. The right middle lobe had two segments; the more medial one was stenotic, with circumferential narrowing and suggestion of possible submucosal disease with overlying normal-appearing mucosa. A very small amount of increased mucus was present in this area. The right lower lobe, including superior segment, anterolateral and basal segments, was also inspected to the subsegmental level, revealing no abnormality. The left upper lobe with lingula and the left lower lobe with superior segment likewise were inspected to the subsegmental level, revealing no abnormalities.
Using fluoroscopic control, a brush was placed into the right middle lobe into the three available orifices. The more stenotic and medial of these came closest to approximating the right heart border where the lesion had been seen on CT. The lesion itself was not clearly visible on fluoroscopy. Although an accentuated density at the right hilum was noted, it was not felt to be the lesion seen on CT. Consequently, biopsies were not clarified a great deal by fluoroscopic localization of the lesion.
Biopsies were taken from the medial and stenotic portion of the right middle lobe, approximating the right heart border on at least one occasion. Approximately four pieces of tissue were removed, plus two fairly significant endobronchial biopsies from the region of the narrowed orifice into the right middle lobe and its associated carina.
Specimens included dry and wet brush slides, plus biopsies in formalin. Chief differential diagnosis of neoplasm was done. After the procedure, the patient was given 0.3 mg of Romazicon to aid in recovery from Versed. Fluoroscopy has been used after transbronchial biopsies to ensure no pneumothorax at that time. Subsequent chest x-ray was ordered.
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