BA 1A Bronchoscopy Report

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1A: The Bronchoscopy Report

BRONCHATLAS©
 Prepared By

www.Bronchoscopy.org

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Bronchoscopy reports

 The following slides serve as a guideline to


what should be included in a report.
 More, but usually NOT less information
may be warranted depending on the
bronchoscopist and the bronchoscopist’s
place of practice.

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The Bronchoscopy report

 Patient name
 Bronchoscopist’s name
 Assistant’s name
 Indication for the procedure
 Contains a brief history of the patient’s illness
 Procedures performed
 For example, lavage, washing, brushing, biopsy,
transbronchoscopic lung biopsy, transbronchial needle
aspiration….
 Anesthesia
 Topical anesthesia, conscious sedation, other
medications (amount and type administered).

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The Bronchoscopy report

 Oral or nasal introduction of bronchoscope


 Nasopharynx, hypopharynx
 Larynx, vocal cords
 Subglottis
 Trachea
 Carina
 Left and right bronchial segments

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The Bronchoscopy report

 Summary of abnormalities noted


 Description of procedures performed
 Status of specimens obtained
 For example, for microbiology, cytology,
histology.
 Complications
 Assessment and plan

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Bronchoscopy reports
The bronchoscopy report should tell a story that everyone can read and
understand the same way.

Morphology: Caliber, patency, shape, normal variants.


Appearance: Normal, abnormal
Mucosa: Color, texture, fragility.
Abnormalities: Location, type, extent, associated lesions.
Secretions: Amount, type, color, location.

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Topics for Lesson 1

 Mucosa
 Examples of abnormalities
 Secretions
 Examples of abnormalities
 Other abnormalities

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Mucosa
 Color changes dependent on light and
video source as well as pathology.
 Need to become familiar with
particularities of one’s own equipment.
 Limitations of resolution, screen color, and
picture quality must also be considered.
 Normal color can only be approximated
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Bronchial Mucosa
 Normally pale and pinkish
 Shines slightly when illuminated
 Easily bruised and erythematatous with minimal trauma

Bronchitic changes
Lingula

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Bronchial Mucosa
 Placing the distal extremity of the scope against the airway
wall easily causes « red out » with echymoses and
erythema, but also causes « white out » with tissue
blanching from the pressure exerted on the mucosa.
 Suction can also cause hyperemia, echymoses, or even
bleeding.

White out Red out

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Mucosal erythema or redness
 Usually a sign of inflammation
 But many patients have bronchitis or underlying
lung disease, so their airways may appear
chronically inflammed.
 Erythema may be associated with
 Bronchitic changes
 Tissue swelling
 Angry, swollen, easily bruised mucosa
 Purulent secretions

 Color changes can also be quite subtle

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Mucosal changes

Raised nodularity/benign Erythema


cause unknown

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Mucosal edema
 Common with inflammatory processes
 May be seen along minor carina and along
cartilaginous rings
 May cause narrowing of airway lumen

Edema from chronic lower lobe


pneumonia and retained secretions

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From EB #31

This abnormality is

A. Pale, raised, and irregular

B. Thick and erythematous

C. Extrinsic compression

Click here for correct answer: A


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From EB #43

This bronchial mucosa is

A) Swollen and erythematous

B) Pale and granular

C) Extrinsic compression

Click here for correct answer: A


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Bronchial mucosal abnormalities a

Suction trauma Hyperemia

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Bronchial mucosa abnormalities b

Hyperemia, and Palor, erythema, and


neovascularization anthrocosis

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Bronchial mucosa abnormalities c

Prominent posterior Petechia


tramlines (muscularis)
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Airway Secretions

 Usually little mucous or clear slightly frothy


secretions are noted.
 Secretions can be increased
 As in chronic or acute bronchitis
 Purulent infectious lung diseases
 Rarely can be thick and tenacious as in
asthma, mucous plugging from infection,
atelectasis, and postobstructive processes

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Bronchitis and Airway secretions

Bronchial
Pits Tan

Frothy
Green

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Secretions

COLOR AMOUNT LOCALIZATION


White, tan, green, blood tinged None, scant, abundant Segmental, Lobar

TYPE CONSISTENCE
Mucoid, purulent, bloody Thin, tenacious, watery, thick

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Mucous and mucous plugs

Tenacious and thick

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From EB #42

These secretions are

A. Clear
B. Frothy
C. Mucoid
D. Purulent

Click here for correct answer: D


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This finding is BEST described as

A) Hypervascular mucosa overlying


cartilaginous rings with thick
yellow distal airway secretions.

B) Neovascularization with extrinsic


compression.

C) Volume loss with airway wall


invasion.

Click here for correct answer: A


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Other Abnormalities:
Tracheal stenosis

 Web-like subglottic stricture

 Circumferential subglottic
stenosis

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Other Abnormalities:
Intraluminal exophytic lesions

Necrotic Squamous cell Nodular Adenocarcinoma Nodular Squamous cell

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Other Abnormalities:
Extrinsic compression

 Compression Left Main


Bronchus from Esophageal
cancer

 Compression trachea (with


invasion) from Adenoid Cystic
Carcinoma

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Other Abnormalities:
Infiltrating tumors

Small cell Lung Cancer Adenocarcinoma Lung

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Other Abnormalities:
Volume loss

Lower lobe bronchus volume


loss from pleural effusion

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Step by Step© BRONCHATLAS©

& YouTube Instructional videos

This presentation is part of a


multidimensional competency-
oriented curriculum for Flexible
Bronchoscopy.

Our goal is to eliminate patient


suffering caused by unequal physician
expertise and on-the-job training.
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All efforts are made by Bronchoscopy International
to maintain currency of online information.
Multimedia presentations and videos can be cited as:
Bronchoscopy International: BronchAtlas©, an Electronic On-Line
Multimedia Slide Presentation.
http://www.Bronchoscopy.org/Bronchatlas/htm. Published 2017
(Please add “Date Accessed”).
BRONCHATLAS©
Thank you

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www.Bronchoscopy.org

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