Endoscopic examination methods in pulmonology

Diagnostic capabilities of bronchoscopy

In modern pulmonology, bronchoscopy is an indispensable diagnostic method. Primarily, it provides direct visualization of the mucous membrane and airway lumen throughout its entire length—starting from the vocal cords and ending at the level of the subsegmental bronchi. This allows the detection of local changes that are inaccessible to assessment by other methods.

In addition to visual inspection, the method provides broad opportunities for laboratory and morphological diagnostics:

• Secretion collection: airway contents are obtained via an endoscope for subsequent bacteriological and cytological examination.
• Bronchoalveolar lavage: the procedure of washing a specific area of the bronchial tree followed by fluid collection. The resulting washings are examined to evaluate cellular composition and the presence of pathogens.
• Morphological verification (biopsy): punch biopsy directly of the bronchial mucosa is used to confirm the diagnosis at the tissue level. In addition, transbronchial biopsy is possible—the collection of fragments from adjacent structures, such as the lung parenchyma or intrathoracic lymph nodes.

Therapeutic bronchoscopy

Endoscopic access allows not only for exploration, but also for the active treatment of airway pathologies. Therapeutic manipulations can be divided into two main groups:

1. Sanation of the bronchial tree. Most relevant in bronchiectasis. The procedure involves thorough washing of the affected bronchi from purulent contents and targeted local administration of antibacterial drugs, which significantly increases treatment efficacy.
2. Relief of bronchial obstruction. Endoscopy is life-saving in severe asthma attacks. In situations where «silent chest» syndrome develops (complete absence of breath sounds due to bronchial occlusion), liquid and aspiration of thick, viscous mucus are performed through the bronchoscope. The method is also the gold standard for the rapid detection and removal of foreign bodies from the bronchial lumen.

Clinical indications and diagnostic workup

The choice of bronchoscopy tactics directly depends on the leading clinical syndrome. The method addresses specific tasks in various life-threatening conditions:

• Hemoptysis and pulmonary hemorrhage. The physician's priority task is to quickly establish the exact source of bleeding (trachea, bronchi, or lung parenchyma) and identify its cause (e.g., tuberculosis, disintegrating tumor, or bleeding bronchiectasis). Once the source is visualized, immediate actions are taken to stop the bleeding.
• Suspected oncological process. If the patient presents with an unexplained chronic cough, endoscopy aims to search for an endobronchial tumor that may be completely invisible on standard radiographs. In confirmed lung cancer, the method is essential for obtaining a biopsy, morphological verification of the tumor type, and assessing the patient's surgical resectability.
• Parenchymal and pleural pathologies.
• In slowly resolving pneumonia, it is necessary to rule out local bronchial obstruction (e.g., by a tumor) that hinders adequate drainage and recovery.
• In atelectasis (collapse of a lung area), the examination helps determine the direct cause of bronchial lumen occlusion.
• In lung abscess, bronchoscopy accomplishes three tasks at once: it rules out obstruction of the draining bronchus, allows reliable material to be taken for bacteriological culture, and improves pus outflow.

Thoracoscopy and mediastinoscopy

In addition to bronchoscopy, other endoscopic approaches are used in pulmonology. They are necessary for examining «blind» zones that are physically inaccessible to the bronchoscope. The main goal of these interventions is visual control and obtaining high-quality biopsy material for histological examination.

• Thoracoscopy is used for direct inspection of the pleural layers, assessing the nature of the effusion, and taking biopsies in pleurisy of unclear etiology or suspected mesothelioma.
• Mediastinoscopy is used to revise the anterior mediastinum. It allows the assessment of the state of intrathoracic lymph nodes and tissue, which is critically important when staging oncological processes and diagnosing disseminated diseases.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Technique of bronchoalveolar lavage
• Transbronchial biopsy of intrathoracic lymph nodes
• Bronchiectasis: principles of local sanation
• «Silent chest» syndrome in asthma: pathophysiology
• Endobronchial tumors: causes of radiologic negativity

Other topics in the "Respiratory System" section

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