Dr Thomas Crowhurst

Bronchoscopy

Bronchoscopy is an important diagnostic and / or therapeutic procedure usually undertaken by respiratory physicians.

It involves passing a thin flexible fibreoptic tube (bronchoscope) either through the nose or mouth and then past the larynx (voice box), down the trachea (windpipe) and into the airways / lungs. The patient is sedated or anaesthetised for the procedure. Additional general information regarding bronchoscopy can be found here.

Bronchoscopy is typically performed as a ‘day procedure’, although it is important to remember that you cannot drive after an anaesthetic and it is a requirement that you have a friend or family member stay with you the night after the procedure. It usually takes around two to three business days for results from a bronchoscopy to be available, but the wait can be longer if more sophisticated laboratory work is required.

All medical procedures entail certain risks and bronchoscopy is no different; medical procedures should only be recommended where it is judged that the likely benefits outweigh the potential risks to the patient in their individual circumstances. Dr Crowhurst will carefully explain these benefits and risks as part of an informed consent process.

Bronchoscopy can seek to achieve many different diagnostic or therapeutic goals:

General bronchoscopy can allow sampling of the airways or lung through washings or bronchoalveolar lavage respectively. In broad terms, this involves instilling saline through the bronchoscope and then sucking this fluid back into a sample reservoir. Collecting samples in this manner can allow identification of infectious organisms that may not be detectable in sputum samples (sputum is phlegm coughed from the lungs).

Forceps can be passed down the bronchoscope to take biopsies of the lining of larger airways (endobronchial biopsies) and / or the lung itself (transbronchial biopsies). Biopsies can be helpful in diagnosing a range of conditions including cancer, infection, and certain autoimmune and interstitial lung diseases.

The linear endobronchial ultrasound (EBUS) bronchoscope has a specialised miniature ultrasound probe on the end. This enables the proceduralist to identify lymph nodes (glands) lying adjacent to the airways and then sample those nodes with a needle under direct ultrasound guidance. Sampling of these nodes via linear EBUS bronchoscopy is less invasive than the historical method of surgical mediastinoscopy, and has a good diagnostic yield. Linear EBUS may be recommended if there is concern that there are enlarged lymph nodes in the chest due to cancer, lymphoma, sarcoidosis or other disorders.

Radial endobronchial ultrasound (EBUS) bronchoscopy involves the use of a very fine catheter containing a rotating miniature ultrasound probe. After careful assessment of the relevant airway anatomy, this catheter is passed deep into the lung to find a pulmonary nodule or mass that is not otherwise accessible via general bronchoscopy. Once this abnormality is identified, the ultrasound probe is withdrawn from within the catheter and forceps are passed down the catheter to take biopsies of the lesion. This procedure can mitigate the need for more invasive methods of obtaining lung biopsies.

There are a range of other bronchoscopic techniques, some of which are subspecialised. Cryobiopsy is where a catheter with a rapidly freezing tip is used to take a larger lung biopsy than can be achieved with a standard transbronchial lung biopsy; this is most often used to investigate interstitial lung disease. Argon plasma coagulation can be used to debulk tumour that is causing larger airways to become narrowed. Balloon dilatation can be used to temporarily increase the size of larger airways that may be narrowed due to non-cancerous or cancerous processes. Bronchoscopy can also be used to implant endobronchial valves, which are an advanced treatment for severe chronic obstructive pulmonary disease.

Pleural procedures

Some patients develop abnormal fluid in the pleural space, which is the potential space that exists between the outside of the lung and the inside of the chest wall. This is called a ‘pleural effusion’ and is essentially a pocket of fluid within the chest cavity but outside the lung itself. In order to establish the underlying diagnosis, it is often necessary to take a sample of this fluid by passing a needle into the pocket under ultrasound guidance and after the use of local anaesthetic. If there is a larger volume of fluid, sometimes a drain (a thin flexible plastic tube) needs to be placed within the pocket to allow all of the fluid to drain out over a few days. More information about pleural effusions is available here.

There are a range of other pleural procedures that are sometimes required including closed pleural biopsies, insertion of an indwelling pleural catheter (a drain that remains in indefinitely) or insertion of a drain for a collapsed lung (pneumothorax). As with bronchoscopy, all of these procedures have risks that should be explained prior to the consideration of providing informed consent.

Procedures by Dr Crowhurst

Dr Crowhurst is certified in the full range of bronchoscopic and pleural procedures included in the Thoracic Society of Australia and New Zealand program. He performs these procedures at Calvary Adelaide Hospital and the Lyell McEwin Hospital. Dr Crowhurst will carefully explain to you the reasons why he may recommend a particular procedure in your case. He will outline the likely benefits and potential risks, and require informed consent before proceeding.

If Dr Crowhurst believes that you require subspecialised input from an interventional pulmonologist or cardiothoracic surgeon, he will explain this and arrange necessary referrals with appropriate clinical handover in order to streamline your ongoing care.