Bronchoscopy with transtracheal biopsy
Alternative names:
biopsy - lung - transtracheal (transbronchial)
How the test is performed:
This procedure is performed as part of a bronchoscopy. The pulmonologist (a pulmonary specialist trained to perform a bronchoscopy) sprays a topical or local anesthetic in your mouth and throat. Then a cannula (a metal tube about 6-inches long that is curved on one end) is inserted, curved end first, to hold your tongue out of the way. An anesthetic is injected through the cannula into back of your throat, through your larynx, trachea, bronchial tubes, and into your lungs. This will cause coughing at first, which will cease as the anesthetic is increased. When the area feels "thick," it is sufficiently numb.
An anesthetic jelly will be inserted into one nostril. When your nostril is numb, the scope will be inserted until it passes through your throat into your bronchus. Usually, a flexible bronchoscope is used unless dilation is required, an obstruction is present, or tissue needs to be removed (biopsy). The flexible tube is less than 1/2-inch wide and about 2-feet long. The rigid bronchoscope is somewhat larger. The outside end is connected to several bottles on a nearby table and has an eyepiece. Some of the bottles are connected to a small motor that suctions out and collects the fluids from the bronchi. Other fluids can be introduced to flush the area and collect cells for analysis by a pathologist. When a rigid bronchoscope is used, a catheter, wire, brush, or small scissors may be introduced through the scope to remove some of the tissue for evaluation. Multiple tissue samples can be removed with transtracheal (transbronchial) biopsy.
How to prepare for the test:
This test may require an overnight stay in the hospital. Fasting is required for 6 to 12 hours before the test. You must sign an informed consent form. Arrange for transportation to and from the hospital. Many patients want to rest the following day, so make arrangements for work, child care, or other obligations.
Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:
How the test will feel:
Local anesthesia is used to relax your throat muscles, so there is the feeling of fluid running down the back of the throat and the need to cough or gag until the anesthetic takes over.
Once the anesthetic takes effect, there may be sensations of pressure or mild tugging as the tube moves through the trachea. Many patients experience the feeling of suffocation when the tube is in the throat (there is no risk of suffocation). If coughing occurs during the test, more anesthetic will be added.
An X-ray is often taken after the bronchoscope is removed to compare with the original that indicated the need for the bronchoscopy. When the anesthetic wears off, your throat may be scratchy for several days. After the test, the cough reflex will return in 1 to 2 hours, then normal eating and drinking is allowed.
Why the test is performed:
This test is recommended if an X-ray or other diagnostic procedure shows a tumor, obstruction in the tracheobronchial tree, or if secretions plug the small airways.
A transtracheal (transbronchial) biopsy is most often used when there is diffuse infiltrative pulmonary disease, tumors, or when severe illness contraindicates open lung biopsy.
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