[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical skills](https://durgical.com/en/clinical-skills/) › [Other investigations](https://durgical.com/en/clinical-skills/areas/investigations/) › Bronchoscopy

# Bronchoscopy

- Investigation

A thin camera is passed through the nose or mouth into the windpipe and lungs to look inside, take samples or remove a blockage.

Updated Nov 13, 2026

## Key points

- Flexible bronchoscopy: topical anaesthesia with moderate sedation; rigid bronchoscopy: general anaesthesia, for massive haemoptysis, foreign bodies and stents.
- EBUS-guided needle aspiration samples mediastinal nodes to diagnose and stage lung cancer.
- BAL samples the alveoli: infection in immunocompromised patients (for example Pneumocystis), tuberculosis, interstitial lung disease.
- Refractory hypoxaemia, haemodynamic instability and uncorrected bleeding risk (before biopsy) are the key contraindications.
- After transbronchial biopsy, watch for pneumothorax (chest pain, breathlessness) and bleeding; nothing by mouth until the throat is no longer numb.

On this page

- The basics Key points
- What it is
- Indications
- Preparation and what happens
- Flexible and rigid bronchoscopy compared
- Next step
- Elsewhere in DurgiPedia

- Clinical Risks and complications

- Safety Contraindications

- Study Test yourself

- Connections Connections

## What it is

Bronchoscopy inspects the larynx, trachea and bronchi down to the segmental airways. Flexible bronchoscopy is the usual form: it is done through the nose or mouth (or an endotracheal tube) with topical anaesthesia and moderate sedation, often as a day case. It allows bronchoalveolar lavage (BAL: saline is instilled and aspirated to sample the alveoli for infection, cells or malignancy), bronchial washings and brushings, endobronchial and transbronchial biopsy, and, with endobronchial ultrasound (EBUS), needle aspiration of mediastinal lymph nodes to diagnose and stage lung cancer. Rigid bronchoscopy is done under general anaesthesia in theatre; its wide channel suits massive haemoptysis, large foreign bodies, tumour debulking and airway stents. The referring doctor decides the question to answer, reviews the CT (which guides where to sample), prepares the patient, and acts on the results: cytology, histology, cultures (including for tuberculosis) and the BAL cell count. Hypoxaemia is the commonest problem during the test; pneumothorax and bleeding are the main risks of transbronchial biopsy.

## Indications

- Suspected lung cancer: central mass, collapse, nodes; biopsy and staging (EBUS).
- Haemoptysis, persistent unexplained cough, localised wheeze or stridor.
- Infection: non-resolving pneumonia, suspected tuberculosis with negative sputum, pneumonia in an immunocompromised patient.
- Interstitial lung disease or sarcoidosis: BAL, transbronchial or cryobiopsy, EBUS of nodes.
- Therapy: foreign body removal, clearing mucus plugs and secretions, control of bleeding, stents, guiding a difficult intubation.

## Contraindications

- Hypoxaemia that does not correct with oxygen, or haemodynamic instability.
- Recent myocardial infarction, unstable angina or an uncontrolled arrhythmia.
- Uncorrected coagulopathy, low platelets or anticoagulation before biopsy (inspection and BAL may still be possible).
- Severe pulmonary hypertension or uraemia: higher bleeding risk with biopsy.
- A patient who cannot cooperate or protect the airway, unless done under general anaesthesia.

## Preparation and what happens

- Agree the question with the team and review the CT — it shows where to sample and which technique to use.
- Explain the test, sampling and risks (bleeding, pneumothorax) and get consent — the patient knows what to expect and report.
- Fast as the unit instructs; check blood count, clotting and oxygen saturation — biopsy is unsafe with poor clotting.
- Plan anticoagulants and antiplatelets with the guideline — clopidogrel and anticoagulants raise biopsy bleeding.
- Ask about asthma, allergies to local anaesthetic, and sedation history — bronchospasm can occur and doses must be limited.
- On the day: cannula, monitoring and supplemental oxygen — oxygen saturation falls during the test, especially during BAL.
- Topical anaesthetic to the nose, throat and airways, with sedation — it blunts cough and laryngospasm.
- The scope is passed under vision and the airways inspected, then samples taken — inspection first avoids missing a lesion.
- Recovery: observe saturation and breathing; nothing by mouth until the throat is no longer numb — the gag and cough are blunted.

## Flexible and rigid bronchoscopy compared

| Feature | Flexible | Rigid |
| --- | --- | --- |
| Setting | Endoscopy suite or bedside; topical anaesthesia and moderate sedation | Operating theatre; general anaesthesia |
| Reach | Segmental and subsegmental airways; EBUS reaches nodes | Trachea and main bronchi |
| Strengths | Diagnosis: BAL, brushings, biopsies, EBUS; ventilated patients | Wide channel: massive haemoptysis, large foreign bodies, debulking, stents |
| Limits | Small channel for suction or large objects | Needs anaesthesia and specialist skills; distal airways not seen |

## Risks and complications

- Hypoxaemia during the procedure, the most common problem, worse with BAL and in patients with poor reserve.
- Bronchospasm or laryngospasm, more likely in asthma or COPD.
- Bleeding after biopsy, usually minor; massive bleeding is rare but can block the airway.
- Pneumothorax after transbronchial biopsy: chest pain or breathlessness after the test.
- Transient fever after BAL, local anaesthetic toxicity if limits are exceeded, arrhythmias and sedation problems.

## Next step

- Follow up all samples: cytology and histology, bacterial, fungal and mycobacterial cultures, and BAL cell differential.
- After transbronchial biopsy: chest radiograph if symptoms suggest pneumothorax, or as the unit protocol says.
- Breathlessness, chest pain, ongoing haemoptysis or falling saturation after the test: call a senior.
- Fever in the first day after BAL is usually transient; persistent fever or a new infiltrate needs review.
- Results go to the respiratory or lung cancer multidisciplinary team, which plans the next test or treatment.

## Test yourself

Think of the answer, then tap the question to see it.

## When is rigid bronchoscopy preferred to flexible bronchoscopy?

For massive haemoptysis, large or difficult foreign bodies, tumour debulking and airway stents, because its wide channel allows suction and instruments.

## What is bronchoalveolar lavage, and what is it used for?

Saline instilled into a segment and aspirated to sample the alveoli, used for infection in immunocompromised patients, tuberculosis and interstitial lung disease.

## Which complication should you suspect when a patient becomes breathless with chest pain after transbronchial biopsy?

Pneumothorax; examine the patient, check saturation and get a chest radiograph, and call a senior.

## What does EBUS-guided needle aspiration add to bronchoscopy?

It samples mediastinal and hilar lymph nodes through the airway wall, to diagnose and stage lung cancer and diagnose sarcoidosis.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-skills/bronchoscopy/)

## Elsewhere in DurgiPedia

- [A nodule or a mass on the chest X-ray](https://durgical.com/en/radiology/a-nodule-or-a-mass-on-the-chest-x-ray/)
- [Lobar collapse (atelectasis) on the chest X-ray](https://durgical.com/en/radiology/lobar-collapse-on-the-chest-x-ray/)
- [Pneumothorax on the chest X-ray](https://durgical.com/en/radiology/pneumothorax-on-the-chest-x-ray/)
- [The bronchial circulation](https://durgical.com/en/physiology/the-bronchial-circulation/)

## Connections

## Related 4

- [Reading spirometry: obstructive or restrictive?](https://durgical.com/en/clinical-skills/reading-spirometry-obstructive-or-restrictive/)
- [Upper GI endoscopy](https://durgical.com/en/clinical-skills/upper-gi-endoscopy/)
- [Needle aspiration and decompression of a pneumothorax](https://durgical.com/en/clinical-skills/needle-aspiration-and-decompression-of-a-pneumothorax/)
- [The informed-consent station](https://durgical.com/en/clinical-skills/the-informed-consent-station/)

## Related conditions 7

- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Foreign body aspiration in children](https://durgical.com/en/conditions/foreign-body-aspiration-in-children/)
- [Pulmonary tuberculosis](https://durgical.com/en/conditions/pulmonary-tuberculosis/)
- [Sarcoidosis](https://durgical.com/en/conditions/sarcoidosis/)
- [Pneumocystis pneumonia (PCP)](https://durgical.com/en/conditions/pneumocystis-pneumonia/)
- [Interstitial lung disease](https://durgical.com/en/conditions/interstitial-lung-disease/)
- [Bronchiectasis](https://durgical.com/en/conditions/bronchiectasis/)

## In Pharmacology 3

- [Lidocaine](https://durgical.com/en/pharmacology/lidocaine/)
- [Midazolam](https://durgical.com/en/pharmacology/midazolam/)
- [Fentanyl](https://durgical.com/en/pharmacology/fentanyl/)

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Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.

Sources: [Bronchoscopy](https://www.ncbi.nlm.nih.gov/books/NBK448152/) (StatPearls (NCBI Bookshelf), 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-skills/bronchoscopy/