Bronchoscopy is one of the most commonly performed medical procedures and also defines the procedural practice of chest physicians. In most training programs, however, there is little structured education, and trainees learn by watching and doing. This book is intended as a road map for any physician looking to master or improve skills in this important area. It outlines what the authors, who are all experts in the field, think a standard approach to common procedures should be and covers everything from anatomy and equipment care to how to set up a bronchoscopy unit. Step-by-step descriptions and abundant illustrations provide the reader with detailed instructions for performing diagnostic procedures such as bronchial washing and lavage, lung biopsy, and transbronchial needle aspiration. The book also covers bronchoscopy in the intensive care unit and lung transplant patients. Advanced diagnostic bronchoscopy and basic therapeutic techniques are reviewed in the final two chapters.
Armin Ernst, MD, graduated from the University of Heidelberg and completed his residency at the University of Texas Health Sciences Center in San Antonio, Texas. He then completed his fellowship in pulmonary and critical care medicine at the combined program of Harvard Medical School. Dr. Ernst is Chief of Interventional Pulmonology and Director of the Complex Airway Center at Beth Israel Deaconess Medical Center. He is a member of multiple professional associations and has received numerous awards for his work and achievements, most recently the Pasquale Ciaglia Medal in 2007 from the American College of Chest Physicians.
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© Cambridge University Press 2009
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First published 2009
Printed in the United States of America
A catalog record for this publication is available from the British Library
Library of Congress Cataloging in Publication data
Introduction to bronchoscopy / edited by Armin Ernst. p. ; cm.Includes bibliographical references and index.ISBN 978-0-521-71109-8 (pbk.)1. Bronchoscopy. I. Ernst, Armin. II. Title[DNLM: 1. Bronchoscopy. WF 500 I618 2009]RC734.B7I62 2009616.2′3–dc22 2008025368
ISBN 978-0-521-76628-9 hardcover
ISBN 978-0-521-71109-8 paperback
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Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.
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Contributors
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vii |
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Introduction
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xi |
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Abbreviations/Acronyms
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xiii |
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1 A Short History of Bronchoscopy
Heinrich D. Becker
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1 |
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2 Multidetector Computed Tomography Imaging of the Central Airways
Karen S. Lee and Phillip M. Boiselle
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17 |
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3 The Larynx
Daniel C. Chelius, Jr., and William W. Lunn
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30 |
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4 Airway Anatomy for the Bronchoscopist
Rani Kumaran, Arthur Sung, and Armin Ernst
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38 |
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5 Anesthesia for Bronchoscopy
John Pawlowski and Stephen D. Pratt
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46 |
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6 Anatomy and Care of the Bronchoscope
Robert Garland
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62 |
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7 Starting and Managing a Bronchoscopy Unit
Rabih Bechara
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71 |
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8 Flexible Bronchoscopy: Indications, Contraindications, and Consent
Aaron B. Waxman
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78 |
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9 Bronchial Washing, Bronchoalveolar Lavage, Bronchial Brush, and Endobronchial Biopsy
Carla Lamb
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85 |
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10 Transbronchial Lung Biopsy
Scott Shofer and Momen M. Wahidi
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98 |
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11 Transbronchial Needle Aspiration
William Fischer and David Feller-Kopman
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107 |
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12 Bronchoscopy in the Intensive Care Unit
Jed A. Gorden
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115 |
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13 Bronchoscopy in the Lung Transplant Patient
Anne L. Fuhlbrigge
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126 |
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14 Advanced Diagnostic Bronchoscopy
Ross Morgan and Armin Ernst
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134 |
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15 Basic Therapeutic Techniques
Luis F. Angel and Deborah J. Levine
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142 |
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Index
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151 |
Luis F. Angel, MD
Rabih Bechara, MD, FCCP
Heinrich D. Becker, MD, FCCP
Phillip M. Boiselle, MD
Daniel C. Chelius, Jr., MD
Armin Ernst, MD
David Feller-Kopman, MD
William Fischer, MD
Anne L. Fuhlbrigge, MD, MS
Robert Garland, RRT
Jed A. Gorden, MD
Rani Kumaran, MD
Carla Lamb, MD, FCCP
Karen S. Lee, MD
Deborah J. Levine, MD
William W. Lunn, MD
Ross Morgan, MD
John Pawlowski, MD, PhD
Stephen D. Pratt, MD
Scott Shofer, MD, PhD
Arthur Sung, MD
Momen M. Wahidi, MD
Aaron B. Waxman, MD, PhD