Bronchoscopy: This is done for looking directly at the larynx, trachea, the two main bronchi and their subdivisions. Two types of bronchoscopes are used—the rigid and the flexible. Both have their uses, but the procedure with the flexible one is easy.
The bronchoscope is introduced generally through one of the nostrils, past the pharynx, the vocal cords, into the larynx, trachea and bronchi. The nostrils, the pharynx and the larynx are locally anasthetized with a spray anaesthetizer.
The bronchoscope has arrangement for seeing the parts directly. It also has a hollow narrow tube in it, through which secretions in the airways can be sucked out. A wire with an arrangement for taking punch biopsy as well as taking a smear with a brush from the suspected surface of the airways are also there.
The procedure is helpful for making a diagnosis of lung cancer, it can also see whether the vocal cords are working properly or not; this examination is usually done in cases of hoarseness of voice. There may be a cancer of the vocal cords in the larynx which if detected early, can be removed surgically.
Laryngoscopy: A small round mirror, a rupee-coin size is inserted in the mouth and pharynx, with the tongue held out, the mirror reaches the back (posterior) wall of the pharynx from where the shadow of the larynx and vocal cords in the mirror can be seen by the doctor doing this test.
Pleural Biopsy and Aspirate: If fluid collects in the pleural space around the lungs and is seen to be present in the X-ray films, then a small quantity of this fluid is removed by inserting a needle through the skin into the pleural space.
Whatever cause has led to the presence of the fluid in the pleural cavity, has its effect on the pleural surfaces also. So if a piece of the inner pleural surface is removed and examined histologically, it shows cause of the disease, whether it be tuberculosis or a cancer.
For taking this piece of pleura, a special needle is used, which after insertion punches out the required piece. While this is being done, the patient holds breath, so that there is no movement in the lung or the pleura due to breathing and a tear in it does not occur.
Slight pain or discomfort does occur at the time of taking the biopsy. In some cases, some air may also collect in the pleural space, the process called pneumothorax, but this air disappears usually in a day or so.
Lung Function Tests: These are helpful in the following circumstances:
1. To get an objective assessment of the patient’s disability of the lungs.
2. To follow the progress of a disease and the effect of treatment.
3. To try to differentiate the possible causes of patient’s breathlessness.
4. To assess patients prior to anaesthesia and surgery, particularly thoratic surgery leading to lung resection or surgical removal of lung.
Lung Scans: The lung is scanned:
1. To see the flow of blood in the blood vessels (perfusion).
2. To see the air in the lung (ventilation).
For perfusion scanning, i.e. for scanning the passage of blood through the lung capillaries the isotope is injected intravenously, and for ventilation scanning, the air that the patient breathes is mixed with a radioactive gas so that wherever that air goes, it can be seen and recorded by the gamma camera. Perfusion scan is done to see any abnormality or block in die blood vessel, such as is the case in pulmonary embolism in which a blood clot is carried in the circulation to lodge in the pulmonary artery and thus obstructs the blood flow. Ventilation scan is done to see in which part of the lung, the air does not go or come back, as happens in cases of emphysema, i.e. condition of enlarged or damaged air sacs (alveoli) of the lungs.