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Flexible endoscopy: respiratory tract

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Abstract

Flexible endoscopy of the respiratory tract can be a valuable therapeutic, diagnostic and prognostic tool for most patients with respiratory disease. Endoscopy can be used for diagnostic evaluation of the airways, including the nasal passages, nasopharynx, dorsal soft palate, pharynx, larynx, trachea and pulmonary tree, and to assess laryngeal function. Collection of tissue and fluid samples can be performed for microbiological or histopathological evaluation. The bronchoscope is also available as a valuable therapeutic tool and can be used to remove foreign objects from the pharynx, trachea and bronchi. It can also be used to place and evaluate airway stents. Visualization of airway injury or chronic airway changes can be monitored over time and will aid in determining the prognosis of conditions. Bronchoscopy is most rewarding when the veterinary surgeon has a good understanding of airway anatomy, use of equipment, anaesthetic protocols and techniques. This chapter covers Indications; Instrumentation; Premedication and anaesthesia; Patient positioning; Procedure; Pathological conditions; Foreign body removal; Postoperative care; and Complications.

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Figures

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6.3 Flexible endoscopes in several different sizes are available.
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6.4 Cytology brush in sheath (top) and in extended position (bottom). Use of a cytology brush in an airway.
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6.5 Aspiration/lavage catheter.
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6.6 Transbronchial biopsy needle. Transbronchial aspiration needle.
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6.7 A swivel tip T-adaptor attached to an endotracheal tube. It has a rubber valve at the top of the port, which opens enough to allow the fibrescope into the airway without allowing gas to escape into the environment. This allows maintenance of oxygen and anaesthetic gas flow to the patient.
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6.8 A Babcock forceps with gauze squares is used to protect from aspiration of blood or particulate matter during posterior rhinoscopy.
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6.9 Lung and airway anatomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.10 Normal larynx of a dog. (Courtesy of B McKeirnan) Everted laryngeal saccules and an accumulation of foamy saliva are common findings in brachycephalic dog breeds. Larynx of a dog with laryngeal paralysis. (b,c Courtesy of T McCarthy)
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6.11 Tracheal anatomy. Note the distinct C-shaped cartilages and the smooth, taut dorsal tracheal membrane. (Photograph courtesy of T McCarthy) Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.12 Strand of mucus in the normal airway. (Courtesy of T McCarthy)
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6.13 Bifurcation of the trachea. The left and right mainstem bronchi are clearly visible. Right mainstem bronchus. (Photographs courtesy of T McCarthy) Right cranial lung lobe. Right middle lung lobe. Entrance to the right accessory lung lobe. Inside the right accessory lung lobe. Right caudal lung lobe. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.14 Left mainstem brochus. Inside the left cranial lung lobe. Inside the left caudal lung lobe. Deep sub-segmental airways. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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6.15 Equipment required to perform a BAL.
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6.16 Bronchial brush cytology sampling technique.
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6.17 Changes in the trachea associated with tracheobronchitis. (Courtesy of T McCarthy)
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6.18 Mucopurulent secretions in the trachea of a cat with tracheobronchitis. (Courtesy of T McCarthy)
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6.19 Mild cervical tracheal collapse. (Courtesy of T McCarthy)
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6.20 Moderate intrathoracic tracheal collapse. (Courtesy of T McCarthy)
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6.21 Dog with severe extrathoracic and intrathoracic tracheal collapse, chronic cough and dyspnoea.
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6.22 Severe intrathoracic collapse. (Courtesy of T McCarthy)
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6.23 Mainstem bronchus collapse. (Courtesy of T McCarthy)
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6.24 Severe intrathoracic tracheal collapse in a dog. Following placement of an intraluminal stent. (Courtesy of T McCarthy)
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6.25 (a) Deformed tracheal rings and (b) foamy airway secretions in a brachycephalic puppy with tracheal hypoplasia. (Courtesy of T McCarthy)
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6.26 Tracheal mucosal surface with nodules. Severe airway collapse at the carina caused by an extraluminal mass.
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6.27 Carinal blunting is seen in this chronically irritated airway. Granulomatous inflammation from coccidioidomycosis in a young dog. (Courtesy of K Gulikers)
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6.28 Pulmonary oedema seen in the airways due to heart failure.
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6.29 Removal of a deep airway foreign body.

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