1887

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. This chapter discusses indications, instrumentation, premedication and anaesthesia, patient positioning, procedures, pathological conditions, foreign body removal, postoperative care and complications. The chapter also includes five video clips.

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Figures

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7.3 Flexible endoscopes in several different sizes are available.
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7.4 (a) Cytology brush in its sheath (top) and in the extended position (bottom). (b) Use of a cytology brush in an airway.
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7.5 Aspiration/lavage catheter.
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7.6 (a) Transbronchial biopsy needle. (b) Transbronchial aspiration needle.
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7.7 A swivel-tip T-adaptor attached to an endotracheal tube. The adaptor has a rubber valve at the top of the port, which opens enough to allow the endoscope to pass 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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7.8 Babcock forceps with gauze squares are used to protect the airway from aspiration of blood or particulate matter during posterior rhinoscopy.
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7.9 Lung and airway anatomy. Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.10 (a) Normal larynx of a dog. (b) Everted laryngeal saccules and an accumulation of foamy saliva are common findings in brachycephalic dogs. (c) Larynx of a dog with laryngeal paralysis. (a, Courtesy of B McKeirnan; b–c, Courtesy of T McCarthy)
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7.11 (a) Laryngeal carcinoma in a cat. (b) Severe laryngeal swelling in a cat. Note the placement of a urinary catheter for airway patency. (a, Courtesy of L Balmain; b, courtesy of G Brick)
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7.12 Tracheal anatomy. Note the distinct C-shaped cartilaginous rings 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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7.13 Strand of mucus in the normal airway. (Courtesy of T McCarthy)
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7.14 (a) Bifurcation of the trachea. The left and right mainstem bronchi are clearly visible. (b) Right mainstem bronchus. (c) Right cranial lung lobe. (d) Right middle lung lobe. (e) Entrance to the right accessory lung lobe. (f) Inside the right accessory lung lobe. (g) Right caudal lung lobe. (a–b, Photographs courtesy of T McCarthy). Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.15 (a) Left mainstem bronchus. (b) Left cranial lung lobe. (c) Left caudal lung lobe. (d) Deep subsegmental airways. Drawn by S. J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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7.16 Equipment required to perform bronchoalveolar lavage.
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7.17 Bronchial brush cytology sampling technique.
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7.18 Changes in the trachea associated with tracheobronchitis. (Courtesy of T McCarthy)
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7.19 Mucopurulent secretions in the trachea of a cat with tracheobronchitis. (Courtesy of T McCarthy)
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7.20 Mild cervical tracheal collapse. (Courtesy of T McCarthy)
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7.21 Moderate intrathoracic tracheal collapse. (Courtesy of T McCarthy)
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7.22 Lateral view of a dog with severe extrathoracic and intrathoracic tracheal collapse. The dog showed chronic cough and dyspnoea.
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7.23 (a–e) Examples of severe intrathoracic mainstem bronchial collapse. (Courtesy of T McCarthy)
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7.24 (a) Severe intrathoracic tracheal collapse in a dog. (b) Appearance of the trachea following placement of an intraluminal stent. (Courtesy of T McCarthy)
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7.25 (a) Deformed tracheal rings and (b) foamy airway secretions in a brachycephalic puppy with tracheal hypoplasia. (Courtesy of T McCarthy)
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7.26 (a) nodules on the tracheal mucosal surface. (b) Severe airway collapse at the carina caused by an extraluminal mass.
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7.27 (a) Blunting at the carina is seen in this chronically irritated airway. (b) Granulomatous inflammation associated with coccidioidomycosis in a young dog. (Courtesy of K Gulikers)
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7.28 Pulmonary oedema seen in the airways of a patient with heart failure.
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7.29 (a) Removal of a foreign body from a deep airway. (b) The foreign body (a grass stalk) after removal.

Supplements

Epiglottic retroversion.

Epiglottic retroversion – intermittent spontaneous retroflexion of the epiglottis during inspiration causing obstruction of the rima glottidis.

Bilateral laryngeal paralysis in a cat.

Bilateral laryngeal paralysis in a cat. (Courtesy of S Gadson)

Laryngeal carcinoma in a cat.

Laryngeal carcinoma in a cat. (Courtesy of S Gadson)

Grade III collapsing trachea in a Chihuahua.

Grade III collapsing trachea in a Chihuahua. (Courtesy of T Hoffmann)

Endoscopic removal of a grass stalk foreign body from the airway of a dog.

Endoscopic removal of a grass stalk foreign body from the airway of a dog.

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