Newer techniques in fiberoptic bronchoscopy.

Flexible fiberoptic bronchoscopy has assumed a major role in the diagnosis and management of upper respiratory tract and pulmonary diseases. A new technique, utilizing a C-arm fluoroscopic control with an image intensification system, for the localization of peripheral lung lesions and subsegmental parenchymal infiltrates, is described. This method has proved useful in the early histologic and cytologic diagnosis of nonendoscopically visible bronchogenic carcinoma and in the drainage of lung abscesses. By employing a transendotracheal tube route with a ventilating, side-arm adaptor, continuous airway control and a selected inspired oxygen or anesthetic content is maintained. In addition, the problems of arterial hypoxemia, airway resistance, and ventilation-perfusion abnormalities are minimized. Several representative cases are discussed.