DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Pulmonary infiltrates.
2. Dyspnea.
POSTOPERATIVE DIAGNOSES:
1. Pulmonary infiltrates.
2. Dyspnea.
PROCEDURE PERFORMED: Video flexible bronchoscopy with bronchoalveolar lavage and transbronchial biopsies x6, right lower lobe.
SURGEON: John Doe, MD
COMPLICATIONS: None.
MONITORING: The patient was monitored with continuous oximetry, telemetry, and intermittent blood pressure monitoring. No variations in saturations or other abnormalities occurred. A chest x-ray is pending at this time to rule out pneumothorax.
SPECIMENS:
1. Bronchoalveolar lavage for bacterial Gram stain and culture, AFB, fungus, as well as cytologies cum differential.
2. Transbronchial biopsies x6, right lower lobe, for pathology with staining for organisms.
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old gentleman referred to us for dyspnea and pulmonary infiltrates. The purpose of bronchoscopy was to further evaluate pulmonary infiltrates.
Informed consent prior to the procedure with the risks, benefits, and alternatives were explained to the patient. After weighing options, the patient gave informed consent for the bronchoscopy with bronchoalveolar lavage and transbronchial biopsies.
MEDICATIONS: Prior to the procedure and throughout the procedure, the patient received a total of 9 mg of Versed, 87.5 mcg of fentanyl slowly, intravenously, in incremental doses. This allowed the patient to achieve excellent conscious sedation. The patient received a total of 6 mL of 2% lidocaine for topical airway anesthetization.
DESCRIPTION OF PROCEDURE: The procedure was performed in the endoscopy suite with the patient in the supine position. A video flexible bronchoscope was used and passed via the right naris and the above medications were given. The upper airways were grossly unremarkable. The larynx was normal in structure and function. Vocal cords were normal in structure and function. Trachea was visualized and was unremarkable. The main carina was midline and sharp.
At this point, both bronchial trees were inspected to the subsegmental lobe. A mild amount of mucosal formation was noted diffusely. No endobronchial lesions or unusual secretions were noted. After inspecting both the right and left lower lobe to the subsegmental level, the bronchoscope was placed in the right lower lobe where a bronchoalveolar lavage was done.
A total of 180 mL of normal saline was infused with a return of 30 mL of golden-colored effluent. After this was done and the airway suctioning was performed, the bronchoscope was then placed back in the right lower lobe in the lateral segment. Under fluoroscopic guidance, a total of 6 transbronchial biopsies were obtained in the right lower lobe. The patient had some mild bleeding from this and received a total of 3 mL of 1:10,000 epinephrine for topical airway hemostasis. As the biopsies were obtained, the area was inspected. No further bleeding was noted on direct visualization. A panoramic view of the chest was obtained, which showed no initial pneumothorax. The bronchoscope, at this point, was withdrawn from the patient and the procedure was terminated. The patient was wheeled out to ICU where he will stay until he meets criteria for discharge home.
