Bronchoscopy and bronchogram (B&B) is a combination of two tests used to look closely at your child's airway and how it is working. An optical coherence tomography (OCT) test gives us images of the cartilage rings which make up the airway wall.
This combination of tests is carried out in the Interventional Radiology department. Other forms of bronchoscopy studies are carried out in other departments at Great Ormond Street Hospital (GOSH).
What is a bronchoscopy and bronchogram (B&B) test?
Bronchoscopy and bronchogram (B&B) is a combination of two tests.
Firstly, a camera contained in a flexible tube (bronchoscope) is inserted into the airway to look closely at the airway wall. This allows us to see if the lining of the airway is inflamed or compressed.
Secondly, a tiny amount of contrast – a substance that shows up well on X-rays – is put into the airway and X-rays are taken from various angles to give us accurate measurements of the size of the airway.
What is an optical coherence tomography (OCT) test?
An optical coherence tomography (OCT) test gives us images of the cartilage rings which make up the airway wall. A thin plastic tube containing a light at the end is passed into the airway and the images are video recorded.
Why might they be suggested?
A B&B test is usually suggested if your child has breathing difficulties, such as tracheomalacia, where the trachea is floppy and collapses inwards during breathing.
Sometimes, these tests might be suggested for children who are using a ventilator to help them breathe and the doctors need to work out why they are having trouble breathing.
A B&B may also be used to monitor your child’s progress after surgery or treatment for breathing difficulties, such as after surgery for tracheal stenosis.
An OCT may be suggested if your child has a narrow airway or is having difficulties breathing.
What happens before the test?
B&B studies, with or without an OCT, are always carried out while your child is under general anaesthetic. It can be carried out while your child is on a ventilator or as a day case procedure.
Day case procedures only
It is very important that your child’s stomach is as empty as possible on the day of the procedure, as this reduces the risk of vomiting during and after the anaesthetic.
If someone vomits during an anaesthetic, there is a chance that the stomach contents could get into the lungs, damaging them. Your child’s nurse will explain exactly what time your child can last eat or drink before the procedure, but as a general rule, the following applies.
Food and milk
- Breast-fed babies should be given their last feed four hours before the procedure is scheduled.
- Bottle-fed babies and children should be given their last milk feed, food or milk drink six hours before the procedure is scheduled.
Please follow these instructions carefully, otherwise your child’s procedure may be delayed or even cancelled.
You will already have received information about how to prepare your child for the procedure in your admission letter. The doctor will explain the procedure in more detail, discuss any questions you may have and ask you to sign a consent form giving permission for your child to have the test.
What do the tests involve?
If your child is on a ventilator in intensive care when the test is suggested and they are being given medicines to keep them still, the doctors may have to gradually reduce these medicines so that your child is able to breathe on their own.
Your child will remain on the ventilator when they are being transferred to the Interventional Radiology department but will be taken off it briefly for the B&B studies. An experienced anaesthetist will stay with your child throughout the studies to monitor their airway.
The bronchoscopy is the first part of the study. This involves putting a camera inside a flexible tube into your child’s airway through the breathing tube. While the camera is in your child’s airway, the radiologist will record a video of your child’s breathing, which will either be used for analysis or to compare with previous or future recordings. Using the flexible tube, they may also wash out the area if it is full of mucus and take samples for examination.
The second part of the study is the bronchogram. This involves inserting a tiny amount of contrast into your child’s airway through the same breathing tube. The radiologist will watch your child’s breathing by recording a series of pictures for two to three breaths. This gives them a real-time view of your child’s breathing and can show if they have tracheomalacia, for instance.
If your child is having an OCT during the same procedure, this will be the final part. The bronchoscope will be removed from your child’s airway and a thinner tube containing an infrared light is passed. This records a film of your child’s airway which can be examined closely after the study has been completed.
The entire B&B study takes around 30 minutes, and an OCT adds about five minutes to the procedure. Depending on the results of the studies, the radiologist may decide to treat your child’s breathing difficulties during the same procedure or plan treatment for another occasion.
Are there any risks?
This is a very safe test. It is possible to cause a small amount of bleeding from the wall of the airway, which will stop of its own accord.
It is also possible that your child would need to be on a ventilator for a short period of time following the procedure. This is extremely rare.
If your child is already on a ventilator, the intensive care doctors may need to increase the settings for a short time. An experienced anaesthetist will stay with your child to monitor your child throughout the study.
Are there any alternatives?
A CT scan can show the structure of your child’s airway but not how it functions during breathing. The advantage of a B&B study is that it gives a real-time view of how your child’s airway functions during breathing. OCT is the only test which shows the detail of the cartilage in the airway wall.
What happens afterwards?
If your child was in intensive care before the study, they will return there once stable on the ventilator again. The medicines to keep your child still may be restarted again, depending on their condition.
If your child was not on a ventilator previously, they will return to the ward to recover from the general anaesthetic. During the procedure, the doctors may have needed to put some local anaesthetic spray on your child’s vocal cords, so that the airway tube could be inserted safely. This makes your child’s throat numb and could make swallowing difficult. If your child has local anaesthetic spray, they will not be able to eat for two hours after the procedure until the effects of the local anaesthetic have worn off and it is easier and safer to swallow.
Some children feel sick and vomit after a general anaesthetic. Your child may have a headache or sore throat or feel dizzy, but these side effects are usually shortlived and not severe. The nursing staff will let you know when your child can start to eat and drink. Your child will be able to go home in the evening, once they are eating and drinking normally.
Last reviewed by Great Ormond Street Hospital: November 2011
Ref: 2011F1206 November 2011
Compiled by the Interventional Radiology team in collaboration with the Child and Family Information Group
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.