Interventional

Rigid Bronchoscopy & Airway Stenting

Added by Dr. Andrew · Last updated 2024-01-15

Overview

Rigid bronchoscopy provides a large-bore airway conduit for management of central airway obstruction (CAO), massive hemoptysis, and foreign body removal. It is performed under general anesthesia and allows use of multiple therapeutic modalities including laser, APC, cryotherapy, and stent deployment.

Key Points

1Indications: central airway obstruction (malignant or benign), massive hemoptysis, foreign body removal, stent placement/removal, tracheal stenosis
2Advantages: large working channel, jet ventilation, superior hemorrhage control, can use all therapeutic tools simultaneously
3Airway stents: silicone (Dumon) vs self-expanding metal stents (SEMS)
4Silicone stents: removable, preferred for benign disease; require rigid bronchoscope for placement
5SEMS: easier to place (flexible bronchoscope), but difficult to remove — preferred for malignant CAO with short life expectancy
6Complications: stent migration, mucus plugging, granulation tissue, infection

Clinical Pearls

Malignant CAO: debulk first (laser/APC/cryo), then stent if needed for patency
Tracheal stenosis (post-intubation): balloon dilation ± silicone stent; surgical resection for definitive treatment
Massive hemoptysis: rigid bronchoscopy + isolate bleeding lobe + Fogarty balloon tamponade
Foreign body: rigid bronchoscopy preferred for large/sharp objects; flexible for distal/small objects

Board High-Yield

Exam Focus

Silicone stents: benign disease, removable, require rigid bronchoscope
SEMS: malignant CAO, easier placement, difficult removal — avoid in benign disease
Post-intubation tracheal stenosis: most common benign cause of CAO
Massive hemoptysis (>300–500 ml/24h): rigid bronchoscopy + isolation of bleeding lobe
APC (argon plasma coagulation): non-contact coagulation — good for superficial hemostasis and tumor debulking

ABIM Exam Weight

Interventional Pulmonology represents approximately 5% of the PCCM certification exam.