Is bronchoscopy needed for fever and cough problems?

Question

Hello doctor,

One week before, I had some fever and cough problem for which the doctor suggested a chest x-ray, sputum culture, and sensitivity test and give some antibiotic courses for five days. Currently, I am fine, with no fever or chest pain. Only some coughing is there. On examining lung x-ray, the doctor suggested for computed tomography (CT) chest plain and contrast. Below are the finding of the CT scan of the chest. Same I am uploading for details. Now the doctor is suggesting for bronchoscopy for further diagnosis. I am not sure whether to go for it as it is an expensive process. A lot of diagnoses are already done (x-ray, tests, CT scan, etc). But I do not much faith in hospital or doctor, as I feel, he is making money from all tests and I am feeling fine, with no problem, as the problem for which I had gone to the doctor is cured. I want your advice, whether bronchoscopy is required or not? Or refer me some alternative treatment or medicine or precaution.

Answer 1

Hello,

Welcome to icliniq.com. I have seen all reports attached to your query and justify your concern about an invasive procedure like bronchoscopy. (attachment removed to protect patient identity). The history you mentioned is quite clear but many important points are missing too. Without which it is very difficult to advise which appropriate test should be chosen next. Physical findings and clinical examination for nodes in the cervical (neck) or axillary area is very important as they can be biopsied for exact tissue diagnosis. Simultaneously tuberculin test can be done to rule out tuberculosis. As per the CT (computed tomography) scan, you have some nodes surrounding the lungs in the hilar area. Most commonly they are due to tubercular infection. But other causes have also to be ruled out like sarcoidosis or any other infections or malignancy. As per your history, after antibiotics, you are feeling better now and do not have any other active symptoms. So it should be your clinical history and physical findings that will guide us for the next investigation to be done. To rule out tuberculosis or sarcoidosis, we need some histological proof. So as I said earlier, if any palpable nodes are present, it should be excised for tissue diagnosis and bronchoscopy can be avoided. If no external nodes are palpable or excision biopsy is nonconclusive then the only way to get the tissue diagnosis is taking biopsy through bronchoscopy through hilar nodes. Thus once the tissue diagnosis is done, then only definitive treatment can be advised. X-ray or CT scan only shows the nodes but for tissue diagnosis, a biopsy is must. So the next investigation should be planned in the context of present symptoms and physical findings. And it is the sole decision of the treating doctor to do any invasive test if required. What I can say at the moment is any investigation is justified until definitive tissue diagnosis is obtained. So the priority is for excision lymph node biopsy and then for transbronchial or trans esophageal biopsy of hilar lymph nodes. I think the whole idea of doing bronchoscopy is clear to you now. So just follow your doctor's instructions till the tissue diagnosis is done. If you still have any doubts feel free to write to me. The investigation to be done is tuberculin test. The differential diagnosis is TB (tuberculosis) or sarcoidosis or any other infection or malignancy. Treatment plan is as per the definite tissue diagnosis.