establishing your final- lungs

8/3/2019 Establishing Your Final- Lungs

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Establishing Your Diagnosis LungInvestigations Explained

Patient Information


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IntroductionThis leaflet tells you about tests that may be performed to investigate thecause of your chest symptoms or the abnormal findings on your X-ray.This leaflet is not meant to replace the discussion between you and your

consultant but helps you to understand more about what is discussed.

During your first hospital visit you will see one of the doctors of therespiratory team who will take a medical history and do a physicalexamination. You may require one or more of the investigations belowwhich are used to diagnose infection, pneumonia, scar tissue or moreserious conditions such as tuberculosis or cancer of the lung. You willreceive detailed information about the tests and investigations you need,with your appointment letter. These will outline the benefits, risks and

any alternatives of the procedure(s) that have been recommended foryou. If you do not receive this information, please ask a member of themedical team looking after you.

Sometimes tests need to be repeated to ensure the correct diagnosis. Ifyou need any more information then your consultant or clinical nursespecialist will be happy to explain more about the tests you are having.

Blood testsThese can help find out about your general health and how well yourkidneys and liver are working.

Flexible bronchoscopyA bronchoscopy is a common test performed to examine the lungsand airways and is carried out under local anaesthetic. A doctorpasses a thin flexible tube called a bronchoscope through the nose ormouth, through the air passages and into the lungs. Photographs andsamples or biopsies will be taken. These are then examined underthe microscope and the results discussed at your next clinic visit.

Additional, detailed information will be given to you if you require thistest (see patient information leaflet Flexible BronchoscopyExplained).

Endobronchial ultrasoundAn endobronchial ultrasound (EBUS) is a similar test to abronchoscopy and performed under local anaesthetic and sedation. Adoctor passes a thin flexible tube called a bronchoscope through themouth and air passages into the lung. The bronchoscope has an

ultrasound probe attached which allows the doctor to see anyenlarged lymph nodes through the wall of the wind pipe and take a


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biopsy via a needle passed through the bronchoscope. Thesesamples are then examined under a microscope and resultsdiscussed with you at the next clinic visit.

CT (Computerised Tomography) scanCT scan uses special X-ray equipment to obtain many images fromdifferent angles. A specially designed computer programme joins theimages together to show detailed pictures of the inside of the body. ACT scan can help to give more information regarding the abnormalityseen on your X-ray. The scan is painless and takes around 10minutes. CT scans give a small amount of radiation, which is veryunlikely to harm you. You can usually go home as soon as the scan isover.

CT (Computerised Tomography) guided biopsyA biopsy is a procedure in which a small piece of tissue is removedand examined under a microscope. Sometimes the CT scan showsan abnormal area or shadow that is close to the outside of the lungs orin a position that is easy to access by using a biopsy needle. Aradiology doctor will usually take the biopsy and decide the best placeto take it from using the CT scanner. The biopsy usually takes about15 minutes and some discomfort is possible. A local anaesthetic isinjected into the area before the biopsy is taken to reduce anydiscomfort. Additional information is available on the patientinformation leaflet given to you by the imaging department or yourclinical specialist nurse (see patient information leaflet CT GuidedLung Biopsy Explained).

Echocardiogram test (also known as echo test)This is a similar test to an ultrasound scan (see below) but is done toexamine your heart function. It is usually suggested if you have somehistory of heart problems and can be recommended prior to surgery.

Ultrasound scanUltrasound uses high frequency sound waves which are transmittedthrough the skin to build up a picture of the inside of your body. Thisis the same sort of test used on pregnant women. Ultrasound imagingis painless, usually fast and easy. You will be asked to lie on yourback on an examining table. Gel is put onto the skin in the area to bescanned and a small, hand-held scanner is passed over that area. Acomputer converts the reflected sound waves into a picture on a

television screen.


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The procedure is not painful, but there may be varying degrees ofdiscomfort from pressure as the probe moves over your skin. Theprocess takes around 10 to 15 minutes.

Lung function testsThese are tests to establish how well your lungs are working (air /oxygen capacity). These may help decide on appropriate treatmentfor you if have other lung conditions, such as emphysema or ChronicObstructive Pulmonary Disease (COPD). These simple tests usuallyinvolve blowing into machines via a mouthpiece.

Quantitative perfusion scanThis is a simple test sometimes suggested to assess how well

supplied your lungs are with blood. This is known as perfusion. Itmay be recommended if your doctors think you may be suitable for anoperation. It takes about 20 minutes and involves having an injectionof a harmless radioactive substance which develops a picture on acomputer screen. The test is not harmful and has no lasting effects.

PET (Positron Emission Tomography) scanA PET scan is an imaging technique that uses small amounts of aradioactive tracer (similar to sugar). This injection is harmless andleaves the body with no ill effects. It produces images on a televisionscreen, highlighting possible abnormalities. CT uses X-rays toproduce pictures showing the different organs in the body. Bycombining these two techniques important information can beprovided to your doctors to help plan appropriate treatment. This testlasts two to three hours and is usually performed at the QueenElizabeth Hospital in Birmingham.

Pleural aspiration and biopsyThese tests are carried out when you have a collection of fluid in your

lung. The easiest way to find out what is causing this collection is totake samples of the fluid (this is called an aspiration) and to take asmall biopsy of the pleura (the membrane that covers the lungs).These samples are examined under a microscope. Some discomfortis possible but you will be given a local anaesthetic before the biopsyneedle is used.

The procedure usually takes about 30 minutes or possibly longer if thecollection of fluid is being drained. Additional information will be given

to you if you require this test, see patient information leaflet Pleural


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Aspiration, Pleural Biopsy with Insertion of Inter-costal Tube andPleurodesis Explained.

Sputum test

Examining a sample of your spit (sputum) may assist in establishing ifyou have any infection or abnormal cells present.

Bone scanSometimes patients with chest symptoms experience pain in theirbones. This could be anywhere in the body, although it is often in thelarger bones. If you are experiencing pain in your bones it could berelated to your chest symptoms or it could be something completelydifferent. A bone scan will only be done after you have discussed

your symptoms with a doctor in the clinic and is one way to find outthe cause of any bone pain you are experiencing.

A small amount of a mildly radioactive substance is injected into avein, usually in your arm. The radioactivity used in these scans is verylow and not harmful. It disappears from the body within a few hours.A bone scan shows up abnormal areas of bone more clearly becauseabnormal bone absorbs more radioactivity than normal bone. There isgenerally a wait of approximately two to three hours between receivingthe injection and the scan taking place.

Your doctor will look at the images created by the scanner and usethem to find out more about your condition. You will then be able tomeet and discuss the results further. A second appointment will bemade with you for this meeting.

Rigid bronchoscopySimilar to flexible bronchoscopy, this is a minor operation carried outby a thoracic (chest) surgeon. You will need to have a general

anaesthetic and a short stay in hospital which could be overnight.Other surgical tests may be carried out at the same time. Additionalinformation will be given to you about any tests that you require.

MediastinoscopyThis is minor operation carried out by a thoracic surgeon. This testlooks at the lymph nodes, which are glands at the centre of yourchest. You will need to have a general anaesthetic and a short stay inhospital which could be overnight. A small cut is made at the base of

the neck so that a small camera can be passed into the chest to lookat the lymph nodes. The surgeon can then take samples, which will


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be studied under a microscope. Additional information will be given toyou if you require this test.

Video Assisted Thoracoscopy (VATS) biopsy

A VATS Biopsy is similar to a mediastinoscopy (described above). Itis an operation carried out by a thoracic surgeon. This test looks atyour lungs and you will need to have a general anaesthetic and willusually stay in hospital for several nights. Small cuts will be made onthe side of the chest so that a small camera can be passed into thechest to examine the lungs. The surgeon can then take samples,which will be studied under a microscope. Additional information willbe given to you if you require this test.

Open lung biopsyIf a biopsy is not possible using one of the above procedures it may benecessary for the surgeon to make an opening in the side of the chestto take the biopsy. You will need to have a general anaesthetic andwill usually stay in hospital for several nights. Additional informationwill be given to you if you require this test.

Thoracoscopy, frozen section and proceedThis is an operation carried out by a thoracic surgeon. You will needto have a general anaesthetic and will usually stay in hospital forseveral nights. The thoracosopy is carried out to take biopsies thatare immediately studied under a microscope. While the biopsies arebeing studied you are still under the anaesthetic, the surgeon is giventhe results. Depending on the results from the biopsies the surgeonmay then to carry out further surgery. If you are having this procedureyou will be given additional information about this possible surgery.Some of these test results will be available immediately but most testswill take several days for the results to be ready. If you have any testscarried out you should have a follow up appointment made before you

go home. If for some reason this has not happened or if you haveadditional questions please contact your clinical nurse specialist.

Name_____________________________________________________

Phone number_____________________________________________

It is important that you make a list of all medicines you are takingand bring it with you to all your follow-up clinic appointments. If

you have any questions at all, please ask your doctor or nursespecialist. It may help to write down questions as you think of


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them so that you have them ready. It may also help to bringsomeone with you when you attend your outpatient appointments.

Local support groups

Please visit on our website for details of local support groups:www.birminghamcancer.nhs.uk

Local sources of further informationYou can visit any of the health/cancer information centres listed below:

Heart of England NHS Foundation TrustHealth Information CentreBirmingham Heartlands HospitalBordesley GreenBirmingham B9 5SSTelephone: 0121 424 2280

Cancer Information and Support CentreGood Hope HospitalRectory RoadSutton Coldfield B75 7RRTelephone: 0121 424 9486

Sandwell and West Birmingham Hospitals NHS TrustThe Courtyard CentreSandwell General Hospital (Main Reception)LyndonWest Bromwich B71 4HJTelephone: 0121 507 3792Fax: 0121 507 3816

University Hospitals Birmingham NHS Foundation Trust

The Patrick RoomCancer CentreQueen Elizabeth HospitalEdgbastonBirmingham B15 2THTelephone: 0121 371 3537/39

Walsall Healthcare NHS TrustInformation and Support Services

Walsall Palliative Care CentreGoscote Lane


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Walsall WS3 1SJTelephone: 0800 783 9050

About this information

This guide is provided for general information only and is not a substitutefor professional medical advice. Every effort is taken to ensure that thisinformation is accurate and consistent with current knowledge andpractice at the time of publication. We are constantly striving to improvethe quality of our information. If you have a suggestion about how thisinformation can be improved, please contact us via our website:www.birminghamcancer.nhs.uk

This information was produced by Pan Birmingham Cancer Network and

was written by Consultant Surgeons, Clinical Nurse Specialists, AlliedHealth Professionals, Patients and Carers from the following Trusts:

Heart of England NHS Foundation TrustSandwell and West Birmingham NHS TrustUniversity Hospitals Birmingham Foundation TrustWalsall Healthcare NHS Trust

We acknowledge the support of Macmillan in producing this information.

Pan Birmingham Cancer Network 2011

Publication Date: Feb 2011

Review Date: Feb 2014

establishing your final- lungs

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