A rhinoscopy being performed at Sunstone Vets. On the screen you can see the inside of a nasal cavity. The white plaques are fungus!
A rhinoscopy being performed at Sunstone Vets. On the screen you can see the inside of a nasal cavity. The white plaques are fungus!

In the last installment of our blog, we introduced you to one of our favorite diagnostic tools- endoscopy! We went over the basics and talked about gastrointestinal endoscopy, the most common form of endoscopy we do here at Sunstone Vets. Here’s the link to that blog in case you missed it! This week, we will learn about the other types of flexible and rigid endoscopy that we offer and how they can help your four legged family member.

Bronchoscopy

In this procedure, one of our Internal Medicine Specialists sends a long, thin flexible camera (a bronchoscope) down your pets airways. They will start in the mouth, go down the trachea, and into the lungs. They will be watching on a video screen the whole time while they guide the camera through the respiratory tract.  Common indications for this type of procedure include chronic coughing, difficulty breathing, and lung changes on x-rays, among others.

 In addition to being able to visualize the inside of your pets lungs (and even potentially remove a foreign object if found!), bronchoscopy can allow your Internist to take a variety of samples. Bronchoalveolar lavage (or BAL) is a fancy word that describes instilling a small amount of sterile saline through the scope and into the lungs. The fluid is then collected back and examined by a pathologist for infectious agents (bacteria, fungus, etc), blood cells, immune cells or tissue cells. This can help give a definitive diagnosis and guide therapy moving forward.

Image from a patients lungs showing a collapsed mainstem bronchi (patient left, image right).
Image from a patients lungs showing a collapsed mainstem bronchi (patient left, image right).

 Another common test done via bronchoscopy is cytology. With this test, the doctor will use a very small brush passed through the scope to collect airway cells. These cells are again examined by a pathologist in hopes of gaining more information. A culture and sensitivity may also be added on to these tests. This is where the laboratory takes the submitted sample and tries to grow organisms. If they do, they will then see what antibiotic(s) they are sensitive to. This is a valuable tool that allows your doctor to provide targeted antibiotic therapy. There are a variety of other tests that may be recommended with bronchoscopy (ie: viral testing, PCR tests, etc.) based upon your pets specific case.

In addition to general anesthetic considerations, your doctor may discuss some increased risk in pets with respiratory disease. In general, bronchoscopy is a fairly safe, quick, minimally invasive diagnostic tool. Your doctor will also discuss treatment options moving forward based upon their findings. This may include oral or inhaled medications and rechecking x-rays all the way to referral to another specialist (ie: for stent placement, lung lobe removal, oncology, etc.). Whatever the outcome of your pets bronchoscopy, your Internist and the team at Sunstone Vets will be with you every step of the way. Check out this blog for one pet owners experience with their dog Summer’s bronchoscopy.

Rhinoscopy

This is another fairly common type of endoscopy we offer, in which we actually use a rigid scope to gently examine and sample the inside of the nasal cavity. Symptoms that may lead your Internist to recommend a rhinoscopy include chronic sneezing, nasal discharge (one side or both nostrils), nasal bleeding, nasal swelling, noisy breathing, etc.

In this procedure, your pet is anesthetized and a small rigid scope is inserted into the nostril, one side at a time. Saline is instilled at the same time to flush away debris and help with visualization. The doctor is again guiding and watching on a video screen. They will use biopsy instruments to collect tissue samples of any areas of interest. They may also collect samples for culture and sensitivity, or a variety of other tests, similar to bronchoscopy. Oftentimes, a small flexible scope is also used to examine the back of the throat (the nasopharynx), where the nasal cavity joins the mouth.

Sometimes we get “lucky” and find a piece of grass or other foreign object stuck in the nose that can explain your pets symptoms. Removing this object can be curative. Most often however, after the biopsies or samples come back, we find infection, autoimmune disease, or even cancer among other specific issues. Again, your doctor will come up with a treatment plan that works for your family and your pet after the procedure.

A nasal mite crawling around!
A nasal mite crawling around!
A nasal foreign body.
A nasal foreign body.

Along with the rhinoscopy, your Internist may recommend some type of imaging be performed. This may include skull x-rays (often done along with the rhinoscopy) and/or referral for a CT scan of the head. Cryptococcus (a common fungal organism) blood testing may also be recommended prior to rhinoscopy for cats with nasal symptoms. Rhinoscopy is again considered a minimally invasive diagnostic procedure with fairly quick recoveries. Your pet may have some increased nasal symptoms and/or bleeding for a day or two after the procedure. This is normal however, in the rare case of a large nosebleed, we recommend having your pet seen via an emergency service.

Cystoscopy

We will give a quick mention to this last less common type of endoscopy that we perform. Cystoscopy is used to visualize the lower urinary and genital tract. A camera is advanced through the urethra and into the urinary bladder, allowing visualization of the ureters connecting to/entering the bladder. Ureters are the thin tubes connecting the kidneys to the bladder. Cystoscopy can provide valuable information about the vulva, vagina or penis as well as the urinary tract. Cystoscopy does have specific requirements in regards to patient size and thus is not always an option.

Cystoscopy may be recommended in cases of chronic urinary tract infections, urinary incontinence, vaginal bleeding or discharge, etc. It can help diagnose ectopic ureters, bladder stones, masses or polyps, and strictures among other issues. If you or your family veterinarian think cystoscopy may be needed for your pet, please give us a call.

Image of a ureter entering the urinary bladder!

Endoscopy Conclusion

Between this blog and the last, we hope that you now have a better understanding of how valuable the different types of endoscopy can be. From shorter recovery times, and minimal to no incisions, to the wide variety of information that can be gained, its easy to see why we are fans of endoscopy here at Sunstone Vets! As always, please contact us if we can be of help to you and your pet.

Best wishes for health and happiness. Sincerely,

Katie BS, AAS, CVT, VTS (SAIM) and the family here at Sunstone Vets