INTRODUCTION

Bronchoscopy is a diagnostic and therapeutic procedure that permits direct visualization of normal and pathological alterations of the upper and lower airways. Expert knowledge of airway anatomy is a prerequisite for successful performance of the procedure. The major advantages of the flexible bronchoscope (FB) include the ability to insert it nasally, orally, or through a tracheostomy stoma to visualize apical segments of upper lobes as well as segmental and subsegmental bronchi in all lobes. This chapter focuses on identification of normal anatomy, landmarks, and pathologies seen during bronchoscopy of upper airways (from nares to glottis) and lower airways (trachea and conducting bronchi).

Bronchoscopists commonly refer to airway anatomy according to the Jackson–Huber classification with segmental airway anatomy named according to spatial orientation (i.e., anterior/posterior, superior/inferior, and medial/lateral) (Figure 4.1) Table 4.1 lists the nomenclature accordingly. Many thoracic surgeons prefer to use the Boyden surgical classification, which assigns numbers to the segmental airways (Table 4.1). It is advised that beginning bronchoscopists learn the Jackson–Huber classification first, emphasizing accurate and consistent usage.

The FB is introduced by the bronchoscopist standing either behind the head of the supine patient or facing the patient. The anatomic orientation of airways varies depending on the operator's position. For the purpose of consistency in this chapter, the anatomical orientation is presented with the operator standing behind the supine patient.