Endoscopy of the Chest

What is endoscopy of the chest?

Endoscopy of the chest is a procedure that may be done to look inside the upper chest. A sample of tissue may be removed from the area between the lungs and above the heart for tests. Often the tissue is taken from the lymph nodes.

This procedure is also called mediastinoscopy.

When is it used?

This procedure is done when there is a problem in the tissue between your lungs and above the heart. The tissue may have grown too big, it may have gotten too thick, or it may be cancerous. Lymph nodes can be checked for certain diseases or tumor spread. The procedure may help your healthcare diagnose a medical problem or help your provider determine the best treatment.

Examples of possible alternatives are:

• using a needle guided by a CT scan, bronchoscopy, or an echocardiogram to get sample tissue
• choosing not to have treatment, recognizing the risks of your condition.

You should ask your healthcare provider about your choices.

How do I prepare for this procedure?

Plan for your care and recovery after the procedure. Find someone to drive you home after the procedure. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow your provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you are taking daily aspirin for a medical condition, ask your provider if you need to stop it before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Follow any instructions your provider may give you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

What happens during the procedure?

A general anesthetic is given. It will relax your muscles and put you to sleep. It will keep you from feeling pain during the operation.

Your healthcare provider will make a small cut (incision) in the lower part of your neck just above the sternum or on the left side of your chest near the sternum between the 4th and 5th ribs. (The sternum, or breastbone, is the bone down the middle of the chest.) Your provider will put a tube (the mediastinoscope) through the cut and into your chest. Your provider can look through the tube to see inside your chest. Your provider may remove some tissue for tests. Then the scope will be removed and the cut will be closed with stitches.

What happens after the procedure?

You may be able to go home after the procedure, or you may need to stay in the hospital for a day or two.

Your healthcare provider will tell you if you need more treatment.

Ask your provider what other steps you should take and when you should come back for a checkup.

What are the benefits of this procedure?

This procedure will help your healthcare provider make a more accurate diagnosis.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• The veins or arteries in the area could be damaged. The damage can be serious because these blood vessels are quite large. If the veins or arteries are damage, you may need surgery to open the chest through the sternum (breastbone) to control the bleeding.
• Your lung(s) could collapse and need reinflating.
• You may have infection or bleeding.

You should ask your provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have a fever over 100°F (37.8°C).
• You have redness, swelling, pain, or drainage from your incision.
• You get short of breath.
• You have chest pain you cannot control.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.