The Diagnostic impact of flexible bronchoscopy in paediatrics: revealing unseen dimensions

<bold>Introduction:</bold> Flexible bronchoscopy (FB) is a pivotal diagnostic modality in paediatric respiratory diseases. Our centre performs FB under general anaesthesia as part of the assessment of complex chronic respiratory symptoms. We explored the impact of flexible bronchoscopy on paediatric diagnoses, its ability to uncover hidden pathology, and to guide targeted therapeutic interventions. <bold>Methods:</bold> A retrospective analysis was conducted on patients (age range: 6 months to 18 years) who underwent flexible bronchoscopy at the Royal London Children’s Hospital between 2021 and 2024. Clinical indications and consequent alterations in diagnosis were reviewed. <bold>Results:</bold> Ninety five procedures were performed: Male to Female ratio 1.5:1; median age 7 years(IQR:7). Chief indications were: recurrent lower respiratory tract infections 30 patients (32%); chronic wet mucoid cough 19 patients (20%) and microbiological screening 14 cases (15%). Flexible bronchoscopy revealed structural airway abnormalities in 21 cases (22%) (comprising tracheomalacia (5%), bronchomalacia (16%) and tracheal bronchus in (1%). Significant mucosal hyperaemia was seen in 24cases (25%). Thirty-three patients(35%) had positive microbiological findings (comprising Aspergillus fumigatus (15%) and non-tuberculous mycobacteria (18%) 2 patients had non cystic fibrosis bronchiectasis. Flexible bronchoscopy guided therapeutic intervention in 2 patients (2%), both of whom were referred subsequently for consideration of tracheal stenting. <bold>Conclusion:</bold> FB proved to be a safe and well tolerated procedure with the reliable potential to confirm or exclude diagnoses and to aid the resolution of uncertainties.