Flexible bronchoscopy is preferred over rigid bronchoscopy for all of the following except:

D. The removal of a bronchus intermedius foreign body from an infant.

DISCUSSION: Neither patients with significant cervical spine disease or injuries nor those with large aortic arch aneurysms should undergo rigid bronchoscopy, given the greater risk of complications. Even if severe, smoke inhalation injury can be assessed adequately by flexible bronchoscopy. Transbronchial needle aspiration of lesions that on computed tomography (CT) look suspicious is safe and quite easily performed with fluoroscopic guidance. Hemoptysis as a presenting symptom should be evaluated by flexible bronchoscopy. In contrast, for massive hemoptysis an airway should be secured for ventilation with a rigid bronchoscope. Similarly, an airway needs to be maintained while removing endobronchial foreign bodies from infants or children. Since adequate port sites for instrumentation are also needed, the rigid bronchoscope is preferred in this setting.