Question

Which of the following structures is not seen on bronchoscopy?

• A. Trachea
• B. Vocal cords
• C. Subcarinal lymph nodes
• D. First segmental division of bronchi

Hint:

The scope sees only the lumen. Nodes outside the airway wall stay hidden.

Answer 1

The Correct Option is C

Step 1: Bronchoscopy is the visual inspection of the lumen of the airway. The bronchoscope passes through the larynx, trachea and bronchi, so it shows only structures that line or project into the airway lumen.

Step 2: As the scope is introduced, the vocal cords are seen at the laryngeal inlet. Beyond them the entire trachea is visualised down to the carina. The scope can then be advanced into the main bronchi and onward to the lobar and the first (segmental) divisions of the bronchi.

Step 3: Subcarinal lymph nodes lie outside the airway wall, in the mediastinum below the carina. They are not in the lumen, so they cannot be seen directly through a standard bronchoscope. Widening of the carina can suggest subcarinal disease, but the nodes themselves are not visible.

Step 4: Sampling subcarinal nodes needs endobronchial ultrasound guided needle aspiration or mediastinoscopy, which proves they are not a normal direct bronchoscopic finding.

Answer: C. Subcarinal lymph nodes.