What is Interventional Pulmonology?

Interventional pulmonology is a relatively new field in pulmonary medicine. Interventional pulmonology uses endoscopy and other tools to diagnose and treat conditions in the lungs and chest.

Bronchoscopy

Bronchoscopy is the most common interventional pulmonology procedure. During bronchoscopy, a doctor advances a flexible endoscope (bronchoscope) through a person’s mouth or nose into the windpipe. The doctor advances the bronchoscope through the airways in each lung, checking for problems. Images from inside the lung are displayed on a video screen.
The bronchoscope has a channel at its tip, through which a doctor can pass small tools. Using these tools, the doctor can perform several other interventional pulmonology procedures Best Pulmonology in Nellore.

TBNA

Transbronchial needle aspiration (TBNA) is used for diagnosis and staging of bronchial diseases, including mediastinal or peripheral pathologies, subcarinal and parabronchial nodes and parenchymal abnormalities. It has been established as a minimally invasive, safe and cost-effective bronchoscopic technique. TBNA is a minimally invasive procedure that provides a nonsurgical means to diagnose and stage bronchogenic carcinoma by sampling the mediastinal lymph nodes. Applications of bronchoscopic needle aspiration have expanded to include not only sampling of paratracheal or mediastinal lymph nodes, but peripheral, submucosal, and endobronchial lesions. The procedure allows for sampling tissue through the trachea or bronchial wall, and sampling of tissue beyond the vision of the dedicated operator.

In addition to the equipment needed for bronchoscopy, the equipment needed specifically for TBNA include TBNA needles, which are designed to pass through a bronchoscope without causing damage and to be flexible enough to facilitate the positioning of the bronchoscope, yet rigid enough to penetrate the airway wall. Two types of TBNA needles, cytology needles and histology needles, should be available for the procedure.

Biopsy

A biopsy is a sample of tissue taken from the body in order to examine it more closely. A doctor should recommend a biopsy when an initial test suggests an area of tissue in the body isn’t normal.
Doctors may call an area of abnormal tissue a lesion, a tumor, or a mass. These are general words used to emphasize the unknown nature of the tissue. The suspicious area may be noticed during a physical examination or internally on an imaging test.

BAL

Bronchoalveolar lavage (BAL) is a diagnostic procedure where lavage fluid is introduced to the terminal bronchioles and then recollected for analysis to examine cells, inhaled particles, infectious organisms or fluid constituents. This mildly invasive procedure should be performed prior to biopsy or brushing procedures to avoid contamination with excess blood.

BAL aims to establish a diagnosis, to find out if infections and malignancies are present and to estimate the degree of disease activity e.g. in case of interstitial lung disease.

To ensure that sufficient aspirate is available for analysis, the successive instillation of lavage fluid (100 – 300 ml for adults) into the target area is necessary. The highest aspiration rates of fluid have been identified in the right middle lobe. Usually a syringe is utilised in the middle lobe for re-obtaining lavage fluid to minimise the overall level of cell damage. For the upper and lower lobe suction can be applied.

Aspirate

Pulmonary aspiration is the entry of material (such as pharyngeal secretions, food or drink, or stomach contents) from the oropharynx or gastrointestinal tract into the larynx (voice box) and lower respiratory tract (the portions of the respiratory systemfrom the trachea—i.e., windpipe—to the lungs). A person may either inhale the material, or it may be delivered into the tracheobronchial tree during positive pressure ventilation. When pulmonary aspiration occurs during eating and drinking, the aspirated material is often colloquially referred to as “going down the wrong pipe.”

Thoracoscopy

In thoracoscopy, a thin, flexible viewing tube (called a thoracoscope) is inserted through a small incision in the chest. Fiberoptic cables permit the surgeon to visually inspect the lungs, mediastinum (the area between the lungs), and pleura (the membrane covering the lungs and lining the chest cavity). In addition, surgical instruments may be inserted through other small incisions in the chest, to perform both diagnostic and therapeutic procedures.

Purpose of the Thoracoscopy

 To visually inspect the lungs, pleura, or mediastinum for evidence of abnormalities.

 To obtain tissue biopsies or fluid samples from the lungs, pleura, or mediastinum in order to diagnose infections, cancer, and other diseases.

 Used therapeutically to remove excess fluid in the pleural cavity or pleural cysts, or to remove a portion of diseased lung tissue (wedge resection).

 To evaluate patients with pulmonary disease or abnormalities of the sac that surround the heart (pericardium) or the lining of the chest (pleura).

 To obtain a tissue sample (biopsy) for further evaluation and to diagnose inflammation, infection, fibrosis and cancer.

 As a minimally-invasive method to perform certain types of surgery, such as pericardiectomy.

Biopsy

A biopsy is a sample of tissue taken from the body in order to examine it more closely. A doctor should recommend a biopsy when an initial test suggests an area of tissue in the body isn’t normal.
Doctors may call an area of abnormal tissue a lesion, a tumor, or a mass. These are general words used to emphasize the unknown nature of the tissue. The suspicious area may be noticed during a physical examination or internally on an imaging test.

Pleurodesis

Pleurodesis: A procedure that causes the membranes around the lungs to stick together and prevents the buildup of fluid in the space between the membranes (pleural space). Pleurodesis is done in cases of severe recurrent pleural effusions (outpourings of fluid around the lungs) to prevent the reaccumulation of the fluid. During pleurodesis, an irritant is instilled inside the pleural space in order to create inflammation that tacks the two pleura together. This procedure thereby permanently obliterates the space between the pleura and prevents the reaccumulation of fluid.

Fluid Aspirate

What is drainage or aspiration of fluid?

Fluid can build up inside the body for many reasons. Small amounts of fluid can be drawn off using a needle and syringe. This is called aspiration. Larger amounts or thicker liquid will need to be drained over a period of time using a thin plastic tube (drain).
Drainage or aspiration can be carried out by various departments – this page explains what happens when your child visits the Interventional Radiologyteam for drainage or aspiration.
Fluid can build up inside the body for many reasons, for example as a result of infection. As the body is fighting off an infection, the white blood cells form fluid (pus). Pus is a liquid mixture of dead cells and exhausted white blood cells. It usually is a yellow or green colour. Pus can collect in the area of infection making your child feel unwell and in pain.
Sometimes other fluids can build up inside the body, for example, lymph fluid, which is part of the immune system. Fluid can build up in the abdomen or chest, putting pressure on the internal organs. Blood can collect inside the body following surgery, or as a result of trauma.
The joints in the body can become swollen with excess fluid called synovial fluid which surrounds the bone surfaces reducing friction as the joint moves.

Chest Drain Tube

Chest drainage is a procedure to drain fluid from the pleural space, between the lung and chest wall. Inflammation, infection and traumatic injury, among other things, can cause fluid to build up in the cavity.

Airway Stenting

Interventional pulmonology, otherwise known as “airway stenting,” has developed in the field of pulmonary medicine focused on using advanced bronchoscopic techniques to treat airway disorders. Tracheobronchial disorders can be caused by malignant or benign tumors, extrinsic compression, postintubation tracheal injuries, tracheobronchomalacia, or sequelae after tracheostomy. Tracheobronchial prostheses, known as airway stents, are used to palliate the effects of large airway obstruction. Specially designed stents are being used increasingly, not only in the airways, but also in the biliary tree, esophagus, urinary tract, and vascular system. There are two main types of airway stents currently available; tube stents made of silicone, and expandable metallic stents. Silicone stents are usually placed with the aid of a rigid bronchoscope while the patient is under general anesthesia. Unlike silicone stents, metal stents can be placed with a flexible bronchoscope. We examine the advantages and disadvantages of currently available stents and present our thoughts on the future development of airway stenting.

Silicone Stent

Silicone stent insertion improves functional status immediately after intervention in patients with expiratory central airway collapse, but is associated with a high rate of stent-related complications and need for repeat bronchoscopic interventions.