Interventional Pulmonology

Bronchoscopy allows doctors to see inside the airway using a small tube, called a bronchoscope, which is fitted with a tiny camera. During flexible bronchoscopy, doctors use a long, flexible, lighted tube to examine the airways and collect small tissue samples. During rigid bronchoscopy, which requires general anesthesia, a straight metal tube is used to look at the airways, remove objects blocking the airway or collect large tissue samples.

Endobronchial ultrasound (EBUS) is a highly effective tool used to diagnose a variety of disorders that affect the chest, including infections, inflammatory diseases, lung cancer, lymphoma and other cancers that have spread to the chest. In fact, EBUS has helped revolutionize the ways in which lung cancer is diagnosed—and subsequently treated.

When lung cancer spreads, it may involve lymph nodes in a portion of the chest called the mediastinum. Previously, patients would often undergo two separate procedures to diagnose and then stage their lung cancer (determining the stage of the disease is a very important step, because it dictates how a patient will be treated). In most cases, EBUS allows physicians to diagnose and stage their disease all in one procedure. This expedites their care and eliminates the need for more invasive and risky diagnostic procedures to stage their disease.

And as the field of cancer care continues to evolve, with targeted new ways of treating lung cancer at the genetic level, EBUS is quickly becoming the tool of choice for doctors who need to determine the genetic make-up of a tumor. That's because EBUS is a safe and effective method for collecting numerous tissue samples from the lungs or lymph nodes, all at one time.

Electromagnetic navigation bronchoscopy (ENB) uses specialized software—similar to a global positioning (GPS) system found in many vehicles or smart phones—that helps doctors first identify the location of a lung mass, and then guide a bronchoscope to that location so a tissue sample can be taken.

As the name implies, ultrasound-guided biopsy uses ultrasound technology to help physicians take tissue samples from the lungs or fluid samples from either the pleural cavity or lymph nodes.

Medical thoracoscopy allows doctors to examine the pleura, which is the large, thin sheet of tissue that wraps around the outside of the lungs and lines the inside of the chest cavity. The procedure is used to diagnose the cause of pleural thickening or fluid build-up around the lungs (a condition known as pleural effusion), and to obtain pleural biopsies.

Closed pleural biopsy, also known as pleural needle biopsy, allows doctors to remove a small piece of pleural tissue from the chest using a hollow needle injected through the skin and into the chest cavity. Despite being minimally invasive, it provides a larger sample of tissue than other biopsy techniques.

Bronchoscopy allows doctors to see inside the airway using a small tube, called a bronchoscope, which is fitted with a tiny camera. During flexible bronchoscopy, doctors use a long, flexible, lighted tube to examine the airways and collect small tissue samples. During rigid bronchoscopy, which requires general anesthesia, a straight metal tube is used to look at the airways, remove objects blocking the airway or collect large tissue samples.

Tracheobronchial (airway) stenting allows physicians to temporarily or permanently prop open an airway that has become narrowed due to cancer, infection or other diseases. Small devices called stents are customized to the patient's airway and placed inside by specially trained pulmonologists during bronchoscopy.

During fiducial marker placement, doctors may use special guidance software, such as electromagnetic navigation bronchoscopy, to place tiny metal markers (called fiducial markers) in or near a tumor. These markers allow radiation oncologists to more precisely target radiation, so it destroys the tumor while preserving the surrounding healthy tissue.

Balloon dilation is used to help widen an airway that has become narrowed. During the procedure, a tiny balloon is threaded into the airway via flexible or rigid bronchoscopy. Pressure from the balloon, once inflated, helps expand the narrowed airway. Balloon dilation is sometimes used in combination with airway stent placement.

Bronchial Thermoplasty (BT) is a novel therapy in which radiofrequency energy is used to decrease bronchoconstriction by a reduction in airway smooth muscle. Current clinical evidence suggests that bronchial thermoplasty may be effective in reducing asthma exacerbations and improving asthma symptoms.

Endobronchial radiation therapy, also known as brachytherapy, is a type of high-dose radiation therapy used to treat cancer in the trachea and lungs. During the procedure, a catheter is placed via bronchoscopy and then tiny radiation seeds are placed directly into the catheter. This type of targeted treatment helps destroy the tumor while preserving the surrounding healthy tissue.

Electrocautery and argon plasma coagulation (APC) are procedures that use heat to burn and remove diseased, damaged or bleeding tissue from the airway. During electrocautery, a small amount of electricity is applied to the damaged tissue via a flexible or rigid bronchoscope. During APC, argon gas is ignited to produce a plasma beam, which burns away the damaged tissue.

Large volume pulmonary lavage, or whole lung lavage, is reserved for patients who have a condition called pulmonary alveolar proteinosis (PAP), which causes a type of protein to build up inside the lungs. During the procedure, several liters of saline fluid are pumped into the lungs and then eventually suctioned out. This process helps flush away the excess proteins that make it difficult for the lungs to absorb oxygen.

A specific type of laser treatment utilizing the Nd:YAG laser is used to treat cancers, abnormal tissue growth or bleeding within the airway. This specific type of laser, comprised of neodymium, yttrium, aluminum and garnet, is often used to treat airway diseases.

Percutaneous tracheostomy is a minimally invasive procedure that provides physicians access to the trachea via a small incision in the neck. Doctors often perform tracheostomies in patients with chronic neuromuscular weakness in order to remove secretions from the trachea, or to assist with mechanical ventilation. This procedure is also commonly performed in the intensive care unit when a patient has required prolonged mechanical ventilation.

Photodynamic therapy is a unique form of airway cancer treatment that combines a drug, called Photophrin, with laser light energy. After Photophrin has been injected intravenously, the tumor begins to absorb the medication. Two to three days later, laser light energy applied to the airway "activates" the medication. This chemical interaction between the drug and the laser destroys the tumor cells.

Rigid bronchoscopy, which can only be performed by doctors with advanced training, provides access to the airway via a straight metal tube. Because the tube is rigid, with a larger diameter than a flexible bronchoscope, other devices can be threaded through the tube—allowing a physician better access to remove tumors or foreign objects blocking the airway, to treat tracheal stenosis using stents or other devices and to stop internal bleeding within the airway.

Compared to traditional methods of oxygen therapy, which deliver oxygen through a special device fitted into the nose, transtracheal oxygen therapy is a more efficient (and often more comfortable) way of providing oxygen to patients with COPD and other chronic lung conditions. Scripps interventional pulmonologists can place a small, thin tube called a catheter in the trachea, allowing oxygen to skip the "dead space" in the mouth and upper airways and pass directly into the trachea. This helps reduce the overall volume of oxygen needed during rest and exercise.

Thoracentesis removes excess fluid from the pleural cavity (the space between the lungs and the chest wall), alleviating symptoms such as shortness of breath or discomfort caused by the presence of the fluid.

Tunneled or indwelling pleural catheters are used to treat patients who have chronic fluid build-up in their pleural cavity or pleural effusion. Patients who elect to have a catheter placed in their chest can drain the fluid themselves in the comfort of their home—reducing or eliminating the need for frequent trips to their doctor's office.

In addition to helping doctors examine the pleura and diagnose pleural diseases, medical thoracoscopy can be used to apply medication that helps prevent further pleural fluid build-up (a procedure called pleurodesis).