Interventional Pulmonology

Procedures for interventional pulmonolgy include:

Flexible 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.

Bronchoalveolar lavage. Bronchoalveolar lavage is performed during bronchoscopy. Sterile water is injected through the bronchoscope into a segment of the lung. The fluid is then suctioned back and sent for tests. Bronchoalveolar lavage can help diagnose infection, cancer, bleeding, and other conditions.

Biopsy of lung or lymph node. During bronchoscopy, a doctor may collect a small piece of tissue from either the lung or a nearby lymph node. The interventional pulmonologist can use a needle or forceps advanced through the bronchoscope to get a sample of tissue. Biopsies can detect cancer, infection, sarcoidosis, and other conditions. For people with lung cancer or other cancers, interventional pulmonology biopsies can often accurately identify spread of cancer into lymph nodes. This can prevent unnecessary surgery or help determine the best choice for treatment.

Airway stent (bronchial stent). Advanced cancer or certain other conditions can constrict or compress an airway tube (bronchus). If the bronchus becomes blocked, difficulty breathing, cough, and pneumonia can result. Using a bronchoscope, a doctor can advance a wire mesh stent into a narrowed airway. Expanding the stent can open a bronchus and relieve symptoms caused by the constriction.

Balloon bronchoplasty. A doctor advances a deflated balloon into a section of abnormally narrowed airway. By inflating the balloon with water, the airway is expanded, potentially relieving symptoms. Balloon bronchoplasty may be performed prior to airway stent placement to help expand a bronchus.

Rigid bronchoscopy. In rigid bronchoscopy, a long metal tube (rigid bronchoscope) is advanced into a person’s windpipe and main airways. The rigid bronchoscope’s large diameter allows the doctor to use more sophisticated surgical tools and techniques. Rigid bronchoscopy requires general anesthesia (unconsciousness with assisted breathing), similar to a surgical procedure.

Foreign body removal. Bronchoscopy is the preferred interventional pulmonology procedure to remove inhaled foreign objects that are lodged in an airway. A doctor may be able to remove the object using flexible bronchoscopy, or rigid bronchoscopy may be required.

Interventional pulmonology procedures offer the potential advantage of avoiding more invasive surgery. For example, before interventional pulmonology, biopsy of lymph nodes in the chest required chest wall surgery.

Electromagnetic Navigation Technology. PMA physicians in our Roseville and Carmichael offices,  are experienced in the use of superDimension Electromagnetic Navigation Technology (ENT).  This procedure helps doctors reach lesions deep in the lungs, unreachable with bronchoscopy, with minimal trauma to the patient and enables them to diagnose benign and malignant lung disease.  ENT provides computerized guidance, permitting needle biopsy instead of a surgical diagnostic procedure.  ENT patients are usually treated under general anesthesia in the operating room.  SuperDimension

Endobronchial Ultrasound Procedures. PMA physicians are also the only physicians in the area who have performed many endobronchial ultrasound procedures (EBUS).  This technology allows doctors to perform a technique known as transbronchial needle aspiration to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery.  The samples can be used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis or other cancers like lymphoma.

EBUS provides real-time imaging of the surface of the airways, blood vessels, lungs, and lymph nodes allowing the physician to easily view difficult-to-reach areas and access more, and smaller lymph nodes.  The accuracy and speed of the EBUS procedure lends itself to rapid onsite pathologic evaluation so that pathologists in the operating room can process and examine specimens and request additional samples if needed.  EBUS is performed under moderate sedation and patients generally recover quickly and go home the same day. Endobronchial Ultrasound