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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.

These procedures may be offered by pulmonologists (lung specialists) who have undergone extra training. Cardiothoracic and other surgeons also routinely perform interventional pulmonology procedures.

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Interventional Pulmonology Procedures

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.

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