Interventional Pulmonology: Extending the Breadth of Thoracic Care.

Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive techniques, interventional pulmonologists diagnose and treat pathologies that previously required more invasive options such as surgery. By mitigating procedural risk, interventional pulmonologists have extended the reach of care to a wider pool of vulnerable patients who require therapy.

ATS Core Curriculum 2021. Adult Pulmonary Medicine: Thoracic Oncology.

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine at the annual international conference. The 2021 Pulmonary Core Curriculum focuses on lung cancer and include risks and prevention, screening, nodules, therapeutics and associated pulmonary toxicities, and malignant pleural effusions. Although tobacco smoking remains the primary risk factor for developing lung cancer, exposure to other environmental and occupational substances, including asbestos, radon, and burned biomass, contribute to the global burden of disease.

ATS Core Curriculum 2020. Adult Pulmonary Medicine.

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine in a 3- to 4-year recurring cycle of topics. The topics of the 2020 Pulmonary Core Curriculum include pulmonary vascular disease (submassive pulmonary embolism, chronic thromboembolic pulmonary hypertension, and pulmonary hypertension) and pulmonary infections (community-acquired pneumonia, pulmonary nontuberculous mycobacteria, opportunistic infections in immunocompromised hosts, and coronavirus disease [COVID-19]).

Pre-Procedural COVID-19 Nasopharyngeal Swab Has Good Concordance with Bronchoalveolar Lavage in Patients at Low Risk for Viral Infection.

Background: The coronavirus disease 2019 (COVID-19) pandemic has drastically affected hospital and operating room (OR) workflow around the world as well as trainee education. Many institutions have instituted mandatory preoperative SARS-CoV-2 PCR nasopharyngeal swab (NS) testing in patients who are low risk for COVID-19 prior to elective cases. This method, however, is challenging as the sensitivity, specificity, and overall reliability of testing remains unclear.

Benign Central Airway Obstruction.

Benign central airway obstruction (CAO) is responsible for significant morbidity due to dyspnea and impaired quality of life. While iatrogenic causes, including stenosis after endotracheal intubation, tracheostomy tube placement, and surgery, account for the majority of cases of benign CAO, there are a multitude of other causes including infections, inflammatory disorders, extrinsic compression, benign endobronchial tumors, and tracheobronchomalacia. The approach to management depends on the underlying process responsible for the disorder and may include systemic therapy, endoscopic therapy, and surgery.

The Diagnosis and Management of Airway Complications Following Lung Transplantation.

Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2% to 4%. The incidence of lethal and nonlethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplantation airway complications is anastomotic ischemia.

Simulation for Skills-based Education in Pulmonary and Critical Care Medicine.

The clinical practice of pulmonary and critical care medicine requires procedural competence in many technical domains, including vascular access, airway management, basic and advanced bronchoscopy, pleural procedures, and critical care ultrasonography. Simulation provides opportunities for standardized training and assessment in procedures without placing patients at undue risk. A growing body of literature supports the use and effectiveness of low-fidelity and high-fidelity simulators for procedural training and assessment.

Toward the guidance of transbronchial biopsy: identifying pulmonary nodules with optical coherence tomography.

Background: Solitary pulmonary nodules (SPNs) frequently require transbronchial needle aspiration (TBNA) or biopsy to determine malignant potential, but have variable diagnostic yields. Confirming needle placement within SPNs during TBNA could significantly increase diagnostic yield. Optical coherence tomography (OCT) provides nondestructive, high-resolution, microstructural imaging with potential to distinguish SPN from parenchyma.

Evaluation and management of pill aspiration: case discussion and review of the literature.

Pill aspiration represents a unique type of foreign body aspiration requiring a distinct diagnostic and therapeutic approach. In many cases, the "foreign body" itself may no longer be present, whereas the airway manifestations may persist for months to years. Limited data exist to guide management decisions.

Fully biodegradable airway stents using amino alcohol-based poly(ester amide) elastomers.

Airway stents are often used to maintain patency of the tracheal and bronchial passages in patients suffering from central airway obstruction caused by malignant tumors, scarring, and injury. Like most conventional medical implants, they are designed to perform their functions for a limited period of time, after which surgical removal is often required. Two primary types of airway stents are in general use, metal mesh devices and elastomeric tubes; both are constructed using permanent materials, and must be removed when no longer needed, leading to potential complications.

Postradiofrequency ablation inflammatory pseudotumor associated with pulmonary venoocclusive disease: case report and review of the literature.

Radiofrequency ablation of pulmonary veins is a common therapeutic intervention for atrial fibrillation. Pulmonary vein stenosis and venoocclusive disease are recognized complications, but the spectrum of pathologies postablation have not been previously reviewed. A recent case at our hospital showed a left hilar soft tissue mass in association with superior pulmonary vein stenosis in a patient 4 years postablation.

Pulmonary langerhans cell histiocytosis diagnosed in a cervical lymph node: a case report.

Background: Pulmonary Langerhans cell histiocytosis (PLCH) is usually confined to the lungs and is therefore an unexpected finding in a cervical lymph node.

Case: A 52-year-old male with a 40-pack-year smoking history presented to our clinic with cough, fever and cervical lymphadenopathy. Chest computed tomography (CT) showed bilateral pulmonary nodules and enlarged mediastinal lymph nodes, worrisome for an infectious or malignant process.

A tree grows in bronchus.

A tracheobronchial foreign body (TFB) can be a life-threatening emergency that requires urgent intervention. TFBs occur most commonly in childhood as a result of aspiration. Traumatic TFB is not frequently reported in the literature.

Safety of topical tetracaine in patients undergoing flexible bronchoscopy.

Lidocaine is currently the most commonly used topical anesthetic during flexible bronchoscopy (FFB) in North America. Tetracaine, a longer-acting agent, might produce better airway analgesia; however, previous literature has suggested that tetracaine is more risky and can even result in cardiac arrest. The maximum recommended tetracaine dose for topical anesthesia is 20 mg.