Novel Insights from Clinical Practice Autologous Blood Patch Pleurodesis and Endobronchial Valves for Management of Persistent Air Leaks in Two Cases of Tuberculosis.

Introduction: Pulmonary infections, such as tuberculosis, can result in numerous pleural complications including empyemas, pneumothoraces with broncho-pleural fistulas, and persistent air leak (PAL). While definitive surgical interventions are often initially considered, management of these complications can be particularly challenging if a patient has an active infection and is not a surgical candidate.

Case Presentation: Autologous blood patch pleurodesis and endobronchial valve placement have both been described in remedying PALs effectively and safely.

A Rare Case of Esophageal Carcinoma Cuniculatum Palliated by Esophageal and Endobronchial Stenting.

Carcinoma cuniculatum is a rare variant of well-differentiated squamous cell carcinoma. To date, there are less than 30 cases of esophageal carcinoma cuniculatum reported. It is frequently a diagnostic challenge: A definitive diagnosis typically cannot be made before esophagectomy.

Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital.

Purpose: Lung cancer screening (LCS) results in earlier detection of malignancy and decreases mortality but requires access to care to benefit. We assessed factors associated with timing of lung cancer diagnosis in the absence of systematic LCS in an urban safety net hospital.

Patients And Methods: Retrospective chart review was performed of patients with pathologic diagnosis and/or staging of lung cancer at our institution between 2015 and 2018.

Biphasic Flow-Volume Loop in a Patient With Idiopathic Unilateral Mainstem Bronchus Obstruction.

Unilateral mainstem obstruction is an uncommon cause of dyspnea in the clinic setting. However, it is identifiable on spirometry as the "two-compartment phenomenon," in which the expiratory and/or inspiratory flow is decreased, followed by a further rapid decrease, resulting in a flattened end-expiratory or end-inspiratory tail, respectively. This case report outlines a 48-year-old woman with prior subglottic stenosis who presented with recurrent dyspnea.

COVID-19 Impact on Interventional Pulmonology Training.

The impact of the coronavirus disease (COVID-19) pandemic extends beyond the realms of patient care and healthcare resource use to include medical education; however, the repercussions of COVID-19 on the quality of training and trainee perceptions have yet to be explored. The purpose of this study was to determine the degree of interventional pulmonology (IP) fellows' involvement in the care of COVID-19 and its impact on fellows' clinical education, procedure skills, and postgraduation employment search. An internet-based survey was validated and distributed among IP fellows in North American fellowship training programs.

AABIP Evidence-informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters.

Background: While the efficacy of Indwelling pleural catheters for palliation of malignant pleural effusions is supported by relatively robust evidence, there is less clarity surrounding the postinsertion management.

Methods: The Trustworthy Consensus-Based Statement approach was utilized to develop unbiased, scientifically valid guidance for the management of patients with malignant effusions treated with indwelling pleural catheters. A comprehensive electronic database search of PubMed was performed based on a priori crafted PICO questions (Population/Intervention/Comparator/Outcomes paradigm).

Community-acquired Pneumonia and Hospital-acquired Pneumonia.

Pneumonia is among the leading causes of morbidity and mortality worldwide. Although Streptococcus pneumoniae is the most likely cause in most cases, the variety of potential pathogens can make choosing a management strategy a complex endeavor. The setting in which pneumonia is acquired heavily influences diagnostic and therapeutic choices.

Patient- and Hospital-Level Factors Associated With Readmission for Malignant Pleural Effusion.

Purpose: Readmission after hospitalization for malignant pleural effusion (MPE) may represent gaps in the quality of health care delivery. The goal of this study was to determine the frequency of 30-day readmission for MPE and identify clinical factors associated with rehospitalization.

Patients And Methods: A retrospective cohort of adults hospitalized for MPE from 2009 to 2011 was analyzed using an administrative database.

Pulmonary inflammatory pseudotumor causing lung collapse responding to corticosteroid therapy.

Pulmonary inflammatory pseudotumor (PIP) is a rare benign tumor that represents less than one percent of all tumors found in the lungs. Despite the benign etiology, PIP can cause significant clinical problems due to its growth rate and potential to compromise adjacent pulmonary and thoracic structures. Complete surgical resection is the preferred therapy for PIP to prevent recurrence, however, this is not possible in some patients due to the size or location of the tumor.

Successful Removal of a Chronic Aspirated Foreign Body after Twelve Years.

Chronic retention of aspirated foreign bodies is rare but can result in indolent systemic and respiratory symptoms. Bronchoscopy may show features of tissue reaction to the foreign body, including granulation tissue, endobronchial stenosis, strictures, edema, and airway distortion. The diagnosis of foreign body aspiration is often difficult to establish since some patients may not give a clear history of aspiration or may present late.

A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE).

Rationale: This is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV) in patients with little to no collateral ventilation out to 12 months.

Objectives: To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation in the treated lobe.

Methods: Subjects were enrolled with a 2:1 randomization (EBV/standard of care [SoC]) at 24 sites.

Bronchoscopic Therapies for Peripheral Lung Malignancies.

Current advances in guided bronchoscopy methods permit minimally invasive access to essentially any area of the lungs. This provides a potential means to treat patients with localized lung malignancies who might not otherwise tolerate conventional treatment, which commonly relies on surgical resection. Ablation methods have long been used for bronchoscopic treatment of central airway malignancies and percutaneous treatment of peripheral lung cancer.

Primary Laryngotracheal Amyloidosis With Bilateral Vocal Cord Involvement and Associated Bronchiectasis.

Localized tracheobronchial amyloidosis is a rare disease that results from submucosal deposition of insoluble amyloid proteins in the large airways. Amyloidosis affecting the larynx and subglottic space typically results in unilateral, nodular vocal cord infiltration. It rarely can present with bilateral vocal cord involvement and can progress to lifethreatening respiratory failure due to upper airway obstruction.

Large pleural nodules secondary to Mycobacterium tuberculosis.

Mycobacterium tuberculosis disease is a common disease worldwide. Pleural visualization, however, is usually not required as the diagnosis can typically be made by less invasive methods. Thoracoscopic visualization typically reveals pleural erythema and studding with numerous small pleural tubercules and adhesions.

The latest generation in flexible bronchoscopes: a description and evaluation.

Background: Since the introduction of the flexible bronchoscope over 50 years ago, bronchoscopists have seen vast improvement in the technology available for diagnostics and therapeutics in the bronchoscopy laboratory. We set forth to evaluate the latest evolution in flexible bronchoscopes with features designed to improve imaging and airway navigation.

Methods: The BF-Q190, BF-H190, and/or BF-1TH190 bronchoscopes were evaluated prospectively in 105 patients undergoing bronchoscopy from November 2010 to August 2011 at 2 tertiary care centers in the United States.

Percutaneous dilational tracheostomy.

Tracheostomy is a commonly performed intervention with several benefits in the treatment of patients with chronic respiratory failure. Percutaneous dilational tracheostomy techniques have allowed bedside tracheostomy placement in the modern intensive care unit. Percutaneous dilational tracheostomy can be safely performed by interventional pulmonologists, medical intensive care physicians, and surgical specialists.

Multicenter experience with electromagnetic navigation bronchoscopy for the diagnosis of pulmonary nodules.

Background: Physicians are increasingly encountering lung nodules in their practice, and tissue diagnosis is often required. Conventional bronchoscopic sampling yields a range from 14% to 69% depending on the nodule size and location within the lung. We aimed to evaluate the diagnostic yield of electromagnetic navigation bronchoscopy (ENB) in multiple centers and to determine what factors affect the yield of ENB.

Diagnosis of lung nodules with peripheral/radial endobronchial ultrasound-guided transbronchial biopsy.

Background: : Pulmonary nodules are frequently encountered in clinical practice, but diagnostic sensitivity of traditional bronchoscopy remains less than desirable. Transbronchial biopsy (TBBX) under fluoroscopic guidance with flexible bronchoscopy has a sensitivity of 34% for lesions <20 mm and 63% for lesions >20 mm. Navigational technologies such as electromagnetic navigation bronchoscopy have increased the yields of TBBX to approximately 73%.