Multidisciplinary management of adult patients with chylothorax: a consensus statement.

The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and four specialties (pulmonary, interventional radiology, thoracic surgery and nutrition) with experience and expertise in managing adult patients with chylothorax.

Diagnostic Performance and Safety Profile of Robotic-assisted Bronchoscopy: A Systematic Review and Meta-Analysis.

Conventional electromagnetic navigation bronchoscopy and other guided bronchoscopic modalities have a very desirable safety profile, but their diagnostic yield is only 60-70% for pulmonary lesions. Recently, robotic-assisted bronchoscopy (RAB) platforms have been introduced to improve the diagnostic performance of bronchoscopic modalities. To determine the diagnostic performance and safety profile of RAB (using shape-sensing and electromagnetic navigation-based platforms) by performing a systematic review and meta-analysis.

Safety of Transbronchial Biopsies in Patients with Pulmonary Hypertension: Systematic Review and Meta-Analysis.

Transbronchial lung biopsies (TBLBs) are commonly performed by pulmonologists. Most providers consider pulmonary hypertension to be at least a relative contraindication to TBLB. This practice is based primarily on expert opinion, as there are very few patient outcomes data backing it.

Noninvasive Management of Fractured Indwelling Tunneled Pleural Catheter Valve.

Tunneled indwelling pleural catheters (IPCs) are frequently used to palliate symptomatic dyspnea due to recurrent pleural effusions. The drainage valve of IPCs is an important component of the catheter as fracture of the valve leads to malfunctioning of the IPCs. Replacement of the catheter includes risks such as pain, infection, pneumothorax, and procedure cost.

Combined EBUS-IFB and EBUS-TBNA vs EBUS-TBNA Alone for Intrathoracic Adenopathy: A Meta-Analysis.

Background: Endobronchial ultrasound (EBUS)-guided intranodal forceps biopsy (IFB) is considered complementary to EBUS-guided transbronchial needle aspiration (TBNA) (EBUS-TBNA) for patients with intrathoracic lymphadenopathy either when additional tissue is requested for comprehensive molecular testing or for suspected lymphoma and sarcoidosis. This systematic review and meta-analysis investigated the diagnostic yield and complications of combined EBUS-IFB and EBUS-TBNA compared with EBUS-TBNA alone.

Methods: A systematic search was performed of Medline, Embase, and Google Scholar for studies evaluating the use of EBUS-IFB for diagnosis of intrathoracic adenopathy, and the quality of each study was assessed using the Quality Assessment, Data abstraction and Synthesis-2 tool.

Pleural Cryobiopsy: A Systematic Review and Meta-Analysis.

Background: Pleural biopsy using either video-assisted thoracoscopic surgery or medical pleuroscopy is the current diagnostic criterion standard for pleural pathology with a high, yet imperfect, diagnostic yield. Cryobiopsy may provide greater tissue, increase depth of sampled tissue, and/or reduce crush artifact. However, its impact on diagnostic yield remains uncertain, and there are potential concerns regarding its safety too.

Orphan Lung Diseases.

There are hundreds of rare orphan lung diseases. We have highlighted five of them, one from each of the five major categories of pulmonary disorders: pleuroparenchymal fibroelastosis (a rare diffuse parenchymal lung disease), pulmonary alveolar proteinosis (a rare autoimmune and diffuse parenchymal lung disease), lymphangioleiomyomatosis (a rare cystic lung disease), yellow nail syndrome (a rare pleural disease), and Mounier-Kuhn syndrome (a rare airway disorder). The pathogenesis, clinical presentation, diagnostic criteria, treatment options, and prognosis of each disorder is discussed.

Rosai-Dorfman Disease: Rare Presentation as Isolated Mediastinal and Hilar Lymphadenopathy.

Rosai-Dorfman disease (RDD) is a rare, benign, and predominantly nodal disease that most commonly presents as bilateral, painless cervical lymphadenopathy; although inguinal, axillary, mediastinal, and hilar lymphadenopathy has also been reported. Apart from nodal involvement, RDD has extranodal manifestations involving bone, soft tissue, and liver as well as constitutional symptoms of fever, night sweats, and weight loss, which make it reasonable to rule out the infectious, autoimmune, and malignant conditions as the differential diagnosis. We herein report a case of RDD affecting only the mediastinal and hilar region in an 83-year-old woman.

Pediatric Interventional Pulmonology.

Although controversy over the role of flexible versus rigid bronchoscopy for airway foreign body management persists, the effort should focus on prevention of aspiration of foreign bodies instead. This article discusses several recent advances in the bronchoscopic management of congenital tracheal stenosis, pediatric airway stenting, and the use of different types of lasers in children. The lack of randomized clinical trials leaves pediatric interventional bronchoscopic procedures without much national or international standards or guidelines.

Tracheobronchomalacia and Excessive Dynamic Airway Collapse.

Tracheobronchomalacia (TBM) and excessive dynamic airway collapse (EDAC) are more frequently being recognized as the etiology of multiple types of respiratory complaints from chronic cough to exertional syncope to recurrent infections. Identification of these conditions requires a high suspicion, as well as a thorough history and physical examination. Dynamic computed tomography imaging and bronchoscopic evaluation are integral in achieving an accurate diagnosis.

External Validation of the COmorbidity Test.

The COmorbidity TEst (COTE) is a Chronic Obstructive Pulmonary Disease (COPD)-specific co-morbidity score created to predict mortality. Before its wide application at the University of New Mexico we intended to validate it. The study was conducted at the University of New Mexico Hospital (UNMH) in Albuquerque, NM, USA, a tertiary academic hospital.

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.