Recently San Jacinto Methodist Hospital added the newest innovation in pulmonary medicine – interventional pulmonology (IP). Pulmonary medicine is the branch of medicine that deals in the treatment of diseases affecting the lungs, airways and the pleura, or lungs cavity. IP is a new field within pulmonary medicine that uses endoscopy to look directly into the airways and the pleural cavity. This treatment is used for both diagnostic and therapeutic purposes.

New Technology, Faster Diagnoses
A new modality in IP is the endobronchial ultrasound (EBUS); this cutting-edge technology uses both the flexible bronchoscope and a real-time ultrasound probe to take biopsies from the lymph nodes located inside the chest cavity. This state-of-the-art technique enables the interventional pulmonologist to stage different types of cancer, including lung and esophageal cancer as well as other benign conditions such as sarcoidosis, tuberculosis and fungal infections, in a safe and accurate manner.

EBUS has all but replaced the use of other major surgical techniques, like mediastinoscopy and mediastinotomy, helping the patient to avoid a long hospital stay, complications and delayed diagnosis. It also allows the interventional pulmonologist to look at the airway and the chest lymph nodes at the same time, minimizing the number of procedures necessary for making the diagnosis.

Improving Diagnoses' Accuracy
Pleuroscopy is another tool in the arsenal of the IP specialist. It gives a direct visualization of the pleural cavity. Pleuroscopy enables the physician to take biopsies of the pleural membrane while identifying the pathology of the disease, making a diagnosis of previously undiagnosed diseases (e.g., undiagnosed pleural effusion). Pleuroscopy allows the performance of pleural procedures under direct visualization, thus avoiding incorrect results.

A long-forgotten tool in pulmonary medicine, the rigid bronchoscope is making its comeback in serving cancer patients with tumors blocking their airways and causing hemoptysis (coughing of blood), shortness of breath or lung collapse. Using the rigid bronchoscope together with the flexible bronchoscope and one of the different forms of tumor removal (e.g., laser), the IP specialist is capable of removing tumors from the airways and hence easing the patient's symptoms.

Airways can be kept open with airway stents after removing tumors. These stents are also used as support for the airways in some benign airway diseases (e.g., tracheo-bronchomalacia).

• Endobronchial valves for the treatment of emphysema with bronchoscopic lung volume reduction surgery.
• Bronchial thermoplasty for patients with bronchial asthma.
• Electromagnetic navigational bronchoscopy for defining peripheral lung malignancies.

At San Jacinto Methodist Hospital, the IP team is doing its best to bring these advances to the Baytown area.

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