Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Dec 2014
ReviewInterventional pulmonology in the pediatric population.
Endoscopic airway interventions within pediatric populations vary considerably. Some of this variance may be related to institutional experience, however, may also be limited by operator experience and available equipment. Previous reports of pediatric bronchoscopic interventional procedures have been identified within the surgical literature; however, newer reports have identified other specialties participating in the care of these patients. Here, we will provide a review of the current relevant medical literature, including an evidence-based review of advanced diagnostic and therapeutic bronchoscopic treatments within the pediatric population.
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Convex probe endobronchial ultrasound (EBUS) is a minimally invasive diagnostic technique that allows real-time sampling of mediastinal and hilar lymph nodes and central pulmonary lesions. Its utility in diagnosing both malignant and nonmalignant diseases has led to an increased uptake and use by pulmonologists over the past decade. ⋯ It has also a role in providing tissue for molecular analysis, thereby guiding in the selection of agents in the new era of personalized chemotherapies in the treatment of NSCLC. The following review highlights the evidence for EBUS in diagnosing mediastinal pathology and addresses technique, training, and competency and future directions for this technology.
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Semin Respir Crit Care Med · Dec 2014
ReviewRadial probe endobronchial ultrasound and novel navigation biopsy techniques.
Peripheral pulmonary lesions are an increasingly common finding in clinical practice. While many nodules are followed with radiographic surveillance, some may require biopsy. Conventional bronchoscopy with transbronchial lung biopsy has traditionally performed poorly for small, peripheral lesions, and transthoracic needle aspiration with computed tomographic (CT) guidance has been favored as the diagnostic test of choice. ⋯ Virtual bronchoscopy and electromagnetic navigation are CT-based image guidance systems that create virtual bronchoscopic representations of the tracheobronchial tree to assist the bronchoscopist in locating peripheral lesions. Radial probe endobronchial ultrasound utilizes real-time ultrasound to confirm the location of peripheral lesions before biopsy. This article summarizes the technical platforms, procedures, and clinical evidence for these emerging technologies.
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The purpose of this article is to provide an introduction to rigid bronchoscopy (RB). We will briefly discuss its history, evolution, and resurgence while we highlight its versatility and usefulness for today's interventional pulmonologist and thoracic surgeon. Despite being one of the earliest pulmonary procedures described, RB is still an important technique. ⋯ Performing RB requires proper preprocedure preparation, exceptional understanding of upper airway anatomy, specific hand-eye coordination, and open communication between the bronchoscopist and the anesthesiologist. These skills can be primarily learned and maintained with repetition. This article will review information relevant to this technique and lay a foundation to be built upon for years to come.