Interstitial Lung Disease
Interstitial lung disease can be described as hardening of pulmonary tissue. Lungs are soft spongy organs responsible for transmitting inhaled clean oxygen to blood vessels and evacuating unclean air. Hardened pulmonary tissue will prevent delivery of clean oxygen to veins, resulting in complaints such as dyspnea and coughing. Patients suffering from this condition usually do not discharge too much phlegm. At advanced stages, oxygen transmission capacity of lungs decreases significantly and respiratory failure might take place.
Underlying reasons include rheumatic disease, heavy smoking, fungi, organic dust, polluted environment in some occupations and organic agents dissipated from feathers of poultry and animals like pigeons. However, some interstitial diseases might develop without any evident underlying reason. Respiratory function tests are of substantial importance in both diagnosis and monitoring of this category of disease. Blood tests and collecting lung fluid or biopsy samples through bronchoscopy or surgical intervention are other notable means of diagnosis as well.
Once disease has been diagnosed, the underlying reason should be addressed first. If the triggering factor is a domestic pet or occupational exposure, avoiding these is recommended. Cortisone therapy may be initiated, unless progress is achieved. Interstitial lung disease cases are often treated with long-term (3-12 months or longer) administration of immunosuppressant drugs. Therapy is then adjusted in accordance with complaints reported in follow-up, examination and respiratory function test findings and results of a 6-minute walk test.
Novel drugs are being developed, some with desirable results, to treat a group of previously untreatable interstitial lung diseases. If a case has remained untreated for a long while or disease type does not respond to cortisone therapy, supportive treatment is offered. This mode of treatment covers anti-cough medication, continuous oxygen therapy and respiratory physiotherapy (if respiratory failure is present). Lung transplantation may also be considered for some patients who do not respond to therapy.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is mostly characterized with irreversible stenosis of airways and primary dyspnea. The most common etiology is smoking. Actually smoking 1 pack of cigarettes a day for 20 years is considered to be risky for development of COPD. Aside from smoking, working in a polluted environment and some specific occupational exposures are also known to lead to COPD. Furthermore, non-smokers may still suffer from this condition due to passive inhalation of smoke. However, this latter group of non-smokers usually face COPD because of exposure to fumes produced by cooking in a small room or burnt biomass (manure, tandoori fireplaces). Patients are mostly above the age of 50 and the majority of them are males, which is consistent with the statistic that there is a larger smoker population among males.
Patients tend to present with complaints of long-term wheezy respiration, coughing, phlegm discharge and dyspnea when they consult a physician. An examination is bound to reveal how lung sounds are modified in accordance with airway stenosis. A final diagnosis can be obtained by identifying such stenosis through a respiratory function test. Chest x-rays also provide findings indicative of airway stenosis and obliteration of pulmonary tissue. One of the primary reasons why this group of patients should obtain a chest x-ray is that they are also in the high risk group for lung cancer.
Therapy involves inhaled drugs aimed at correcting airway stenosis and reported complaints as much as possible. While oral COPD drugs are available, inhaled drugs still constitute the most basic approach. Oral drugs are added when they do not suffice. The disease may get exacerbated from time to time as the influences of infection, polluted air and cardiac insufficiency keep building up. In such cases, antibiotics, cortisone or diuretics may be administered, depending on the patient’s needs.
At advanced stages of COPD, usual complaints may be accompanied with cyanosis of finger tips and lips, marked decrease in physical capacity and edema in lower extremities. These require evaluation of whether respiratory failure is present or not. A patient with lowered oxygen levels should receive long-term oxygen therapy at home. More severe COPD patients develop not only oxygen insufficiency, but also high carbon dioxide levels. Their treatment requires oxygen support and use of a breathing apparatus.
Still the best way of preventing adverse progress is to quit smoking and receive flu and pneumonia vaccinations on time and regularly. Additionally, it is necessary to treat symptoms of exacerbation, initiate oxygen and respiratory support, if needed, and make sure that patients are monitored by a pulmonary medicine physician, so that possible risks of lung cancer are detected in advance.
Mesothelioma
Mesothelioma is a type of cancer that develops in the mesothelial layer of body. Most often than not, it originates from pleura, i.e. lung membrane. Such cases are known as malignant pleural mesothelioma, and usually emerge secondary to exposure to asbestos. Unfortunately, this disease is more common among the population living in adobe brick houses in central and east Anatolia, as the soil contains asbestos-like erionite in those regions and exposure is normally far higher. Asbestos exposure may be experienced during commercial activities as well. In that regard, European Union harmonization directives prohibit products with asbestos content. Such exposure cases still occurred prior to adoption of the aforementioned directives though.
Dyspnea, coughing, chest pain, malaise and hemoptysis may be observed in cases of pleural mesothelioma. A final diagnosis can be reached on the basis of findings to be obtained from computerized tomography examination and biopsy of suspicious tissues. When the usual biopsy procedure fails to provide definitive information, thoracoscopic biopsy is carried out for the purpose of harvesting adequate specimens from within the thorax. Tomography is occasionally enough for staging purposes. Otherwise, a PET scan will be helpful to draft a treatment plan.
Due to the fact that malignant pleural mesothelioma is a disease that may potentially follow an aggressive course of progress, it may sometimes be necessary to initiate chemotherapy right away and ensure control with surgical intervention. It may also be more fitting to reverse the order and follow surgery with chemotherapy and even radiotherapy, if deemed necessary, in other cases. On the other hand, obtaining better outcomes is possible in specific cases, if warm chemotherapy is applied in the pleura during an operation under general anesthesia. Depending on type and stage of disease as well as on the patient’s specific condition, a custom treatment program is drafted. It should be noted that malignant pleural mesothelioma is a rare disease. Considering potential difficulties regarding diagnosis and treatment, these cases should be followed at well-equipped and experienced medical institutions.
Pleural (Pulmonary Membrane) Diseases:
Pleura is a membrane comprising of two leaf-like structures coating the inner surface of thoracic wall and covering both lungs. Between these two leaves is a small space, appropriately called the pleural space, which contains a minimal amount of fluid. Thanks to this fluid between the two layers, lungs are able to easily carry out respiratory motion inside the rib cage.
Various diseases afflict pleural tissue, just like other tissues around the body. Pleural effusion, emphysema, chylothorax, pneumothorax, hemithorax and pleural tumors can be listed among these.
Pleural effusion: Caused as a result of fluid accumulating in the pleural space, pleural effusion may also stem from benign conditions like lung infections, tuberculosis and pulmonary embolism or lung cancer and tumoral formations in pleura or other organs. It may result in pain in the chest and sides or trigger other complaints like coughing by compressing lungs.
Pleural effusion may transition from being of ordinary nature to infective, in which state it might contain microbes. This is called empyema. In addition to complaints normally expected from pleural effusion, empyema introduces other symptoms to progress of disease, including febrility, malaise and overall unwell condition. Some rare cases may present accumulation of lymph fluid, which is rich in fat content. This is called chylothorax. Surgeries associated with the rib cage and tumoral formations also pose the risk of causing chylothorax.
Pneumothorax: Air accumulated in the pleural space causes this condition, which may develop secondary to spontaneous air leaks from weak spots in the lungs, COPD or trauma. The tension and stimulation it creates on the pleura likely leads to dyspnea due to compression of the lungs or chest pain that invokes a stinging sensation. Urgent intervention may be required in cases where accumulation cannot be contained anymore or the patient exhibits signs of respiratory insufficiency.
Hemothorax: This condition is characterized with accumulation of blood in the pleural space. Although it is mostly associated with trauma, it could also be caused by tumoral formations. Depending on the amount of blood, dyspnea and pain in the sides may be observed. Some cases may be as severe as to require surgical intervention.
Pleural tumors: Spontaneously developing malignant tumors of pleural tissue are called mesothelioma. As a consequence of exposure to asbestos, these tumors show symptoms such as side pain, weight loss and dyspnea. Lung cancer and tumors afflicting other organs may also cause metastatic foci to emerge in the pleura. It is possible to incidentally detect benign tumors of pleural tissue as well.
Diagnosis and treatment of pleural diseases: Upon hearing the patient’s detailed history, thorough examinations and investigations like blood tests, radiological procedures like chest x-ray, computerized tomography and ultrasound scans, and molecular imaging techniques like PET/CT provide useful diagnostic information. Interventional procedures like needle biopsy and thoracentesis as well as more advanced procedures like video-thoracoscopic surgery are also employed for diagnostic purposes.
Treatment approaches include first-instance drug therapies and surgical interventions of small scale, including thoracentesis and chest intubation. Furthermore video-thoracoscopic or robotic surgeries and open surgeries, if necessary, are also practiced for the purpose of treating pleural diseases.
Pneumonia
Commonly known as pneumonia, this condition may be caused by bacteria, viruses, fungi and other microorganisms, and is characterized with inflammation of pulmonary tissue.
It is categorized in 3 main groups in accordance with location of disease and patient characteristics:
1- Community-acquired pneumonia (CAP)
2- Hospital-acquired pneumonia (HAP)
3- Pneumonia in immunocompromised patients
Community-acquired pneumonia: This category of disease, as the name suggests, is acquired during one’s daily course of life. It is also evaluated in two subgroups: Typical and atypical. Typical pneumonia emerges with sudden onset, chills, tremors, fever, coughing, phlegm discharge and chest pain. Onset is usually of bacterial origin. Diagnosis requires observation of relevant findings through chest x-ray and laboratory analyses. Atypical pneumonia, on the other hand, often emerges in young individuals along with symptoms of fever, malaise and headaches. Dry coughing and dyspnea may accompany the aforementioned symptoms as well. Clinical examination, laboratory and radiological findings are mostly incoherent with each other. It is known to be caused by atypical bacteria or viruses.
A patient diagnosed with pneumonia should immediately receive treatment. Despite available advanced laboratory tests, the majority of cases cannot be diagnosed early on. Treatment is carried out with empirical antibiotics. The patient may be treated on outpatient or inpatient basis, depending on their age, clinical status and risk of mortality. Term of treatment is 7-10 days for typical pneumonia and 14-21 days for atypical pneumonia.
Hospital-acquired pneumonia: This type of pneumonia emerges within 48 hours prior to admission to hospital or after discharge. Hospital-acquired pneumonia is often induced due to microorganisms of the patient’s own flora, which may vary depending on the underlying disease, presence of risk factors and onset period of pneumonia.
It is essential in diagnosis to define prominent pathogens and severity of disease. Early and appropriate empirical therapy is bound to improve prognosis significantly. Each hospital and unit will take into consideration their own microbiological data when configuring such therapy, which should be concluded within 10-14 days.
Pneumonia in immunocompromised patients: This group of pneumonia includes patients who receive chemotherapy for solid tumors or hematologic malignancy, organ transplantation recipients, those who take high doses of steroid/chemotherapeutic agents, and congenital or acquired immunodeficiency (e.g.: HIV) patients.
Pneumonia is a significant cause of death among this population with mortality rates reaching 45-100%. As immunocompromised cases tend to be associated with obscure clinical and laboratory findings, non-infectious indicators and more than one factor of infection, their overall condition make it difficult to diagnose pneumonia.
Clinical approach is determined in accordance with neutrophil ratio and whether the case is an AIDS patient or not.
In addition to the primary physician tending to the case, therapy requires a multidisciplinary team approach involving the clinics/units of pulmonary disease, infectious diseases, thoracic surgery and intensive care.
Pulmonary Embolism (Clot in Pulmonary Blood Vessels)
When clots build up in blood vessels of lungs, this condition is called pulmonary embolism. Lungs are where dark blood in the body is cleaned and oxygenated. As a result of vessels being clogged in this area, blood oxygen level drops, sudden onset of dyspnea occurs, and the patient may present with chest/back pain in addition to discharge of blood in phlegm. This condition frequently develops when a small clot building up in and breaking free from a vein of lower extremities clogs a blood vessel in the lungs. Therefore this issue may also be accompanied with swelling, rashes and pain in the legs.
While the disease might not trigger any complaint at all, it may also follow a course severe enough to result in death. Clots of very large scale, for instance, could potentially lead to not only pulmonary embolism but also cardiac failure. This is why suspicions should be taken note of to reach a diagnosis. Doppler ultrasound examination can reveal clots in the leg vessels and contrast lung tomography can be performed thereafter to detect clots in lungs and finalize the diagnosis. Anticoagulants are usually administered for treatment, which should be done immediately, given the possible risks. Severe cases of embolism, however, require thrombolytic therapies to prevent cardiac failure, yet it should be noted that thrombolytic therapies could induce hemorrhage in the brain or other parts of the body. If this category of medication needs to be administered, consent of patients and their relatives should be duly obtained after informing them about the risk of fatal hemorrhage and that pulmonary embolism itself already poses vital risk, making it essential to proceed with the aforesaid therapy. To counter this risk, the medical team following the patient should be prepared for blood transfusion. Once thrombolytic medication has been taken, therapy should be resumed with anticoagulants, which are to be taken for a long period of time in cases of pulmonary embolism. Anticoagulants may be administered intravenously, subcutaneously or orally. In addition to administering therapy, other reasons causing clotting need to be inquired and, if possible, corrected. Previous surgeries, prolonged bed care, long periods of travel, cancer, genetic factors and pregnancy are some of the reasons which might cause pulmonary embolism.
Sarcoidosis
Sarcoidosis is a systemic idiopathic disease that may influence any tissue and organ, most commonly lungs and thoracic lymph glands. More than one organ may be impacted simultaneously.
Characterized with pathological changes called granulomas, which are clusters of afflicted tissues and organs, this condition is classified as a granulomatous disease. Substances like beryllium and zirconium and infectious agents like some pollens, bacteria, viruses and parasites are known to be capable of starting the process and rendering formation of granulomas possible. While the actual underlying reason is not known, the disease may manifest itself with varying symptoms, yet it is thought that low level of exposure or stimulation influences the immune system and possibly triggers onset. Recent reports on familial sarcoidosis have also aroused suspicion that some genetic factors may be influencing emergence of this disease.
What are the symptoms of sarcoidosis?
As a disease affecting mainly young and middle-aged individuals, sarcoidosis presents no symptoms at all in most cases; it is usually incidentally diagnosed based on chest x-rays obtained for other reasons. Of all patients, 25-30% present with quite common symptoms such as fever, malaise, lack of appetite, perspiration and quick exhaustion. Joint pain is also among the most common signs. Organ-specific symptoms vary in accordance with the afflicted organ or tissue, yet none of them are of diagnostic significance. A lymph gland afflicted with sarcoidosis, for instance, is going to cause swollen spots on the neck, in the armpit or around the groins, or if it is a lymph node inside the chest, it might cause symptoms like coughing and chest pain. Swollen lymph nodes are often detected by patients themselves or a physician conducting physical examination. Pulmonary tissues afflicted by sarcoidosis cause complaints such as coughing, dyspnea, wheezing, premature exhaustion and hemoptysis in rare cases. Other patients may present with sudden onset of disease characterized with fever, joint pain, exhaustion, malaise and rough painful red/purple lesions on frontal aspect of legs. Like lungs and lymph nodes, eyes are also susceptible to sarcoidosis. Symptoms are seen in the form of redness in the eyes, blurry vision and light hypersensitivity. Swollen dermal lesions of varying characteristics might be associated sarcoidosis as well. In rare cases where sarcoidosis emerges in the brain, symptoms like headache, dizziness and visual disorders may be observed.
How to diagnose sarcoidosis?
Sudden-onset sarcoidosis is suspected when the patient presents with fever, joint pain and malaise in addition to red/purple nodules on the legs. Commonly known as erythema nodosum, these nodules mostly appear on frontal aspect of the legs and usually below the knees. Dermal sarcoidosis manifests itself with lesions observed during examination. Lymphatic sarcoidosis may trigger swollen lymph nodes. Usually a chest x-ray -and tomography, if necessary- is obtained to find out underlying reasons in case general symptoms like fever, malaise and premature exhaustion or symptoms of the respiratory system like coughing, dyspnea and chest pain are observed. Enlarged lymph nodes or symptoms related to afflicted pulmonary tissue might be seen in these cases. If sarcoidosis is suspected, diagnosis should be confirmed with blood/urine tests, respiratory function tests, ophthalmologic examination and other advanced investigations.
A biopsy is required for final diagnosis. For this purpose, a specimen is harvested from the organ or tissues exhibiting symptoms. A lymph gland specimen is required in case of enlarged lymph nodes or organ specimens are to be collected in case of an afflicted organ like lung or liver, for instance. As lymph nodes in lungs or thorax are frequently impacted, diagnosis is reached by physicians of pulmonary medicine. Bronchoscopic methods are essential for diagnosis in most cases. Video-bronchoscopy and endobronchial ultrasonography (EBUS) are particularly useful to diagnose almost all cases. Bronchoscopic examinations are brief painless procedures that are performed under general or local anesthesia and do not require hospitalization. Introduced as one of the most up-to-date methods, endobronchial ultrasonography (EBUS) has promoted bronchoscopy in diagnosis of sarcoidosis, as it is a useful and practical means of visualizing enlarged lymph nodes found in airways. Endobronchial ultrasonography enables a physician to collect biopsy samples with a needle under visual guidance. Few patients that cannot otherwise be diagnosed using this method can undergo mediastinoscopy, which is carried out under general anesthesia in the operating theater, for a final diagnosis.
Follow-up and treatment of sarcoidosis
Merely the lymph nodes are affected in the big majority of patients who have this disease. With no affected organs, they do not require treatment. There is a 70-80% percent chance that the disease will regress on its own within one year or simply stay stable. However, symptoms like persistent coughing and dyspnea, adverse respiratory function test findings and impacted organs such as brain, liver, heart etc. may require medical therapy. The decision on therapy or follow-up without treatment should be made by a physician specialized in this area.
It should be noted that sarcoidosis may last a lifetime and recur after successful treatment.
Tuberculosis
Tuberculosis (phthisis) is a contagious disease most commonly occurring in the lungs, though it may occur in any other part of the body as well. Pulmonary tuberculosis may cause complaints like coughing, hemoptysis, fever, weight loss and night sweating. It should definitely be considered in case of long-lasting persistent coughs. In line with recent recommendations of World Health Organization (WHO) and relevant preventive methods, contagion of this disease has been relatively taken under control in our country. Nevertheless tuberculosis still poses a severe threat for public health.
Diagnosis can be attained by detecting tuberculosis microbe in phlegm or affected organs. As drug-resistance is a serious problem with tuberculosis, samples should also be evaluated for microbial resistance to medication. This will ensure effective treatment with medication that has actual potency over the microbe, configuring term of therapy accordingly.
Tuberculosis treatment typically comprises intense medication therapy during the first 2 months and maintenance therapy with less amount of medication for the next 4 months. Up to 10 different drugs may need to be taken daily for the duration of intense therapy. Sustaining therapy without interruption and taking prescribed medication regularly and without skipping doses matter substantially for complete recovery and prevention of microbes from developing drug resistance. Treatment may be reconfigured after analyzing phlegm samples during the course of therapy and finding out whether microbial count has regressed or not. Reduction in coughs, weight gain, improved chest x-ray findings and lack of microbes in phlegm samples all suggest positive response to treatment. It should still be noted that chest x-ray findings might not be entirely normal and traces of disease may remain throughout the patient’s lifetime even after complete recovery.
Due to the fact that tuberculosis is a contagious disease, screening the patient’s family and immediate circles for disease is of utmost importance in order to diagnose infected individuals early on. At the same time anti-tuberculosis medication should be administered on younger children, youngsters and individuals with weaker immune systems who are close the patient. Tuberculosis is a prominent public health issue in our country, and should thus be countered with preventive measures including early diagnosis and treatment and screening.
TRANSACTIONS
Bronchoscopy
Bronchoscopy is an endoscopic method practiced usually under local anesthesia for diagnosis and treatment of numerous pulmonary diseases. Introduced in 1897 for the first time by Gustav Killian, the device was further developed into a flexible format by Ikeda in 1970’s. The new flexible bronchoscope was easily used on a patient under local anesthesia without causing much discomfort. Following Ikeda’s novelty, bronchoscopes have been further improved over the course of time and can now be advanced all the way to further localizations of the bronchial tree.
Bronchoscopy can be roughly described as visualization of the bronchial network from inside. It enables one to examine anatomic structure of the bronchial tree and diagnose many diseases, lung cancer in particular. The flexible bronchoscope that is widely used nowadays incorporates a very thin extension that invokes only minimal discomfort. A lens at the tip transmits view of the airways to a monitor outside. Biopsy samples can be collected from bronchial mucosa using a brush during the procedure. Sterile saline solution can also be injected and retrieved at the same time to analyze presence of bacteria or tumoral cells in the fluid. It has recently become possible as well to cauterize or apply laser on stenotic non-tumoral structures in airways. Latest bronchoscopy technologies are equipped with light sources of various wavelengths that are very useful in early diagnosis of tumors which would otherwise not be visible or noticeable to an ordinary bronchoscope.
Who should be examined with bronchoscopy?
Bronchoscopy aimed at diagnosis or treatment can be performed for the following cases upon the decision of a specialized physician, if;
- A lesion suggestive of pulmonary tumor is detected in a chest x-ray or computerized tomography examination, which may have been performed for various reasons;
- A lesion has been detected in chest x-ray, but not diagnosed using other methods;
- Hoarseness lasts over 2 weeks and is not directly associated by a specialized ENT physician with a disease relevant to vocal cords;
- A patient has been suffering from chronic coughing for a long while, yet no conclusive diagnosis could be reached under the light of findings from investigations such as chest x-ray, tomography, allergy test and respiratory function test;
- Coughing is accompanied with hemoptysis;
- Complaints of dyspnea are reported, but examinations cannot reveal a plausible diagnosis that could explain the symptoms;
- Wheezing is heard during respiration especially in a specific pulmonary segment and there is no finding that could explain the symptoms;
- Chest traumas and injury are at hand;
- Excessive bronchial secretion is present and needs to be removed;
- Foreign objects need to be extracted from airways;
- Benign or malignant tumors originating from main bronchi that arouse a sensation of choking or excessive dyspnea require extraction using means of interventional bronchoscopy, i.e. laser, argon plasma cautery, electrocautery and cryocautery; and
- A stent is to be inserted to treat stenosis of main bronchi, which might have been caused by various factors.
Preparation of the patient prior to bronchoscopy
Prior to the procedure, objective of bronchoscopy, risks of not performing it and how it is practiced is explained in detail to the patient. Patients who are going to undergo fiber-optic bronchoscopy under local or general anesthesia are recommended to fast for at least 6 hours beforehand. In this regard, fasting should start at 12:00 a.m., if the procedure is scheduled for the next morning.
Bronchoscopy performed under local anesthesia usually does not require operating room circumstances, and is performed as an office procedure. In this case the patient is brought to the bronchoscopy room and informed in detail once again, after which the procedure is carried out. Bronchoscopy performed under general anesthesia, on the other hand, should take place in an operating room or an advanced endoscopy unit. Making sure that an anesthesiology specialist is present throughout the operation is recommended for patient safety, regardless of the type of anesthesia to be administered.
How is fiber optic flexible bronchoscopy performed under local anesthesia?
The patient is brought to the bronchoscopy unit, where the throat and mouth are anesthetized using a spray. This step is necessary to suppress the gag and coughing reflex while eliminating the sensation of nausea that is expected to occur once the bronchoscope enters the mouth. Bronchoscopy is a painless process, which means anesthesia administered beforehand is not aimed at subsiding pain. After anesthetizing the mouth and throat, an intravenous injection is made. The bronchoscope is then advanced through the mouth or nose all the way to throat, vocal cords and primary airway (trachea), respectively. Anatomy and motions of vocal cords are examined at this time as well. Coughing may sometimes be experienced upon initial entry of the bronchoscope into the airways and during the procedure, but the patient does not otherwise feel any kind of pain or ache, as mentioned before. Fiber optic bronchoscope can visualize the trachea, left and right main bronchi, bronchi of the 2 lobes in left and 3 lobes in right, and even further areas. Biopsy samples may be collected from these zones or other extremities of lungs using special devices to be inserted through the scope. Lavage can be performed too. It is possible to cytopathologically and bacteriologically examine any obtained specimen. If deemed necessary, the procedure can be conducted under guidance of endobronchial ultrasonography or radioscopy to increase possibility of an accurate diagnosis. The procedure of flexible bronchoscopy takes 10-12 minutes on average, after which the patient may return home. Should numbness emerge in the mouth and throat after the procedure, patients are advised to avoid consuming food or drinks for 2 hours.
EBUS
Having reached the level of excellence in line with the advancements in technology since 1970’s, when they were first used, bronchoscopes saw the most significant breakthrough in early 2000’s. The ultrasonography device, which had already been in use for medical purposes for about 70 years at that time, was combined with the bronchoscope, introducing endobronchial ultrasonography (EBUS). The reason why this was such a notable development was that EBUS could now be used not only in the bronchial tree but also in mediastinum, the medium section of thorax, and extreme ends of lungs.
EBUS essentially comprises a flexible bronchoscope and an ultrasonography device. The ultrasonography probe may be affixed to the tip of the bronchoscope or it may be advanced through the channel inside the bronchoscope. Although only brief descriptions are made here, this revolutionary innovation actually broke new grounds in the field of pulmonary diseases. Thanks to EBUS, some inpatient diagnostic surgical interventions previously performed under general anesthesia, which many patients had to undergo, are no longer necessary.
Used mostly for the purpose of diagnosing and staging pulmonary cancer, EBUS is also utilized in diagnosis of sarcoidosis, lymphoma and various other types of cancer and diseases. It can be performed under general or local anesthesia + sedation without hospitalization.
A correct staging study is of utmost importance in configuring an accurate mode of therapy for lung cancer. Finding out whether tumoral spread is present in mediastinal lymph nodes is the determining factor for treatment of lung cancer patients who do not present with any organ metastasis. With EBUS, ultrasonographic view of these lymph nodes can be obtained from within bronchi and specimens can be collected for microscopic examination. This process takes approximately 15-30 minutes and collected specimens can be evaluated by a pathologist in the same room while the procedure is still in progress, which effectively reduces the overall time required for a diagnosis while enhancing diagnostic value of the entire investigation. Up to 95% of cases benefit from accurate staging, thanks to EBUS. A high rate of non-cancer patients can also be diagnosed. In rare cases where diagnosis may not be possible with EBUS, surgical methods like mediastinoscopy or thoracoscopy can be preferred.
Another noteworthy feature of endobronchial ultrasonography is its low risk of complication. The ability to conduct real-time imaging while collecting a biopsy sample is another major advantage. This enables visualization of vascular structures and prevents potential injuries.