While TEE bubble study is considered to be the gold standard modality for diagnosing PFO, some PFOs may still be missed or misdiagnosed. It is important to understand the limitations of TEE and perhaps use other highly sensitive screening tests, such as transcranial doppler (TCD), in conjunction with TEE before scheduling a patient for transcatheter PFO closure.
Despite many advancements in recent years for the sampling of peripheral pulmonary lesions, the diagnostic yield remains low. Initial excitement about the current electromagnetic navigation platforms has subsided as the real-world data shows a significantly lower diagnostic sensitivity of ~70%. “CT-to-body divergence” has been identified as a major limitation of this modality. In-tandem use of the ultrathin bronchoscope and radial endobronchial ultrasound probe has yielded only comparable results, attributable to the limited peripheral reach, device maneuverability, stability, and distractors like atelectasis. As such, experts have identified three key steps in peripheral nodule sampling—navigation (to the lesion), confirmation (of the correct location), and acquisition (tissue sampling by tools). Robotic bronchoscopy (RB) is a novel innovation that aspires to improve upon these aspects and consequently, achieve a better diagnostic yield. Through this publication, we aim to review the technical aspects, safety, feasibility, and early efficacy data for this new diagnostic modality.
Purpose of reviewExposure to asbestos can cause both benign and malignant, pulmonary and pleural diseases. In the current era of low asbestos exposure, it is critical to be aware of complications from asbestos exposure; as they often arise after decades of exposure, asbestos-related pulmonary complications include asbestosis, pleural plaques, diffuse pleural thickening, benign asbestos-related pleural effusions and malignant pleural mesothelioma.Recent findingsMultiple recent studies are featured in this review, including a study evaluating imaging characteristics of asbestos with other fibrotic lung diseases, a study that quantified pleural plaques on computed tomography imaging and its impact on pulmonary function, a study that examined the risk of lung cancer with pleural plaques among two large cohorts and a review of nonasbestos causes of malignant mesothelioma.SummaryAsbestos-related pulmonary and pleural diseases continue to cause significant morbidity and mortality. This review summarizes the current advances in this field and highlights areas that need additional research.
Background: Sedation for bronchoscopy at times causes hypoxia. The application of positive pressure ventilation for sedation-induced hypoxia often requires cessation of the bronchoscopy. In contrast, ventilation effected via cyclical abdominal compression, if effective, would allow bronchoscopy to proceed. Initial trials of abdominal displacement ventilation (ADV) proved successful. This report documents extended experience with ADV. Objective: To evaluate and report the efficacy and applicability of ADV in the setting of sedation-induced hypoxia for consecutive patients over an extended interval. Methods: Based upon its initial efficacy, ADV had been incorporated into the standard approach to sedation-induced hypoxia. We retrospectively reviewed all bronchoscopies performed by interventional pulmonary over a 12-month interval. Management and efficacy of every episode of sedation-induced hypoxia were documented. Results: Over the study interval, 893 bronchoscopies had been performed, with sedation-induced hypoxia occurring in 38 (4%). ADV was possible in 37 of the 38 patients. In every case, ADV was effective and allowed completion of the procedure. There were no adverse effects. Conclusion: ADV is a simple, effective, noninvasive approach to sedation-induced hypoxia that effects adequate ventilation and allows safe continuance of procedures.
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