clinical update publication

Therapy for Pleural Effusions

Center for Interventional Pulmonology Offers Nonsurgical Treatments

Through a multitude of minimally invasive interventional procedures offered at Deborah Heart and Lung Center, many of Deborah’s cardiac disease patients enjoy relief of symptoms without the physical and financial hardship of open-heart surgery. Now, with the opening of Deborah’s Center for Interventional Pulmonology, many of the Center’s lung disease patients can also forgo surgery in favor of less invasive interventional treatments, or have a lifesaving interventional procedure where there were previously no treatment options.

“From diagnostic testing to relief of symptoms to tumor destruction, Deborah’s Center for Interventional Pulmonology offers patients a variety of options,” stated David Murphy, MD, Chair, Department of Pulmonary Medicine. “Whether we’re helping patients avoid surgery or offering treatments that previously didn’t exist, these procedures can significantly improve or save the lives of our patients.”

Obstruction of the Trachea
Lung cancer patients can develop obstructive airway tumors; other patients who have had long-term endotracheal or tracheostomy tubes can develop airway narrowing or stenosis. For these patients, options exist to open and maintain the airway, such as endotracheal and endobronchial stent placement. Deborah Pulmonologists place expandable stents to open and maintain the airway, which allows the patient to breathe.

“Endotracheal and endobronchial stent placement is especially useful for patients about to undergo radiation therapy for lung cancer that is occluding the trachea or major airways,” explained Dr. Murphy. “Often, when patients undergo radiation, tumors can swell and close off the airway. These stents can maintain the patients’ breathing capabilities. The procedure is also valuable for patients suffering from tracheal stenosis, in which case, we’d recommend the stenosis opening be followed by stent placement to ensure long-term success.”

Endobronchial cautery is also available for patients with life-threatening airway-occluding tumors. During the procedure, the tumor is burned to destroy cancer tissue; the dead tumor is then removed from the airway to allow air to enter. This procedure is often followed by stent placement to ensure continued patency while radiation therapy is administered.

Diagnosis and Therapy for Pleural Effusions
Deborah’s Center for Interventional Pulmonology also offers numerous nonsurgical procedures for the diagnosis and symptom relief from pleural effusions. Prior to the advent of these procedures, patients with fluid accumulation in the pleural space would undergo a thoracoscopy - an involved diagnostic surgical procedure requiring general anesthesia and operating room time - to determine the etiology of the fluid. These new nonsurgical procedures offer accurate diagnosis with local anesthesia or IV conscious sedation.

Thoracentesis is often the first step taken to diagnose the cause of pleural effusion; after local anesthesia is administered, a needle is inserted into the pleural space through the chest wall, and pleural fluid is extracted. This can be performed to examine the fluid, or, if a diagnosis has previously been made, to remove the fluid for symptom relief.

Flexible fiberoptic pleurascopy is a new technique that is performed to inspect the pleural space, drain pleural effusions, and perform pleural biopsies and chemical pleurodesis. A Deborah Pulmonologist makes an incision in the chest wall, introduces a trochar and passes a flexible pleurascope into the pleural cavity. The pleurascope allows the Pulmonologist to view and biopsy the lining of the lung and remove fluid accumulating in the pleural space. Flexible fiberoptic pleurascopy can be performed under IV conscious sedation. Chemical pleurodesis can be performed in combination with flexible fiberoptic pleurascopy to prevent recurrence of malignant pleural effusions. A sclerosing agent, typically an aerosol of talc, is introduced into the pleural cavity to adhere the lining of the lung to the chest wall. This eliminates much of the space in the pleural cavity, preventing further fluid accumulation.

For patients requiring frequent or constant drainage of pleural effusions, an option exists that allows the patient to drain at home, saving the patient from making frequent - even daily - trips to the hospital. A Deborah Pulmonologist can implant an in-dwelling pleural catheter for intermittent or continuous drainage of pleural effusions. The catheter can provide much-needed symptom relief, and is intended for long-term placement. A short inpatient stay is required for the implantation and education on the use of the catheter.

Diagnosis of Lung Cancer
Patients suspected of having lung cancer can undergo several highly accurate diagnostic procedures, without the trauma of surgical diagnosis. Transbronchial needle biopsy is a nonsurgical diagnostic option for patients with centrally located lesions. A Pulmonologist passes a flexible fiberoptic bronchoscope to the site of the suspected tumor or lymph glands, and a needle is passed to aspirate cells for diagnosis. Transthoracic needle biopsies can also be performed for more peripheral lesions.

Deborah also offers a highly sensitive technique for the early diagnosis of lung cancer arising in the lining of the airways, through its Xillix Life Imaging System. Through fluorescent bronchoscopy, Pulmonologists can examine changes in the fluorescent signals from the lining of the airways, and detect the earliest malignant changes. These changes can then be followed with biopsy to determine a precise diagnosis. Deborah is one of a limited number of centers in the United States to diagnose lung cancer in its earliest stages using Xillix, when other diagnostic procedures would not detect these malignant changes.

Additional Offerings
Transtracheal oxygen delivery is available for patients suffering from advanced Chronic Obstructive Pulmonary Disease causing Respiratory Failure, requiring constant administration of high flow oxygen through a nasal cannula. By making a small incision in the windpipe directly above the sternal notch, a Pulmonologist can insert a cannula for delivery of oxygen directly into the windpipe. This direct delivery into the windpipe drastically lessens the flow rate necessary to deliver the same amount of oxygen into the airway. By reducing the oxygen requirements, patients enjoy more portability because of the increase in the length of time an oxygen canister lasts, and also eliminate the irritation in the nose and behind the ears that can be caused by the nasal cannula. Some patients prefer the aesthetic benefit of not wearing the cannula on their faces, due to their ability to disguise it under a shirt.

Numerous Benefits
“Pulmonary interventions can offer patients less invasive procedures for diagnosis, therapy or relief of symptoms,” stated Dr. Murphy. “We’re proud to be one of only a few centers in the Delaware Valley offering many of these options, and hope to be able to improve the quality of life - or save the lives - of patients suffering with these conditions.”

Dr. Murphy has over 25 years of experience performing flexible bronchoscopy, and has unique certifications and qualifications for performing flexible pleuroscopy and LIFE Imaging. There are very few physicians in the United States who are currently performing flexible pleuroscopy.

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