Atul C Mehta

• M.D., F.A.C.P., F.C.C.P.
• Professor at Cleveland Clinic

Background: COPD is a heterogeneous disorder. We developed a multidisciplinary evaluation scheme to identify patients with COPD who may benefit from phenotype-specific therapy. Methods: Our team of general and interventional pulmonologists, thoracic surgeons, radiologists, respiratory therapists, and advanced practice nurses meets monthly to discus...

Purpose of review The review explores the evolving roles and comparative effectiveness of rigid versus flexible bronchoscopy in interventional pulmonology. This topic is particularly timely due to recent technological advancements and the growing body of literature highlighting the strengths and limitations of each technique. Recent findings Recen...

Purpose of Review: Bronchoscopy related infection is recognized as a leading cause of healthcare hazard and this review delves into its incidence, causes and prevention. Summary: The risk of infection and contamination of endoscopes is well known. Current guidelines recommend that experts perform regular audits to ensure sufficient reprocessing pra...

Diaphragmatic palsy after lung transplantation has been reported infrequently. Given the role of the diaphragm in respiration, the palsy may play a significant role in the post-surgical recovery as well as morbidity and mortality. This review summarises the current literature to better understand diaphragmatic palsy in the post lung-transplant sett...

BACKGROUND Systemic corticosteroids have been shown to improve outcomes in severe coronavirus disease 2019 (COVID-19) pneumonia; however, their role in post-COVID-19 persistent lung abnormalities is not well defined. Here, we describe our experience with corticosteroids in patients with persistent lung infiltrates following COVID-19 infection. RES...

Idiopathic pulmonary hemosiderosis (IPH) is a rare entity with no known underlying etiology. It can be complicated by lung fibrosis. Emphysema is rarely reported as a consequence of IPH. We present a case of a 30-year-old female who presented with recurrent hemoptysis and shortness of breath. Radiographs revealed advanced emphysematous changes of t...

Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, in...

Bronchoscopy-related infection is recognized as a leading healthcare hazard, and this review delves into its incidence, causes, and prevention. Due to both the recognition of the scale of bronchoscopy-related infection and the COVID-19 pandemic, single-use or disposable bronchoscopy (SUFB) technology has progressed beyond the ICU setting to the bro...

Cupravidus paculus is a rare Gram-negative bacterium that can cause a wide range of severe infections, largely in immunocompromised patients. It is a ubiquitous organism found in natural and man-made environments and in the hospital. Herein, we present the first case of C. paculus infection in a lung transplant recipient, which required prolonged a...

German laryngologist Gustav Killian performed the first "Direkte Bronchoskopie" using a rigid bronchoscope to extract a foreign airway body from the right main bronchus over a hundred years ago, transforming the practice of respiratory medicine. The procedure instantaneously became popular throughout the world. Chevalier Jackson Sr from the United...

The era of bronchoscopy began in 1876 with Gustav Killian inserting an esophagoscope into a farmer’s airway to remove a piece of a pork bone. Today that procedure of bronchoscopy has evolved into a super-specialty of Interventional Pulmonology. Several innovators, scientists, and physicians have made invaluable contribution in bringing the procedur...

Electromagnetic navigation (EMN) bronchoscopy has revolutionized the tissue acquisition for diagnosis of lung nodules. EMN-guided biopsy has increased the diagnostic yield of flexible bronchoscopy for the peripheral lung lesions. This system provides simultaneous guidance with steerable biopsy instruments to the pre-selected parenchymal lesion. To...

A heart-lung transplant is considered in patients with end-stage heart and lung disease. However, there is no report of a patient receiving a staged heart transplant followed by a lung transplant. Our case report describes a successful left single lung transplant for idiopathic pulmonary fibrosis 6 years after a heart transplant. This case illustra...

Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically significant airway stenosis. The list of endobronchial stents available on the market continues to grow. More recently, patient-specific 3D-printed airway stents have been approved for...

Chronic obstructive pulmonary disease (COPD) is a condition characterized by chronic airflow obstruction due to chronic bronchitis and/or emphysema. The clinical picture is usually progressive with respiratory symptoms such as exertional dyspnea and chronic cough. For many years, spirometry was utilized to establish a diagnosis of COPD. Recent adva...

Lung ultrasound (US) is a well-established imaging tool in the inpatient and critical care setting. It has proven its worth in the rapid bedside diagnosis of a variety of conditions pertaining to the lungs and the thorax. Lung US was initially introduced as a bedside imaging tool to evaluate the size and characteristics of pleural effusion. Over th...

Objective: The study objective was to determine effects of donor smoking and substance use on primary graft dysfunction, allograft function, and survival after lung transplant. Methods: From January 2007 to February 2020, 1366 lung transplants from 1291 donors were performed in 1352 recipients at Cleveland Clinic. Donor smoking and substance use...

Background Pneumothorax is a rare but deadly complication in patients who require mechanical ventilation. As with any condition associated with acute respiratory distress syndrome (ARDS), coronavirus disease 2019 (COVID-19) is known to be associated with pneumothorax. However, in the literature, comparative data on the risk factors for pneumothorax...

Pneumoconioses are a group of non-neoplastic pulmonary disorders caused by inhaled inorganic particles. Well-described pneumoconioses include asbestosis, silicosis, coal worker's pneumoconiosis, chronic beryllium disease, and hard metal lung disease. Giant cell interstitial pneumonia (GIP) is a distinctive and rare pneumoconiosis most frequently fo...

Purpose of review: With advancements in technology, flexible bronchoscopes have become thinner in diameter and in need of more thorough reprocessing to prevent infection transmission than ever before. Many experienced bronchoscopists are not aware of the critical steps involved in effective bronchoscope reprocessing and we hope to bridge this gap...

Case Presentation A 67-year-old woman developed sudden-onset severe dyspnea 24 h after a bilateral sequential lung transplant for COPD. She had an uneventful surgery performed on cardiopulmonary bypass support. She required two units of packed RBCs as well as fresh frozen plasma during the surgery. She was successfully extubated within 12 h of surg...

Rationale Transbronchial cryobiopsy has been increasingly used to diagnose interstitial lung diseases. However, there is uncertainty regarding its accuracy and risks, mainly due to a paucity of prospective or randomized trials comparing cryobiopsy to surgical biopsy. Objectives To evaluate the diagnostic yield and complications of cryobiopsy in pa...

Airway complications post lung transplant account for significant morbidity (between 2 and 18%) and mortality (2 to 4%). The commonly encountered airway complications include necrosis and dehiscence, exophytic granulation tissue, bronchial stenosis, tracheo-broncho-malacia, bronchial fistulae, and airway infections. With growing experience in surve...

Lung transplant has become definitive treatment for patients with several end-stage lung diseases. Since the first attempted lung transplantation in 1963, survival has significantly improved due to advancement in immunosuppression, organ procurement, ex-vivo lung perfusion, surgical techniques, prevention of chronic lung allograft dysfunction, and...

Background: Endoscopic therapies are firmly established in the management algorithm of benign subglottic and tracheal stenosis (SGTS). The optimal dilation strategy, however, has yet to be elucidated. The objective of this study was to compare the efficacy and safety of balloon versus rigid bronchoplasty in the treatment of benign SGTS. Methods:...

Purpose Gastroparesis is suspected to alter the absorption of immunosuppressive medications in solid organ transplant recipients. Limited data exists in lung transplant recipients (LTRs), who typically have high rate of post-transplant gastroparesis. The objective of this study was to compare the post-transplant route of tacrolimus administration a...

A 36-year-old female with a past medical history of primary ciliary dyskinesia and bilateral lung transplantation was noted to have a rare and confounding postsurgical anatomy acquired as a result of transplantation. Bronchoscopy and computed tomography showed isomeric main bronchi with a tri-lobed right lung, a bi-lobed left lung and dextrocardia....

Building an efficient facility for advanced bronchoscopic procedures involves many considerations. This review places particular emphasis on anesthesiology services, based on experience at a tertiary/quaternary care referral academic medical center. Topics include equipment requirements, applicable clinical standards and multidisciplinary collabora...

Introduction: Thermal ablative therapies (laser, radiofrequency ablation, electrocautery, argon plasma coagulation) are often used during rigid bronchoscopy for the treatment of central airway obstructions (CAO). An airway fire is a feared complication that can occur during endobronchial thermal ablation. Materials and methods: This was a single...

Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Pla...

Bronchoscopy is a commonly performed procedure within thoracic and critical care medicine. Modern bronchoscopes are technologically advanced tools made of fragile electronic components. Their design is catered to allow maximum maneuverability within the semi-rigid tracheobronchial tree. Effective cleaning and reprocessing of these tools can be a ch...

Clinical role of bronchoscopy in everyday care of patients suffering from lung diseases is rapidly expanding. There is interest in providing minimally invasive bronchoscopic therapies as an alternative to more invasive procedures for a variety of lung diseases. Several studies have shown important contribution of bronchoscopy in diagnosis and manag...

Lung transplantation has become an established therapy for end-stage lung diseases. Early postoperative complications can impact immediate, mid-term, and long-term outcomes. Appropriate management, prevention, and early detection of these early postoperative complications can improve the overall transplant course. In this review, we highlight the i...

The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT findings, use of CT c...

The global pandemic of COVID-19 pneumonia caused by the novel coronavirus (SARS-CoV-2) has strained healthcare resources across the world with emerging challenges of mass testing, resource allocation and management. While reverse transcriptase-polymerase chain reaction (RT-PCR) test is the most commonly utilized test and considered the current gold...

Background Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in non-small cell lung cancer (NSCLC) patients as determined by endobronchial ultrasound-transbronchial needle aspiration (E...

Background Pleural complications after lung transplant may restrict allograft expansion, requiring decortication. However, its extent, indications, risk factors, and effect on allograft function and survival are unclear. Methods From 1/2006 to 1/2017, 1,039 patients underwent primary lung transplant and 468 had pleural complications, 77 (16%) of w...

Background: Argon plasma coagulation (APC) is a tool used in the management of tracheobronchial obstruction or bleeding. Complications include gas embolism which can cause devastating effects including hemodynamic instability, cardiac arrest, and stroke. Multiple theories as to how gas embolism occurs with APC have been postulated; however, none h...

Amyloidosis is a heterogeneous group of diseases characterized by the extracellular deposition of misfolded proteins that can affect either systemically or locally confined to one system. Pulmonary amyloidosis is rare and can be classified into three forms according to the anatomic site of involvement: nodular pulmonary amyloidosis, tracheobronchia...

This book provides an unbiased and evidence-based guide to the potential role of interventional pulmonology as an alternative to thoracic surgery. Interventional pulmonology is a new and quickly growing sub-specialty in pulmonary medicine and increasingly more pulmonologists are turning to interventional therapies over the more costly and invasive...

Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including malignancies, infections, inhalation injuries and traumatic damage. As the condition spans multiple organ systems with varying aetiologies and acuities, TOF poses unique diagnostic and...

Background: The diagnostic yield of electromagnetic navigation bronchoscopy (ENB) is impacted by biopsy tool strategy and rapid on-site evaluation (ROSE) use. This analysis evaluates usage patterns, accuracy, and safety of tool strategy and ROSE in a multicenter study. Methods: NAVIGATE (NCT02410837) evaluates ENB using the superDimension naviga...

Objectives Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three pati...

Multiple synchronous lung nodules are frequently encountered on computed tomography (CT) scanning of the chest and are most commonly either non-neoplastic or metastases from a known primary malignancy. The finding may initiate a search for primary malignancy elsewhere in the body. An exception to this rule, however, is a class of rare primary lung...

Lung volume reduction surgery (LVRS) is an option for select patients with advanced chronic obstructive pulmonary disease (COPD). Current guidelines recommend LVRS for patients with appropriate physiology and heterogeneous distribution of emphysema predominately involving upper lobes. We present an unusual case of a 72-year-old male with an advance...

Life-threatening hemoptysis (LTH) is any amount of hemoptysis that causes significant hemodynamic decompensation or respiratory distress which may lead to death if left untreated. While the amount of hemoptysis that qualifies as massive hemoptysis has continued to be debated, any amount between 100 to 1,000 mL/day is considered significant. Up to 1...

Background: End-stage chronic obstructive pulmonary disease (COPD) is one of the common lung diseases referred for lung transplantation. According to the international society of heart and lung transplantation, 30% of all lung transplantations are carried out for COPD alone. When compared to bilateral lung transplant, single-lung transplant (SLT)...

Flexible bronchoscopy is the most commonly used tool for the diagnosis of foreign body aspiration (FBA) and the preferred instrument for foreign body removal in adults. In children, the most common procedure performed for removal of foreign bodies is rigid bronchoscopy with or without the use of adjuvant flexible bronchoscopy. This chapter reviews...

Flexible bronchoscopy is usually performed via either the oral or nasal route. The nose extends from the external nares through the nasal cavity and the nasal pharynx. The pharynx communicates anteriorly with the nasal cavity (nasopharynx) and the oral cavity (oropharynx) and extends to the cricoid cartilage inferiorly to encompass the hypopharynx...

This chapter is intended to outline the history of the conventional technique of transbronchial needle aspiration (TBNA) with a subsequent discussion of the instrumentation, biopsy technique, relevant anatomy, indications, complications, as well as the limitations and potential for this tool in the era of flexible bronchoscopy. The successful use o...

This chapter discusses the infection control issues surrounding bronchoscopy. It addresses the scope of the problem and the current guidelines on reprocessing of bronchoscopes, and discusses how to minimize the risk of transmitting infection during bronchoscopy. Bronchoscope can act as a vector in transmission of infection. A wide variety of bacter...

Many of the basic precepts for the use of stents have remained without significant change, and are reviewed in this chapter. An understanding of central airway anatomy and flow dynamics is essential for proper airway stent selection. A number of biomechanical properties warrant consideration when determining the optimal stent type for a given situa...

Purpose Esophageal dysmotility can decrease luminal clearance and increase the risk of aspiration and GERD and contribute to allograft dysfunction. We sought to determine the impact of pre-transplant esophageal dysmotility on allograft function, GERD, rejection and survival after lung transplantation. Methods From 2012 to 2018, 699 patients underw...

Case Presentation A 46-year-old otherwise healthy woman visited the ED twice over a period of 4 days for chest discomfort, midback pain, and dyspnea. The pain was localized, constant, nonpleuritic in nature, moderate in severity, and was not relieved by over-the-counter medications.

Idiopathic subglottic stenosis (iSGS) is a fibrotic disease of unclear etiology that produces obstruction of the central airway in the anatomic region under the glottis. The diagnosis of this entity is difficult, usually delayed and confounded with other common respiratory diseases. No apparent etiology is identified even after a comprehensive work...

Background: Transbronchial lung biopsies are commonly performed for a variety of indications. While generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for; this purpose. Research question...

Aim: The aim of our study was to assess any association between ICS use and tracheobronchomalacia (TBM). Methods: We conducted a retrospective analysis on asthma and COPD patients with and without TBM. Patients were diagnosed with TBM on the basis of CT scan, flexible bronchoscopy or both. Patients were deemed to be on ICS if they were on treatm...

Cicatricial organizing pneumonia is an uncommon form of organizing pneumonia, which may manifest as persisting linear opacities on computerized tomography (CT) scan mimicking a fibrosing interstitial pneumonia. It may also manifest with pulmonary ossification, which is a metaplastic bone formation within the lung tissue. The latter presentation cou...