Department of

Pulmonology

WE HELP YOU TAKE THAT

DEEP BREATH
UNPARALLELED
EXPERTISE IN
PULMONOLOGY
At the Dept. of Pulmonology at CARE Hospitals,
we bring you the finest and trusted expertise
for lung-related conditions. We are equipped
to provide a wide range of treatments including
diseases of the bronchial tubes including
evaluation of the upper respiratory tract - nose,
pharynx, and throat.

The Pulmonology Department has medical

professionals with medical expertise in the field
of Pulmonology and Bronchoscopy services in
the diagnosis and treatment of a range of
difficult, unusual and complicated diseases of
the respiratory system, such as Asthma, COPD
Lung Diseases, Infections etc.

We have the latest equipment for the lung

function in the management of lung diseases
like interstitial lung diseases, asthma, bronchitis
and other diseases.

Interventional Pulmonology focuses on the

use of advanced diagnostic and therapeutic
techniques to treat patients with lung diseases,
airway disorders, and pleural diseases.
It provides diagnostic and therapeutic services
and cutting-edge treatment in pulmonary
medicine. The pulmonary expertise is combined
with the most sophisticated techniques and
technologies to diagnose and treat patients,
who would otherwise need to undergo
traditional invasive procedures.
SPECIALIZED SERVICES
Bronchoscopy
Bronchoscopy is the examination done to know the health of your lungs and the
path to themstate-of-the-art
or the tracheobronchial tree, using a flexible videoscope. We have
the latest state -of-the art 4K resolution bronchoscope which is the first
installation in India. This new age device offers the chance to examine from inside
the tracheobronchial tree in living patients while keeping the procedure non-
invasive. One of the more common modalities we offer is Bronchoscopies in both
Paediatrics & Adults.

Rigid Bronchoscopy
Rigid Bronchoscope continues to be in demand in Pulmonology mostly because
it offers better visualization, ease of treatment of massive hemoptysis (or bloody
expectorant), dilation of the tracheobronchial passages, and removal of foreign
bodies. However, during laser procedures, it is the Rigid Bronchoscope that is
used since it allows the patient far more reliable ventilation, especially when
attempting to move large obstructing tissue masses to make an airway. These
days, Rigid Bronchoscopy is used mostly in Paediatric Pulmonological cases for
the removal of foreign bodies from the air passages; mostly in conjunction with
fiber-optics bronchoscopy.

Flexible Fibre-optic Bronchoscopy

The Flexible Fibre-Optic Bronchoscope is primarily used for diagnostic studies
but with the advancements in medical technology, it has become an instrument
of choice for therapeutic procedures too. In cases of an undiagnosed cough and
obscure shadow in the lungs, this instrument is invaluable since it can be used
to examine the inside of the lung visually as well as obtain biopsy material from
the area.
 VARIOUS TREATMENT MODALITIES USING FOB
Laser Therapy
in
At times it is necessary to use lasers to manage local airway lesions for patients
with endobronchial lesions, photo radiating early carcinoma, and photo resecting benign
or malignant lesions that may obstruct the trachea or mainstem bronchi. For easy
tissue removal and improved ventilation, it is imperative to use laser treatments,
comma they
after however
can be used repetitively in cases of recurrence of the tumour. This treatment is however
is still yet in the development stages but with its induction in the realm of pulmonology, laser
therapy is expected to revolutionize the possibilities of treatment.

Stent Placement
Stents in the air passages are used to keep the airways open if they are obstructed
by some disease. A stent is a hollow tube made out of plastic or wire mesh to support
the airways. Two main types of stents are available, a wire mesh expandable stent (of
which there are various types) and an expandable silicone stent. Given the wide variation
in stent construction and design, they are not always easily inserted and positioned,
therefore a skilled bronchoscopist is required.

STENT PLACEMENTS FOR BENIGN AND

MALIGNANT AIRWAY OBSTRUCTION

Patients with benign and malignant central airway obstruction suffer from disabling
dyspnea, obstructive pneumonia, and impending suffocation. Airway stenting is the
principal modality used to manage intrinsic tracheobronchial pathology and extrinsic
airway compression. Airway stenting provides prompt and durable palliation in
unresectable patients with central airway obstruction. Frequently multiple stents
and multiple procedures will be necessary to maintain a satisfactory airway.
MEDICAL THORACOSCOPY FOR DIAGNOSIS,
PLEURODESIS, AND EMPYEMA DRAINAGE

Medical Thoracoscopy (MT) is a procedure that involves access to the pleural space
with an endoscope allowing direct visualization of the pleural space and intrathoracic
structures while helping to obtain tissue or performing interventions under direct
visual guidance.

Thoracoscopy is broadly divided into minimally invasive Medical Thoracoscopy (MT)

and surgical thoracoscopy, also called “Video-Assisted Thoracic Surgery” (VATS). MT is
a key component of the interventional pulmonology programs and is used mostly for
diagnosis, pleurodesis (a procedure that obliterates the pleural space to prevent
recurrent pleural effusion or pneumothorax), and empyema drainage (Pleural empyema
is defined as pus accumulation in the pleural space; it is associated with significant
morbidity and mortality in adults and children. Medical Thoracoscopy is used to drain
these pus-filled pleural spaces).

THORACOSCOPIC PERICARDIAL WINDOWS

FOR MALIGNANT PERICARDIAL EFFUSIONS

A Thoracoscopic Pericardial Window (TPW) requires a surgeon with experience in

thoracoscopy whereby a true window is created by partial pericardiectomy, creating
a passage that presumably allows longer-term drainage into an adjacent space, usually
the pleural space. In many cases, drainage for several days with an indwelling catheter
alleviates the effusion without recurrence.

THORACOSCOPIC LUNG BIOPSY

Tissue diagnosis of either interstitial lung disease or indeterminate pulmonary

nodules can be obtained by either limited thoracotomy or thoracoscopic lung biopsy.
Thoracoscopic lung biopsy is safe and effective and has become our procedure of choice
for the diagnosis of either interstitial or focal lung disease. After a general anesthetic
is given, an endoscope is inserted through the chest wall into the chest cavity. Various
types of biopsy tools can be inserted through the endoscope to obtain lung tissue for
examination. This procedure may be referred to as Video-Assisted Thoracic Surgery
(VATS) biopsy.
EBUS
BUS (Endobronchial Ultrasound) Bronchoscopy is a procedure used to diagnose
different types of lung disorders, including inflammation, infections, or cancer.
Performed by a pulmonologist, EBUS bronchoscopy uses a flexible tube that goes
through your mouth and into your windpipe and lungs. The EBUS scope has a video
camera with an ultrasound probe attached to create local images of your lungs and
nearby lymph nodes in order to accurately locate and evaluate areas seen on x-rays or
scans that need a closer look. Using the camera and the ultrasound, your doctor will
examine and collect samples from your lung, which are usually taken with a small
needle.
CRYO LUNG BIOPSY
Transbronchial Biopsy (TBB) with a cryoprobe, or cryobiopsy, is a relatively new
procedure for sampling lung parenchyma. This procedure entails using a flexible
cryoprobe to rapidly freeze an area of the peripheral lung, which is subsequently
extracted as a cryobiopsy. The transbronchial biopsy procedure is performed using
tiny forceps passed through a channel of the bronchoscope into the lungs while
the patient is instructed to breathe out slowly as the pulmonologist obtains a
small sample of lung tissue. Our team at CARE is not only well versed with this
state-of-the-art procedure but has had tremendous success in the area.

EBUS is of two types - Convex EBUS and Radial EBUS. Convex EBUS is used for
diagnosing thestaging
add the before etiology of mediastinal
add a before lymph
plan nodes and masses. It is also a useful tool
for staging of cancer by which plan of treatment is decided. Radial EBUS is used to
sample peripheral lung nodules and masses without much complication.

EBUS bronchoscopy is extremely safe but, as with any medical procedure, there is a
small risk of complications, which may include bleeding from the biopsy, infection after
the procedure, low oxygen levels during or after the procedure, and a very small risk of
collapse of the lung. All of these complications are treatable.

PAEDIATRIC BRONCHOSCOPY

The Pulmonology team at CARE is trained and headed by experienced pulmonologists

in the realm of Paediatric Bronchoscopy, whether using Flexible Fibre-optic
Bronchoscopy or Rigid Bronchoscopy.

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HIGHLY EXPERIENCED USE OF ELECTRO-CAUTERY

AND LASERS IN IP PROCEDURES

A well-trained surgical staff and our experienced team of surgeons are very adept in
the use of electrocautery and lasers in in-patient procedures. Electrocauterisation uses
alternating current at a high frequency (105 to 107 Hz) to generate heat that coagulates,
vaporizes, or cutsadd
tissue, depending on the power setting. Common to pulmonary
comma after procedure
medicine, in this procedure electric current is passed through tissue, entering at a
small electrode (the “probe”) and exiting the tissue at a much larger, dispersive
electrode (the “pad”) and is used mostly to control bleeding during surgical procedures.
TEAM OF EXPERTS

Our team at the Department of Pulmonology is spearheaded by an eminent team

of reputed Pulmonologists with years of experience.

Dr. A. Jayachandra DR. T. L. N. Swamy Dr. SA Rafi

MBBS, DTCD, FCCP (USA) MBBS, MD MBBS, MD, MS CLINF (USA)
Clinical Director, Chief Pulmonologist Interventional Pulmonologist
Dept. of Pulmonology

Department of
Pulmonology

CARE Outpatient Centre, Road No. 10, Banjara Hills

Hyderabad - 500 034 Telangana

For details: 040 61 65 65 65

www.carehospitals.com