Anupam Kumar

Vessels of the Central Airways: A Bronchoscopic Perspective

Blood supply of the tracheobronchial tree is derived from a dual system involving pulmonary and bronchial circulation. Various primary and secondary abnormalities of central airway vasculature can present with patterns that are distinct during bronchoscopy. These patterns maybe visualized during bronchoscopic evaluation of a patient with hemoptysis or as an incidental finding during an airway examination for other indications. Thorough knowledge of airway vasculature abnormalities and recognition of possible underlying pathophysiology is vital for the bronchoscopist. This review is a comprehensive description of vascular anatomy of the airway and the different vascular abnormalities that can be encountered during bronchoscopy.

Lobular Capillary Hemangioma ("Pyogenic Granuloma") of the Trachea.

Lobular Capillary Hemangioma (“Pyogenic Granuloma”) of the Trachea Satish Kalanjeri, Anupam Kumar, Sanjay Mukhopadhyay, and Atul C. Mehta Interventional Pulmonology, Section of Pulmonary, Critical Care, and Sleep Medicine, Louisiana State University Health, Shreveport, Louisiana; and Department of Pulmonary, Allergy, and Critical Care Medicine, and Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio

Pseudoaneurysm of Aorta Presenting as Endobronchial Mass

Received for publication February 28, 2016; accepted August 10, 2016. From the Departments of Pulmonary Medicine and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH. Disclosure: There is no conflict of interest or other disclosures. Reprints: Francisco A. Almeida, MD, MS, Departments of Pulmonary Medicine and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Ave. Area M2-141, Cleveland, OH 44195 (e-mail: almeidf@ccf.org). Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/LBR.0000000000000330 IMAGES IN INTERVENTIONAL PULMONOLOGY

Amniotic Membrane Graft for Bronchial Anastomotic Dehiscence in a Lung Transplant Recipient

Dehiscence of lung transplant bronchial anastomoses is a potentially catastrophic adverse event with major implications for both acute mortality and long-termmorbidity. The complex interplay of infection, tissue ischemia, and immunosuppression presents a formidable challenge and treatment options are limited. Amniotic tissue has been used as an aid to tissue healing in a wide range of surgical procedures for more than a century because of its availability and unique characteristics. There are several U.S. Food and Drug Administration (FDA)–approved acellular preparations available from commercial tissue banks for use in ophthalmology, otorhinolaryngological surgery, and various cutaneous wound-healing specialty practices including the treatment of burns and diabetic leg ulcers. We report an attempt to augment healing of a bronchial anastomotic dehiscence, using dehydrated human amniotic membrane graft to supplement the self-expanding metallic stent. Figure 1. Bronchoscopy image of initial area of dehiscence.

Endoscopic Treatment of Emphysema

Chronic obstructive pulmonary disease (COPD) continues to pose a major health care burden with an estimated 15.4 million office visits (in 2009) and an annual expenditure of

Sudden Onset of Dyspnea Preceded by Shoulder and Arm Pain

49.9 billion. Currently, the third most common cause of death in the United States and worldwide, COPD also compromises patients’ functional status and quality of life. Emphysema is one of the many COPD phenotypes and is characterized by abnormal, irreversible destruction and enlargement of the airways distal to the terminal bronchioles. The destruction of pliable connective tissue results in the loss of elastic recoil and reduction in the gas exchange surface area of the lung. The increased compliance due to ineffective recoil leads to airway collapse in early expiration, air trapping, and dynamic hyperinflation. Because standard medical therapies for emphysema confer only modest benefit, interest has emerged in novel treatments such as lung-volume reduction surgery and endoscopic approaches to lung-volume reduction. Selected patients with advanced emphysema may be candidates for surgical modalities such as lung-volume reduction or lung transplantation. Surgical techniques, although considered as the gold standard by many, are fraught with potential issues including the cost, morbidity, mortality, and limited resources as well as biases against invasive procedures. These limitations of available treatments invite alternative, novel therapies such as minimally invasive bronchoscopic techniques for lung-volume reduction in patients with advanced emphysema. This paper reviews physiology of lung-volume reduction, followed by a discussion of the experience with available endoscopic approaches to lung-volume reduction and patient selection criteria.