Diseases of the Central Airways: A Clinical Guide PDF
Preview Diseases of the Central Airways: A Clinical Guide
Respiratory Medicine Series Editor: Sharon I.S. Rounds Atul C. Mehta Prasoon Jain Thomas R. Gildea Editors Diseases of the Central Airways A Clinical Guide Respiratory Medicine Series editor Sharon I.S. Rounds, Providence, RI, USA More information about this series at http://www.springer.com/series/7665 Atul C. Mehta Prasoon Jain (cid:129) Thomas R. Gildea Editors Diseases of the Central Airways A Clinical Guide Editors Atul C. Mehta,MD, FACP, FCCP ThomasR. Gildea, MD, MS,FCCP, FACP Professorof Medicine Pulmonary, Allergy, Critical CareMedicine Lerner Collegeof Medicine andTransplantCenter Buoncore Family EndowedChair Respiratory Institute, Cleveland Clinic inLung Transplantation Cleveland, OH Respiratory Institute, Cleveland Clinic USA Cleveland, OH USA PrasoonJain, MBBS,MD, FCCP PulmonaryandCritical Care LouisA JohnsonVAMedical Center Clarksburg, WV USA ISSN 2197-7372 ISSN 2197-7380 (electronic) Respiratory Medicine ISBN978-3-319-29828-3 ISBN978-3-319-29830-6 (eBook) DOI 10.1007/978-3-319-29830-6 LibraryofCongressControlNumber:2016931430 ©SpringerInternationalPublishingSwitzerland2016 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpart of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission orinformationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodologynowknownorhereafterdeveloped. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authorsortheeditorsgiveawarranty,expressorimplied,withrespecttothematerialcontainedhereinor foranyerrorsoromissionsthatmayhavebeenmade. Printedonacid-freepaper ThisHumanaPressimprintispublishedbySpringerNature TheregisteredcompanyisSpringerInternationalPublishingAGSwitzerland To my teachers who taught me how to hold the bronchoscope —Atul C. Mehta To my mother and father —Prasoon Jain To my patients —Thomas R. Gildea Foreword Openuponeofthemajortextbooksofpulmonarymedicine,anditreadilybecomes apparent that the central airways of the lung garner little attention beyond an obligatory chapter. Comprised of the trachea and proximal bronchi, the central airways are viewed largely as a conduit for airflow. As such, they tend to become clinically relevant when there is critical narrowing, as occurs in the setting of neoplastic disease or iatrogenic strictures from prior endotracheal or tracheostomy tubes.Thosemostfamiliarwiththecentralairwaysaremembersoftheburgeoning field of interventional pulmonology, who on a daily basis venture into the central airways to biopsy, dilate, laser, stent, and ultrasound, place valves and coils, and applythermalenergy.Itisthesepractitionerswhohavecalledattentiontothemany and varied disorders that can affect the central airways, beyond the tumors and strictures that have conventionally populated the textbook chapters. This scholarly monograph highlights the full spectrum of inflammatory, autoimmune, infectious, neoplastic, and idiopathic disorders that affect the central airways. The editors of this monograph, all practitioners of interventional pul- monology, are to be commended for focusing on the cognitive rather than the technical aspects of their field. Their message is clear: Those who hold a bron- choscope must be diagnosticians first and technicians second. Importantly, this monograph is relevant not only to those who practice interventional pulmonology butforallclinicianswhowanttolearnfromtheinsightsthatthisfieldhasprovided into the diversity of disorders that affect the central airways. Robert M. Kotloff Department of Pulmonary Medicine Respiratory Institute, Cleveland Clinic Cleveland OH, USA Herbert W. Wiedemann Respiratory Institute, Cleveland Clinic Cleveland OH, USA vii Preface As2016dawns,InterventionalPulmonologyhasbecomeanessentialcomponentof pulmonarymedicine, asvital and aswidely accepted asInterventional Cardiology. This subspecialty is extremely attractive to most pulmonologists, and the estab- lishmentofnationalandinternationalorganizations,myriadscholarlycontributions totheliterature,andwell-attendedscientificseminarsprovidedefinitiveevidenceof its worldwide favor. One possible reason for this widespread interest is that endobronchial procedures often yield important results and positively impact patients’ well-being. For example, a successful lung transplantation cannot be achievedwithoutthecontributionsofabronchoscopist.Similarly,thereisnodoubt aboutthecontributionsbronchoscopehasmadeinthediagnosisandstagingoflung cancer.Infact,thereareonlyahandfulofpulmonaryailmentsthatabronchoscope cannot diagnose, palliate, or cure. Interventional pulmonary medicine thrives within the penumbra of multiple specialties: Bronchoscopists provide the transitional step from the unknown to the known, from lesion to cancer, from wheezes to granulomatosis with polyangiitis, and from treatment to palliation. Interventional pulmonologists are uniquely posi- tionedtoimprovemanyfields becausebronchoscopy offersthebestaccesstolung tissue. The modern day interventional pulmonologist has a dual commitment: to be a competent endoscopist and to demonstrate a thorough knowledge of diseases involvingthe central airways, as well as other systemicdiseases that can affect the central airways. This body of knowledge must also include the understanding of symptoms that are not associated with airways disease. The objective of this monograph is to illuminate the fact that Interventional Pulmonology offers more than mere interventions. The bronchoscopist should be abletorecognizeaspirationintheabsenceofaforeignbodyandperhapsdiagnose inflammatory bowel disease before it involves the gastrointestinal tract. The interventional pulmonologist should be able to differentiate when a cardiac or pulmonaryembolismevaluationshouldbeconsidered,ratherthanabronchoscopy. One must consider the patient as an individual, not an endobronchial tree. With ix x Preface appropriate training, anyone can perform a procedure, but the editors strongly believethat“agoodbronchoscopististheonewhoknowswhennottoperformthe procedure.” Theoptimalapplicationofbronchoscopyarisesfromthecoalescenceofmedical science and prudence, and the editors vehemently assert that reducing the cost of health care is a civic responsibility. However, the current directives of InterventionalPulmonology,toasignificantdegree,arebaseduponexpertopinion, not evidence. In addition, the cost-effectiveness of new elective bronchoscopy procedureshasnotbeenwelldocumented.Therefore,theinterventionalistmustrise above his or her technical abilities and consider noninvasive therapeutic options, thenperformanunnecessaryprocedure.Thebronchoscopistshouldbeatechnology savant, not a technology servant. We, the editors, have made a sincere effort to focus only on the conditions that require limited or no technical interventions within the purview of Interventional Pulmonology. Although we do not claim this book encompasses the subject in its entirety, we offer our attempt to illuminate the noninterventional aspects of our subspecialty. We applaud all the authors for their support and timely contributions tothisproject;thecreditistheirstoclaim.Ourultimateobjectiveisthewell-being of patients suffering with central airways diseases, through the safe and cost-effective practice of Interventional Pulmonology. Atul C. Mehta Prasoon Jain Thomas R. Gildea Contents 1 Diseases of Central Airways: An Overview . . . . . . . . . . . . . . . . . 1 Prasoon Jain and Atul C. Mehta 2 Sarcoidosis of the Upper and Lower Airways . . . . . . . . . . . . . . . 71 Daniel A. Culver 3 Airway Complications of Inflammatory Bowel Disease. . . . . . . . . 87 Shekhar Ghamande and Prasoon Jain 4 Airway Involvement in Granulomatosis with Polyangiitis. . . . . . . 107 Sonali Sethi, Nirosshan Thiruchelvam and Kristin B. Highland 5 Tracheobronchomalacia and Excessive Dynamic Airway Collapse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Erik Folch 6 Tracheobronchial Amyloidosis . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Gustavo Cumbo-Nacheli, Abigail D. Doyle and Thomas R. Gildea 7 Tracheobronchopathia Osteochondroplastica. . . . . . . . . . . . . . . . 155 Prasoon Jain and Atul C. Mehta 8 Endobronchial Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Pyng Lee 9 Endobronchial Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . 191 Atul C. Mehta, Tanmay S. Panchabhai and Demet Karnak 10 Recurrent Respiratory Papillomatosis. . . . . . . . . . . . . . . . . . . . . 215 Joseph Cicenia and Francisco Aécio Almeida 11 Parasitic Diseases of the Lung . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Danai Khemasuwan, Carol Farver and Atul C. Mehta xi
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