Interventional pulmonology is a growing field specializing in minimally invasive procedures of the mediastinum, lungs, airways, and pleura. These procedures have both diagnostic and therapeutic indications and are performed for benign and malignant diseases. Endobronchial US has been combined with transbronchial needle aspiration to extend tissue sampling beyond the airways and into the lungs and mediastinum. Recent innovations extending the peripheral access of bronchoscopy include electromagnetic navigational bronchoscopy and thinner
bronchoscopes. An important indication for therapeutic bronchoscopy is the relief of central
airway obstruction, which may be severe and life threatening. Techniques for restoring patency of the central airways include mechanical debulking and multiple modalities for ablation,
stent placement, and balloon bronchoplasty.
Bronchoscopic lung volume reduction improves quality of life in certain patients with severe
emphysema and is an important less invasive alternative to
lung volume reduction surgery.
Bronchial thermoplasty is likewise a nonpharmacologic treatment in patients with severe uncontrolled
asthma. Many of these procedures have unique selection criteria that require precise evaluations at preprocedure imaging. Postprocedure imaging is also essential in determining outcome success and the presence of complications. Radiologists should be familiar with these procedures as well as the relevant imaging features in both planning and later surveillance. Evolving techniques that may become more widely available in the near future include robotic-assisted bronchoscopy, bronchoscopic transparenchymal nodule access, transbronchial cryobiopsy, ablation of early-stage
cancers, and endobronchial intratumoral
chemotherapy. An invited commentary by Wayne et al is available online. ©RSNA, 2021.