Excellencies - Pneumologies

Diagnosis and Exams

There are several clinical-instrumental examinations available to patients suffering from rare pulmonary diseases, to investigate the diseases, their state of development and the most appropriate therapies.

The pulmonary needle biopsy allows to take a sample of tissue from a pulmonary region not reachable by the bronchoscope. After local anaesthesia in the skin that covers the ribs, tissue is removed using a long, thin needle between the ribs, with the guidance of an X-ray or ultrasound.
If more tissue needs to be removed, an ‘open-air’ biopsy is performed under general anaesthesia.

Preparation

Given the risk of bleeding during the manoeuvre, it is necessary to avoid the intake of aspirin or other antiaggregant or anticoagulant therapy for at least the previous 5 days; these suspensions must be carried out with the prior consent of the doctor.

It is a surgical operation: it involves making incisions between the ribs, where the necessary instrumentation for taking the tissue sample is inserted. It is an exhaustive examination, as the sample taken allows a complete laboratory analysis. It is carried out under anaesthesia and requires hospitalisation.

Preparation

The patient, on the day of the examination, has been required to show up on a complete fast for at least 8 hours.

Bronchoscopy allows the examination of the lungs using a very thin fiber-optic instrument, with a diameter of less than 4 mm. The examination is performed after anaesthesia, which can be local, with a spray in the nose, mouth and throat, to prevent coughing and discomfort or deep to make it even more tolerable.
The bronchoscope is inserted through the nose or mouth, descends along the trachea, after passing the vocal cords, and arrives in the bronchi, where biopsies or washes of the explored branches can be performed.

Preparation

the patient, on the day of the examination, has been required to show up on complete fasting for at least 8 hours

Allows for larger tissue fragments than other methods. The examination involves inserting a probe into the lung tissue, where it is then cooled for 3-4 seconds at -89° before removing the tissue. It is a necessary examination for patients with interstitial lung disease.

Preparation

The patient, on the day of the examination, has been required to show up on complete fasting for at least 8 hours

An arterial sample that assesses the amount of oxygen and carbon dioxide present in the blood. On the basis of the values measured, the indication can be set for certain treatments, such as home oxygen therapy.

Preparation

No preparation for the exam is required.

It records the maximum flow of exhaled air in a single exhalation, therefore the maximum capacity of the patient. The patient must perform a forced and explosive exhalation inside a cylindrical tube equipped with a mouthpiece.

By evaluating the amount of exhaled air, it indirectly indicates how obstructed the bronchi are and thus the effectiveness of the treatment for asthma control.

Preparation

No preparation for the exam is required.

It measures lung volumes; it is carried out by sitting the patient in a closed cabin, making him/her breathe through a mouthpiece. Spirometry is associated with this test.

Preparation

No preparation for the exam is required.

The patient is subjected to a very low dose of radiation by radiograph. It allows to visualize the thorax and the organs contained in it: lungs, heart, big vessels, airways. Usually, for a better localization of the structures and possible anomalies, two projections are made: posterior-anterior and lateral. This non-invasive investigation can be carried out in practically any patient and in any clinical condition.

Preparation

No preparation for the exam is required

Helps in the diagnosis of certain diseases. Scintigraphy can be pulmonary perfusion, in which a radioactive substance is injected into the vein, allowing the pulmonary vessels to be visualized on the X-ray, or pulmonary ventilation, in which a radioactive gas is inhaled to highlight the path of the air during inhalation.

The amount of X-rays used in these tests is very small.

Preparation

No preparation for the exam is required.

It assesses the breathing capacity of the lungs; it involves deep inhalation followed by exhalation as quickly as possible until the lungs are completely emptied. This is the most commonly used test to investigate lung disease. Plethysmography is associated with this test.

Preparation

No preparation for the exam is required.

Computerized Axial Tomography (CT) can be used to obtain numerous X-rays at different points in the chest. The CT scan requires the patient to lie still inside the scanner for a variable period of time, which can be as long as 30 minutes. This examination can be performed with the intravenous administration of a contrast medium, a substance based on iodo that allows a better definition of the arteries, veins and other intra-thoracic structures.

Preparation

If contrast medium infusion is used, blood tests such as renal function and seroprotein electrophoresis should be performed first.

It measures lung function and the levels of oxygen and carbon dioxide that are consumed and produced respectively during exercise on a bike. You breathe in a monitoring instrument while monitoring cardiac function with an electrocardiogram.
This examination can help to distinguish whether the origin of dyspnea is cardiac, pulmonary or secondary to lack of training.

Preparation

Before the examination, a spirometry and plethysmography evaluation, a hemogasalysis and a resting ECG should be performed.

It allows you to evaluate your physical performance during a sub maximal effort with a simple activity, walking.
The test is performed by walking for up to six minutes along a corridor of 30 m, while saturation is monitored.

The aim is to assess any desaturation that will be clinically significant if less than 88%, in which case the test can be repeated with oxygen.

Preparation

It is recommended to wear comfortable shoes.

It is used to assess bronchial reactivity and therefore the possibility of a patient suffering from asthma. In fact, in asthmatic patients, metacholine causes bronchoconstriction. It is performed by means of a simple basic spirometry followed by the inhalation of increasing concentrations of metacholine. After each inhalation, a simple spirometry can be used to monitor the decrease in respiratory flow. The test is positive when there is a 20% decrease. The test ends with an aerosol of bronchodilators to return the patient to initial well-being conditions.

Preparation

Stop taking long-acting bronchodilators from 12 hours before the examination and short-term bronchodilators from 6 hours before.