Just three years ago, pleural disease diagnosis and management at Mount Sinai Health System involved invasive approaches such as pleural biopsies and pleurodesis performed using video-assisted thoracoscopic surgery. Patients required general anesthesia and hospital admission.

Realizing that many of the patients he sees are too ill to tolerate such procedures, interventional pulmonologist Udit S. Chaddha, MBBS, saw an opportunity to effect positive change.

“Nobody in our division was performing pleuroscopy at the time,” he says. “It is a minimally invasive procedure, and we are able to perform a biopsy or pleurodesis as a 20-minute outpatient procedure using moderate sedation and a single port. Once we introduced pleuroscopy, it resulted in a cultural change that led to Pulmonology being consulted on almost every patient with pleural disease. It also resulted in a dramatic increase in referrals, and that provided the impetus for us to start a formalized pleural disease program.”

Launched in 2020, the Mount Sinai – National Jewish Health Respiratory Institute’s Pleural Service has attracted considerable interest and referrals, resulting in a 100 percent growth in pleural procedures. Dr. Chaddha, the program’s director, attributes that accomplishment, in part, to state-of-the-art equipment, the implementation of patient management protocols, and the comprehensive array of services and expertise available through the program.

“Pleuroscopy is probably the main procedure we do,” says Dr. Chaddha, Assistant Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), and Thoracic Surgery; Associate Program Director of Interventional Pulmonology; and Associate Director of Interventional Pulmonology with the Catherine and Henry J. Gaisman Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai.

“We also perform indwelling pleural catheter placement, large- and small-bore chest tubes, thoracentesis, closed pleural biopsies and biopsies of pleural-based or chest wall masses using ultrasound, and pleurodesis. Additionally, we participate in the management of empyema patients, such as decisions on when to administer tissue plasminogen activator and deoxyribonuclease, and in the management of pneumothorax patients, managing them in the acute setting and conducting follow-ups to ensure their care is appropriate.”