Dr Vivek Gundappa

07/12/2025

🫁✨ Sparsh Hospitals' 1st LungVision™ Navigation Case

A Lung Nodule That Looked Like Cancer… but Wasn’t!

👤 Patient Profile
➡️ 50-year-old male
➡️ Uncontrolled diabetes
➡️ Incidentally found to have a lung nodule
Imaging suggested a suspicious lesion, raising concern for possible malignancy.
Naturally, anxiety levels were high.

🔍 Why We Investigated Further :
Lung nodules in high-risk patients often mimic cancer.
But appearances can be misleading.
Only a biopsy gives the real answer. 🎯

🛰️ LungVision™ Navigation — Our Game Changer
To reach this deep, peripheral nodule, we used the LungVision™ navigation system, which provides:
📡 Augmented fluoroscopy
🧭 Real-time navigation mapping
🎯 Tool-in-lesion confirmation
🫁 Safe access to difficult areas

It’s truly like having a GPS inside the lung.

🔬 Procedure Summary :
✔️ Navigated precisely to the lesion
✔️ Confirmed accurate positioning
✔️ Obtained multiple biopsies safely
✔️ Avoided risks associated with CT-guided procedures

Smooth. Controlled. Minimally invasive.

💥 The Unexpected Twist
When the biopsy results came:
❌ Not cancer
✔️ Fungal infection 🍄

In patients with uncontrolled diabetes, fungal infections can mimic malignancy on imaging —
a reminder of why tissue diagnosis is essential.

🙌 Outcome :
✨ Correct diagnosis
✨ Antifungal treatment initiated
✨ No malignancy
✨ Patient relieved and reassured

A life-changing moment — thanks to early detection and precision diagnostics.

💡 Key Takeaway :
Not every lung nodule is cancer.
Some wear a malignant disguise but turn out to be infections.
With advanced tools like LungVision™, we can reach deeper, diagnose earlier, and prevent unnecessary fear —
marking a milestone for Sparsh and a meaningful win for patient care. 🫁💙

Disclaimer:
I have no financial relationship, endorsement, or conflict of interest with LungVision or its parent company. This case is shared purely for academic and educational purposes.

Dr. Sharan Shivaraj Patil Cardio-wise Tips Abhishek Thomas Smita Naregal Anil Rajani Surendar Bhat Kedar Hibare Hemanth Lakshmaiah Rohan Naick Ganesh Pratap Tr Gowdah H Ashok B R

11/11/2025

🫁✨ THE HIDDEN POCKETS — When the Pleura Finally Spoke

》👨‍⚕️The Patient《

🧑 Age: 24 years
📉 Weight loss: >8 kg
🌡️ Fever: evening rise of temperature
😮‍💨 Symptoms: progressive breathlessness, right-sided chest heaviness, Cough
🚫 No hemoptysis / trauma

》🩻 Initial Evaluation《
🧾 Chest X-ray: right-sided opacity → pleural effusion
🧪 Pleural fluid (done elsewhere): Exudative + ADA negative + Culture negative
💊 Treated with antibiotics → no improvement
❗ Opacity persisted

》🧠 CT Thorax Findings《
📸 Multiloculated pleural effusion
🕸️ Thick septations, trapped lung
💭 Initially thought to need VATS decortication / thoracotomy

》🔪 Medical Thoracoscopy (Uniport, Rigid)《
Performed under GA

Findings:
🧫 Thick fibrinous septations
💧 Multiple pus pockets
🫁 Trapped right lung
Adhesiolysis + Lavage done
Pleural fluid & biopsies collected

》🧪 Fresh Pleural Fluid Results《
🧴 Exudative
🔬Lymphocyte-predominant
⚗️ ADA positive

》🧬 Biopsy Results《
📄 Histopathology: chronic granulomatous inflammation
🧫 GeneXpert: Positive for Mycobacterium tuberculosis
➡️ Diagnosis: Tubercular multiloculated pleural effusion

》💥 Immediate Post-Procedure Outcome《
🩻 Chest X-ray: dramatic clearing of opacity
🫁 Full lung re-expansion
💡 No need for VATS / thoracotomy

》💊 Treatment & Follow-Up《
Started on first-line anti-tubercular therapy (ATT)
🌡️ Fever resolved
🧍‍♂️ Symptom-free and radiological resolution

》💡 Clinical Pearls《
✅ Inconclusive pleural fluid ≠ inconclusive diagnosis
✅ Rigid uniport thoracoscopy — both diagnostic & therapeutic
✅ Lymphocyte predominance + ADA positivity → think TB
✅ Early thoracoscopy can avoid major surgery
✅ A “surgical lung” sometimes just needs a scope, not a scalpel

》✨ Final Words《
“When the fluid stays silent…
let the pleura speak for itself.” 💭

💉💉💊💊

03/11/2025

🌏 Hands-on Learning from the Leaders — Shanghai Pulmonary Hospital 🇨🇳

An incredibly enriching hands-on training experience at Shanghai Pulmonary Hospital, one of the world’s most advanced and high-volume centers for Interventional Pulmonology and Thoracic Oncology.

Had the privilege to train under the mentorship of Prof. Dr. Ye Gu, Head of Interventional Pulmonology, and Dr. Hai Wang, whose precision, expertise, and structured approach to complex airway interventions were truly inspiring.

💡 The immersive training covered:
🔹 Robotic Bronchoscopy – enabling precise access to peripheral pulmonary lesions through advanced navigation systems.
🔹 Navigational Bronchoscopy – integrating 3D virtual mapping with real-time fluoroscopic guidance for accurate lesion targeting.
🔹 Therapeutic Bronchoscopy – including Cryoablation and Airway Stenting for central airway obstruction and complex airway lesions.
🔹 Post–Lung Transplant Interventions – managing airway complications, anastomotic strictures, and granulation tissue with precision and care.

Each session reflected a seamless blend of technology, teamwork, and clinical excellence, showcasing how innovation is transforming pulmonary medicine.

🙏 Heartfelt gratitude to Prof. Dr. Ye Gu, Dr. Hai Wang, and the entire Interventional Pulmonology team at Shanghai Pulmonary Hospital for their mentorship, warmth, and openness in sharing their knowledge.

Special thanks to Dr. Sharan Shivaraj Patil sir, Dr Ranjan Shetty sir, and Abhishek Thomas from the Sparsh Hospital Management for their unwavering support and encouragement.

Also grateful to Dr Palaniappan Ramanathan for his invaluable guidance and for connecting me with such a world-class center.

Returning home inspired to integrate these advanced techniques into clinical practice — further advancing minimally invasive pulmonary care and post-transplant airway management in India.

24/10/2025

🌫️ “Whiteout Lungs” – When Pneumonia Refused to Settle!

A 39-year-old woman’s journey through Pulmonary Alveolar Proteinosis (PAP)

🏥 Act 1: The Mystery Begins

February 2025.
39-year-old female, breathless and coughing for weeks.
Diagnosed as “viral pneumonia” 🦠 → treated → no improvement!
Chest X-ray: hazy bat-wing opacities 🪽
SpO₂: 91% on room air 😮‍💨

🔍 Act 2: The Clues Unfold

HRCT: Crazy paving pattern 🧩
Bronchoscopy: milky BAL fluid 🥛
Biopsy: PAS-positive surfactant material
➡ Diagnosis: Pulmonary Alveolar Proteinosis (PAP) 🎯

🧪 Anti–GM-CSF antibody test: not done (unavailable at the time)

💧 Act 3: The Turnaround

🫁 Whole Lung Lavage (Left Lung) under GA
🌊 17 liters of warm saline poured in… cloudy effluent washed out until lungs cleared! 💦
💪 Oxygenation improved, breathlessness eased
➡ Right lung lavage planned in 4 weeks

🌈 Act 4: The Transformation

Post-left-lung lavage:
✨ Marked improvement in SpO₂ & exercise tolerance
✨ Symptom relief within days
✨ Radiological clearing expected after right lung lavage

🧠 Key Takeaways

Not all “pneumonias” are infections! 🚫🦠

Crazy paving on HRCT = think PAP

Whole Lung Lavage is lifesaving 🌊🫁

Early suspicion + multidisciplinary teamwork = 💯 outcomes

💬 Final Words

"Sometimes, the cure lies in washing away what lungs can’t clear… with 17 liters of saline.” 💧🫁✨

🙏 Acknowledgments

Special thanks to the entire multidisciplinary team who made this possible:

Anesthesiology Team – for safe airway management and monitoring

Physiotherapy & Respiratory Therapy – for post-procedure recovery and pulmonary rehab

Nursing & ICU Staff – for vigilant patient care

Supportive Departments – for imaging, lab, and procedural support

💙 Your teamwork turned a challenging, rare case into a success story!

08/08/2025

https://www.linkedin.com/posts/dr-vivek-gundappa-49a484b7_images-of-the-procedure-activity-7359590488112336896-92v3?utm_source=share&utm_medium=member_android&rcm=ACoAABjPBbYBQxwV7XqHDHpSdb99BinyywtIpm4

🫁 The Tracheal Stenosis Saga: From Stridor to Silence, and Back to Breath 🫁 When breath becomes a battle - and every millimeter counts. 🧍‍♂️ The Patient A 31-year-old male, recovering from polytrauma and a prolonged ICU stay with tracheostomy, presented with progressive breathlessness...

06/08/2025

🪛 The Broken Needle That Stayed Behind… Until We Went In 🪛

Some foreign bodies aren’t inhaled.
They’re left behind.

A middle-aged patient walked into our department.
Referred post bronchoscopic TBNA.
Calm on the outside…
But carrying a sharp metallic surprise deep in the airway.

The story?
During a routine TBNA done elsewhere, there was slight resistance while sampling a subcarinal node.
On withdrawal… the worst kind of silence.
👉 The tip of the TBNA needle had snapped off.
And was missing.

No coughing. No bleeding.
But somewhere inside - A fragment of stainless steel was waiting.

🚨 This wasn’t just a complication. It was a time bomb.

We took the patient in immediately.
Bronchoscope in.
Eyes sharp. Hands steady.

And then ✨ There it was.
The broken needle tip, glinting like a sliver of danger, lodged inside the tracheobronchial tree.

One wrong move… and it could pierce, cut, migrate.

With surgical precision, we maneuvered biopsy forceps, gently grasped the fragment…
And pulled it out clean, intact, and without a scratch to the airway.

😌 Relief washed over the room.

✅ No bleeding
✅ No trauma
✅ No further damage

The patient? Safe and smiling.
The needle? Now sealed inside a specimen cup - our souvenir of suspense.

🧠 What did this teach us?
Even the most routine tools can fail and when they do, it’s not panic that saves lives - It’s preparation, precision, and presence of mind.

And bronchoscopy, yet again, reminded us why we stay sharp.

03/07/2025

🌶️ The Pepper That Landed in the Right Spot — Just Not the Right Way! 🌶️
Because even a small spice can take a wrong turn…

A 60-year-old gentleman presented with a 2-day history of persistent dry cough and focal wheeze.
He casually mentioned choking while eating spicy food, but thought he’d “coughed it out.”

🩻 Chest X-ray? Normal.
🧠 CT Thorax? Normal again.
But the localized wheeze and subtle findings urged us to take a closer look.

We proceeded with bronchoscopy, and nestled comfortably in the right intermediate bronchus, was the unsuspected culprit:
A whole black pepper seed! 🌶️

A careful extraction later, the wheeze resolved on table — and the patient left smiling.

🧠 Clinical pearl:
Foreign body aspiration isn't just a pediatric problem. In adults — especially the elderly — aspiration events can be subtle, and imaging may be deceptive.
Bronchoscopy remains the gold standard when symptoms and story don’t align.

The patient joked: “That pepper almost made it to my lung curry!”
We laughed — because truly, no airway is ever boring in IP!

27/06/2025

🦷 “Tooth Be Told… This Was a First!” 🦷

As Interventional Pulmonologists, we get used to surprises—each airway tells a story, and every foreign body has a tale of its own. But this case truly bit differently! 😄

A young male patient, following a road traffic accident, was recovering in the ICU when imaging picked up a suspicious opaque object in the right main bronchus. Clinical suspicion? Aspiration.
But the bronchoscope revealed something that made us pause, smile, and then carefully extract — a tooth! 💡

Yes, the patient had lost a tooth during the trauma, and it had silently found its way down the tracheobronchial tree. Fortunately, we managed to retrieve it smoothly.

🔍 Lesson learned: In trauma, expect the unexpected—lungs can sometimes chew up surprises!
💪 Gratitude to the amazing team for making this unusual retrieval safe and successful.

Moments like these remind us that medicine is not just science—it’s also full of stories, serendipity, and smiles 😊

27/06/2025

🦷 “Tooth Be Told… This Was a First!” 🦷

As Interventional Pulmonologists, we get used to surprises—each airway tells a story, and every foreign body has a tale of its own. But this case truly bit differently! 😄

A young male patient, following a road traffic accident, was recovering in the ICU when imaging picked up a suspicious opaque object in the right main bronchus. Clinical suspicion? Aspiration.
But the bronchoscope revealed something that made us pause, smile, and then carefully extract — a tooth! 💡

Yes, the patient had lost a tooth during the trauma, and it had silently found its way down the tracheobronchial tree. Fortunately, we managed to retrieve it smoothly.

🔍 Lesson learned: In trauma, expect the unexpected—lungs can sometimes chew up surprises!
💪 Gratitude to the amazing team for making this unusual retrieval safe and successful.

Moments like these remind us that medicine is not just science—it’s also full of stories, serendipity, and smiles 😊



Smita Naregal Anil Abhishek Thomas

09/02/2025

Bronchoscopic removal of blood clots in the central airway presents challenges and various methodologies. Flexible bronchoscopy, conducted at the bedside, is a primary approach involving suction, lavage, and flexible forceps for clot extraction. However, this method carries risks of bleeding and airway trauma, sometimes hindered by the delicate nature of blood clots. In contrast, rigid bronchoscopy necessitates general anesthesia and may pose challenges in bedside applications.

The utilization of balloon catheters and topical thrombolytic agents in clot removal procedures carries risks of bronchial injury, mucosa damage, and rebleeding. Cryoextraction offers an alternative, enabling the removal of large casts with the potential for bedside application. While cryoextraction has shown efficacy in rapidly removing stubborn clots where other methods have failed, there have been isolated cases of post-procedural bleeding reported.

Current literature emphasizes the efficiency of flexible cryoprobes in expeditiously removing blood clots that resist other techniques, positioning cryoextraction as a viable alternative. Despite its success, cryoextraction is currently considered a secondary option in the realm of clot removal procedures.

15/08/2024

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