Dr. M.S Kanwar

Dr. M.S Kanwar 🗣 More than 47 years of experience
👨🏼‍⚕️ Senior Consultant & Advisor, Pulmonary, Apollo Hospital

09/03/2026

🔬 When Biopsy Confirms the Diagnosis

After detailed evaluation and tissue sampling through
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA),
the pathology report revealed chronic granuloma.

But granuloma itself is not the final disease — it is a pattern of inflammation that can occur in different conditions.

🧠 The Two Major Clinical Possibilities

In such cases, the main conditions doctors consider are:

• Sarcoidosis
• Tuberculosis

Both can produce granulomas in lymph nodes and lung tissue.

🔎 The Key Differentiating Feature

The biopsy report showed:

✔ No caseation necrosis
✔ No tissue dissolution inside the granuloma

This is important because:

• Tuberculosis usually shows caseating necrosis (tissue breakdown).
• Sarcoidosis typically shows non-caseating granulomas.

Since necrosis is absent, the findings do not support TB.

📄 Final Interpretation

The pathology report, combined with clinical findings, strongly favors sarcoidosis.

This confirms the clinical diagnosis of sarcoidosis.

🩺 What Happens Next?

Treatment will now be directed toward sarcoidosis management, which may include:

• Anti-inflammatory therapy
• Careful monitoring of lung and lymph node involvement
• Periodic follow-up imaging and clinical assessment

Early diagnosis allows proper treatment and prevents unnecessary therapies.

📌 Key Message

Granuloma alone is not the diagnosis.
Clinical correlation + biopsy interpretation leads to the final answer.

In this case, the evidence supports sarcoidosis rather than tuberculosis.

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AccurateDiagnosis RespiratoryMedicine 🩺🔬

08/03/2026

🔬 When the Diagnosis Becomes Clear

During evaluation of enlarged mediastinal lymph nodes, we performed
(EBUS-TBNA) to obtain tissue samples.

🩺 How the Sampling Was Done

Using real-time ultrasound guidance:

• The needle was inserted into the lymph node
• The needle was rotated at different angles (about 90°) to obtain adequate tissue
• Multiple passes were taken to ensure diagnostic accuracy

In this case:

✔ Around 6 passes were taken
✔ Samples from different lymph node areas
✔ Approximately 24–26 tissue cores/smears collected

This improves the chances of reaching a reliable diagnosis.

📊 Initial Laboratory Findings

Some markers suggested an inflammatory granulomatous process:

• Tuberculosis-related tests – negative
• (ACE) level elevated – 115

However, laboratory markers alone cannot confirm the diagnosis.

📄 Final Pathology Report

The biopsy report clearly states:

“Consistent with chronic granuloma.”

Granulomatous inflammation may be seen in conditions such as:

•
•
• Certain chronic infections or inflammatory disorders

Clinical correlation and complete evaluation help determine the exact cause.

🎯 The Key Message

Imaging can raise suspicion.
Blood tests may suggest possibilities.

But tissue diagnosis gives the answer.

That is why procedures like EBUS-guided biopsy are crucial in modern respiratory medicine.

📞 For Physical Consultation (India):
9899988653 | 9716415790 | 9971000634

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LungDiagnostics BiopsyMatters 🩺🔬

07/03/2026

🔎 Enlarged Chest Lymph Nodes — TB, Sarcoidosis or Lymphoma?

When we see enlarged mediastinal lymph nodes during evaluation or (EBUS-TBNA),
there are usually 2–3 major possibilities:

• Tuberculosis (TB)
•
•

Sometimes infections may also mimic these conditions.

🤔 The Diagnostic Challenge

Symptoms are often confusing.

In TB & Sarcoidosis:

Many times, major symptoms are absent.

Patients may only have: • Weakness
• Tiredness
• Mild or intermittent fever
• Slight weight loss
• Occasional cough

In several cases, it is picked up accidentally on imaging.

In Lymphoma:

Usually, there are additional warning signs: • Persistent fever
• Night sweats
• Significant weight loss
• Generalized lymph node enlargement

But again — not always textbook.

⚠ Why Biopsy Is Essential

Until we PROBE the lymph node and get tissue confirmation:

We cannot start treatment.

Because treatment for all three conditions is completely different.

• TB → Anti-tubercular therapy
• Sarcoidosis → Steroids / Immunomodulators
• Lymphoma → Chemotherapy

Giving the wrong treatment can be dangerous.

For example:

If steroids are given assuming sarcoidosis,
but the patient actually has TB — infection may worsen.

If anti-TB drugs are given blindly in lymphoma — valuable time is lost.

🎯 Diagnosis Before Decision

Medicine is not assumption-based.

It is: Imaging → Tissue Diagnosis → Targeted Therapy

That is why procedures like EBUS-guided biopsy are crucial.

🩺 Final Message

Not every enlarged gland is TB.
Not every case needs immediate steroids.
Not every swelling is cancer.

But every suspicious node needs confirmation.

For Physical Consultation (India):
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MediastinalNodes Pulmonology AccurateDiagnosis BiopsyMatters

06/03/2026

🔎 Enlarged Chest Lymph Nodes — TB, Sarcoidosis or Lymphoma?

When we see enlarged mediastinal lymph nodes during evaluation or Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA),
there are usually 2–3 major possibilities:

• Tuberculosis (TB)
• Sarcoidosis
• Lymphoma

Sometimes infections may also mimic these conditions.

🤔 The Diagnostic Challenge

Symptoms are often confusing.

In TB & Sarcoidosis:

Many times, major symptoms are absent.

Patients may only have: • Weakness
• Tiredness
• Mild or intermittent fever
• Slight weight loss
• Occasional cough

In several cases, it is picked up accidentally on imaging.

In Lymphoma:

Usually, there are additional warning signs: • Persistent fever
• Night sweats
• Significant weight loss
• Generalized lymph node enlargement

But again — not always textbook.

⚠ Why Biopsy Is Essential

Until we PROBE the lymph node and get tissue confirmation:

We cannot start treatment.

Because treatment for all three conditions is completely different.

• TB → Anti-tubercular therapy
• Sarcoidosis → Steroids / Immunomodulators
• Lymphoma → Chemotherapy

Giving the wrong treatment can be dangerous.

For example:

If steroids are given assuming sarcoidosis,
but the patient actually has TB — infection may worsen.

If anti-TB drugs are given blindly in lymphoma — valuable time is lost.

🎯 Diagnosis Before Decision

Medicine is not assumption-based.

It is: Imaging → Tissue Diagnosis → Targeted Therapy

That is why procedures like EBUS-guided biopsy are crucial.

🩺 Final Message

Not every enlarged gland is TB.
Not every case needs immediate steroids.
Not every swelling is cancer.

But every suspicious node needs confirmation.

For Physical Consultation (India):
📞 9899988653 | 9716415790 | 9971000634

🌍 For International Online Consultations:
📞 WhatsApp/Call: +91 9910319688

MediastinalNodes Pulmonology AccurateDiagnosis BiopsyMatters

03/03/2026

During Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA),
we often explain anatomy in the simplest way possible.

What you are seeing here is called the bronchial tree.

🌿 What Is This “Tree”?

• The windpipe (trachea) divides into two main branches
• One goes to the right lung
• One goes to the left lung

This division point is called bifurcation (carina).

In the video:

➡️ This is the left side
➡️ This is the right side
➡️ And below, you can see enlarged lymph nodes (glands)

🔎 About These Glands (Lymph Nodes)

We can see:

• One large gland
• Two to three glands clustered together
• Additional glands at other numbered stations

During EBUS, these lymph nodes are identified according to international nodal station numbers.

Each gland is carefully examined using ultrasound.

If required:

✔ Needle aspiration is performed
✔ Tissue sample is taken
✔ Sent for pathology

🎯 Why Is This Important?

Enlarged mediastinal lymph nodes can indicate:

• Tuberculosis
• Sarcoidosis
• Lymphoma
• Metastatic cancer

But imaging alone is not enough.

Diagnosis requires tissue confirmation.

🩺 Medicine Is About Precision

We don’t guess.
We visualize.
We sample.
We confirm.

That is the power of EBUS-guided diagnosis.

For Physical Consultation (India):
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MediastinalNodes TBDetection AccurateDiagnosis RespiratoryCare

01/03/2026

TB Treatment Is Just 6 Months”…

But Is It Always That Simple?

Tuberculosis (TB) treatment is generally 6 months for uncomplicated pulmonary TB.

However, many patients are unaware that duration changes depending on the site and severity

📍 When TB Affects Other Organs:

TB is not only a lung disease. It can involve:

• Lymph Nodes (TB Lymphadenitis)
• Spine (Pott’s Spine / Spinal TB)
• Abdomen (Abdominal TB)
• Brain (TB Meningitis)

In such cases:

✔ Treatment duration may extend to 9–12 months
✔ Close monitoring is required
✔ Imaging follow-ups are important
✔ Strict drug compliance is essential

⚠ Why Duration Increases?

Because these areas:

• Have poor drug pe*******on
• Are slow to respond
• Risk permanent damage if treatment is stopped early

Stopping medicines midway can lead to:

❌ Relapse
❌ Complications
❌ Drug resistance

🚨 The Bigger Concern: MDR-TB

One of the most serious complications is:

Multidrug-resistant tuberculosis (MDR-TB)

This occurs when TB bacteria become resistant to the two most powerful first-line drugs.

MDR-TB treatment:

• Lasts 18–24 months
• Requires stronger medications
• Has more side effects
• Needs strict supervision

Most MDR cases happen due to:

❌ Irregular treatment
❌ Self-stopping medicines
❌ Incorrect prescriptions

✅ The Golden Rule

TB is completely curable.

But only if:

✔ Medicines are taken daily
✔ Full course is completed
✔ Follow-ups are not missed

Do not stop treatment just because symptoms improve.

TB bacteria may become silent — but not dead.

🌿 Early Diagnosis + Full Treatment = Complete Cure

Protect yourself. Protect your family.
TB control starts with treatment discipline.

For Physical Consultation (India):
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AbdominalTB LymphNodeTB Pulmonology InfectiousDisease CompleteTheCourse

28/02/2026

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

This is a minimally invasive technique used to evaluate:

• Enlarged mediastinal lymph nodes
• Suspected lung cancer
• Tuberculosis involving lymph nodes
• Sarcoidosis
• Unexplained lung masses

🔬 What Happens During EBUS?

A bronchoscope equipped with an ultrasound probe is inserted through the airway.

Using real-time ultrasound imaging:

✔ Lymph nodes behind the airway are visualized
✔ Precise needle aspiration (TBNA) is performed
✔ Tissue samples are collected safely
✔ No external incision required

This allows accurate diagnosis without open surgery.

💡 Why Is EBUS Important?

Early and accurate diagnosis determines:

• Whether a disease is infectious (like TB)
• Inflammatory (like sarcoidosis)
• Or malignant (like lung cancer)

It helps in:

✔ Proper staging of lung cancer
✔ Avoiding unnecessary surgery
✔ Starting timely targeted treatment

🏥 Procedure :

The procedure was performed under monitored conditions.
It was safe, controlled, and minimally invasive.
The patient tolerated it well.

Tissue samples have been sent for histopathological evaluation.

Diagnosis guides treatment — and precision diagnostics save lives.

For Physical Consultation (India):
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LungCancerDiagnosis TBDetection MinimallyInvasive RespiratoryCare AdvancedDiagnostics

27/02/2026

This PFT shows involvement of peripheral (small) airways.
Expected value: 3.24
Achieved value: 0.60
That is 19% — indicating significant small airway limitation.
What does this mean?
Peripheral airways are the smaller branches of the bronchial tree.
When they narrow or become inflamed:
• Airflow reduces
• Air trapping may occur
• Early obstruction begins
But here is the important part:
✔ Major airways are functioning
✔ Lung expansion is preserved
✔ Condition is manageable
✔ No need for panic
With proper inhaled therapy, airway inflammation can be controlled.
If treatment is followed strictly:
• Lung function can stabilize
• Symptoms can improve
• Quality of life remains normal
• Daily activities continue without restriction
This is not a life-ending condition.
This is a life-manageable condition.
The key is:
Stick to treatment.
Do not stop inhalers suddenly.
Regular follow-up is important.
With discipline, you can live a completely normal lifespan.

For Physical Consultation (India):
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📞 WhatsApp/Call: +91 9910319688

LungHealth Pulmonology RespiratoryCare EarlyDetection

26/02/2026

Case Study:

PFT Reveals Severe Airflow Limitation

“You Thought You Were Breathing Fine… But Your Flow Is Only 38%!”

Expected: 3.49
Achieved: 1.33
Only 38%

This is a classic case explained through Pulmonary Function Test (PFT).

Every person has predicted normal values based on:

• Age
• Height
• S*x
• Ethnicity

In this case:

The predicted value should have been 3.49
But the achieved value was only 1.33

That is just 38% of expected.

What does this mean?

It means airflow through the airways is severely restricted.

More importantly:

The flow rates are significantly low.

In simple terms:

Air is not moving out of the lungs efficiently.

This indicates:

• Obstructive airway disease
• Severe bronchial narrowing
• Possible chronic asthma or COPD pattern

Even if the patient feels temporary relief after inhaler use, the baseline lung function is still compromised.

When air tubes open temporarily, the patient feels:

“Now I am breathing better.”

But the PFT shows the real mechanical limitation.

This is why objective testing is important.

Symptoms can improve temporarily.

But lung mechanics tell the actual story.

For Physical Consultation (India):
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Asthma COPD LungFunctionTest Pulmonology

25/02/2026

:

HYPERINFLATED LUNGS?

This is one of the most common respiratory stories — not just in India, but globally.

Patients often say:

“It started in childhood…
There was cough, wheezing, nasal allergy.
It would improve for 1–2 years…
Then start again.”

Gradually, symptoms become persistent.

Now:

• If inhaler is missed → symptoms return
• Continuous cough
• Recurrent wheezing
• Breathlessness on exertion

On investigation:

✔ CT Scan mostly normal
✔ Mild hyperinflation seen

But what does hyperinflation mean?

Hyperinflation occurs due to air trapping.

When air goes inside the lungs but cannot come out properly, it gets trapped.
This causes lungs to remain slightly over-expanded.

Over time:

• Chest feels tight
• Breathing becomes laborious
• Natural elastic recoil of lungs reduces
• Total lung mechanics get disturbed

This condition is commonly seen in:

• Chronic asthma
• Long-standing allergic airway disease
• Poorly controlled reactive airway disorders

The problem is not always severe lung damage —
It is the chronic airway narrowing and air trapping that slowly changes lung mechanics.

⚠️ Important Message:

If you are dependent on inhalers daily
If wheezing never fully disappears
If breathlessness is gradually increasing

Do not ignore it.
Early evaluation prevents long-term lung remodeling.

For Physical Consultation (India):
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Wheezing AllergicAirway Pulmonology RespiratoryHealth

17/02/2026

Your spine is not just a structural framework — it directly influences how well you breathe.

According to Dr. M. S. Kanwar, disorders of the spine and musculoskeletal system can significantly alter lung mechanics. Conditions like kyphoscoliosis are not merely postural deformities — they affect chest expansion, ventilation dynamics, and overall respiratory efficiency.

🔹 Impact on Lung Mechanics
When the spine curves abnormally, the chest cavity becomes distorted. One lung may be compressed more than the other, leading to uneven airflow and reduced ventilation efficiency.

🔹 Muscle Coordination & Breathing
Breathing is a complex mechanical process. The diaphragm, intercostal muscles, and skeletal alignment must work in harmony. Any impairment in this coordination can reduce vital capacity (VC) and overall lung performance.

🔹 Exercise Intolerance & Functional Limitation
Patients with spinal deformities may experience unexplained breathlessness during physical activity. Often, the underlying structural cause is overlooked.

💡 Key Insight by Dr. M. S. Kanwar:
Spinal health, posture, and musculoskeletal balance are directly linked to lung function. Ignoring skeletal alignment can silently compromise respiratory health.

Early assessment and clinical correlation are essential for accurate diagnosis and proper management of breathlessness.

For Physical Consultation (India):
📞 9899988653 | 9716415790 | 9971000634

🌍 For International Online Consultations:
📞 WhatsApp/Call: +91 9910319688

RespiratoryHealth PostureMatters ChestCare CriticalCareExpert

16/02/2026

🫁 Impact of Posture & Musculoskeletal Disorders on Lung Function

Today’s discussion focuses on an often-overlooked cause of breathing difficulty —
Posture and Musculoskeletal Health.

When lung function declines, we usually think of lung diseases like asthma, COPD, or ILD.
But sometimes, the issue is not primarily in the lungs.

🩺 Important Clinical Insight:

If lung function is impaired, we must evaluate:

✔ Are the respiratory muscles functioning properly?
✔ Is the skeletal framework (spine, rib cage) aligned correctly?
✔ Is poor posture restricting chest expansion?
✔ Is there neuromuscular weakness affecting breathing mechanics?

🫁 Lungs Are Not Just Balloons

The lungs are not passive air bags inside the body.
Breathing is a precise mechanical process involving:

• Diaphragm
• Intercostal muscles
• Rib cage movement
• Spine alignment
• Neural control system

It is a coordinated mechanism that: → Draws air in
→ Holds it briefly
→ Allows proper oxygen exchange
→ Deflates smoothly during exhalation

Any disturbance in this mechanical system can reduce lung efficiency — even if the lung tissue itself is normal.

📌 Why This Matters

Poor posture, spinal deformities, muscular weakness, or chest wall disorders can: • Limit lung expansion
• Reduce oxygen intake
• Cause breathlessness
• Mimic primary lung disease

Understanding each component of this breathing mechanism is essential for accurate diagnosis and treatment.

In this session, Dr. Kanwar explains these components one by one to help patients and clinicians understand the mechanical nature of breathing.

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📍 Consultation Details – Dr. M. S. Kanwar

For Physical Consultation (India):
📞 9899988653 | 9716415790 | 9971000634

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📞 WhatsApp / Call: +91 9910319688

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✴ Dr. M.S.Kanwar has 45 years of experience in handling Critical Care, Acute and Chronic Respiratory diseases like Asthma, COPD Allergies, Lung Infections, Interstitial Lung Fibrosis, Sarcoidosis, and Lung Cancer.

✴ He is a Pioneer in Sleep Medicine in India and started this field for the first time in a big way in 1995 when he set up Asia's Largest and State of the Art Sleep Lab at Indraprastha Apollo Hospital, New Delhi. His team had done the largest Sleep studies in the country and he gets referrals for Sleep consultation from abroad also. His research papers on Sleep Apnea have been presented in the world conferences on Sleep Medicine.

✴ He is currently leading the Lung Transplant Program at Indraprastha Apollo Hospital, New Delhi. He is involved in training the Lung Transplant staff as well as in spreading the awareness on this cutting edge technology among physicians and the general public because this is a new life-saving modality in severely crippled Lung Failure cases.

✴ He had completed his M.B.B.S, M.D from Govt. Medical College, Amritsar and D.N.B ( Respiratory Medicine ) from National Academy of Medical Sciences, New Delhi. He did a Fellowship exam ( Cardiology ) by the University of Vienna ( Austria )after completing training in Rudolfstiftung Hospital, Vienna. He received Pulmonary and Critical care training from famed Mayo Clinic, Rochester( USA ). He also received Sleep Medicine training from Mayo Clinic Rochester. He received training an Echocardiography training at the University of Alabama, Birmingham( USA ). He received training in Lung Transplantation at UNH ( University Network Hospital), Toronto Canada.