Pulmonary Advanced Diagnostic Center

There are some pulmonary conditions that are difficult to diagnose using traditional methods, such as a clinical exam or imaging, like an X-ray, or even using more sophisticated techniques, like standard flexible bronchoscopy.

Patients with pulmonary lesions or those who are immunocompromised present challenges to diagnose, and some of these children will require open or video-assisted transthoracic surgical (VATS) lung biopsy for pulmonary disease tissue diagnosis. However, our team has established diagnostic techniques that can avoid the need for open lung biopsy in some cases. To expand the diagnostic strategies to provide minimally invasive techniques to find answers for children with difficult-to-diagnose pulmonary problems, the Division of Pulmonary and Sleep Medicine at Children’s Hospital of Philadelphia (CHOP) created the Pulmonary Advanced Diagnostic Center.

What we do

At CHOP, we have adapted nonsurgical diagnostic methods that had been in use for adults and made them safe and available for children. Minimally invasive techniques for transbronchial lung and lymph node biopsies under endobronchial ultrasound (EBUS) or computerized tomography (CT) guidance provide a way to gather samples of lung and lymph node tissue without surgical biopsy. This allows us to accurately diagnose difficult-to-diagnose infections and autoimmune and inflammatory disorders in children.

CHOP began performing EBUS-guided transbronchial lung and lymph node biopsies in 2015. There are two forms of EBUS advanced technique:

  • linear EBUS, which is used for the mediastinal, tracheal and proximal parabronchial lymph nodes or lesions
  • radial EBUS, which is helpful in identifying peripheral lesions

Immunocompromised children with pneumonia benefit from the availability of EBUS-guided transbronchial lung biopsy, which can identify the specific infection present so treatment can be targeted. Children usually recover in fewer than 24 hours, without major complications. This can be performed without the need for admission to the hospital.

Children with lymphoma, solid tumors and sarcoidosis have been successfully and safely diagnosed with EBUS-guided transbronchial lymph node aspiration techniques at CHOP. Mediastinal lymphadenopathy (abnormal lymph nodes located between the lungs and nestled among the great vessels coming off the heart) can also be effectively diagnosed with EBUS-guided transbronchial lymph node aspiration techniques.

We also use navigational bronchoscopy using CT imaging, which improves our ability to more precisely locate pulmonary lesions.

Our team

The Pulmonary Advanced Diagnostic Center is led by Joseph Piccione, DO, MS, pediatric pulmonologist and Pulmonary Director for the Center for Pediatric Airway Disorders. Core team members include Pelton Phinizy, MD and Elizabeth Molishus, RN.  The program is part of the Division of Pulmonary and Sleep Medicine, directed by Lisa Young, MD.

Who we treat

The Pulmonary Advanced Diagnostic Center provides care for patients from the Philadelphia region, as well as across the nation and around the world, who needs access to these highly sophisticated techniques to diagnose rare diffuse lung diseases and other pulmonary lesions.

For more information or to make a referral, call us at 267-426-6629.

More techniques planned

Even with these advances, we are unwavering in our commitment to advance and develop new ways to diagnose lung disease in children and will add additional techniques as they become available.