Thoracic Interventional Program (TIP)

The Thoracic Interventional Program (TIP) offers the most advanced diagnostic and therapeutic approaches to various diseases in the chest, including lung nodules and masses, enlarged lymph nodes (mediastinal adenopathy), complex airways and pleural effusions.  Our trained interventional pulmonologists are leaders in the field and have more experience than anybody in the state and surrounding area.  Our goal is to provide an expedited, comprehensive assessment and state-of-the-art treatment with the following services:

  • Endobronchial ultrasound (EBUS):The TIP physicians have the most experience in the state with EBUS, and other hospitals have sent physicians to be trained here at Yale. Whether using convex probe EBUS for mediastinal lymph node enlargement, often circumventing the need for more invasive procedures like mediastinoscopy, or peripheral EBUS for lung nodules, our program provides the greatest diagnostic accuracy possible with the bronchoscope.
  • Electromagnetic navigational bronchoscopy (ENB):  Being the first in the state to offer this “GPS-type” of bronchoscopy, our interventional pulmonologists strive to diagnose lung nodules or masses with the highest accuracy.  TIP is the leading referral center in the state for ENB.
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  • Airway stenting:  The TIP physicians perform flexible and rigid bronchoscopy to place any type of stent available for complex airway disease.  This includes obstruction due to cancer as well as the unique “Y-stents” for tracheobronchomalacia.  No other hospital in the state offers our comprehensive complex airway services.
  • Laser therapy:  Lasers, argon plasma coagulation (APC), electrocautery or cryotherapy can be used to treat malignant tumors or benign growths in the main airways of the lungs.  We perform this wide-range of procedures, often without the need for hospitalization.
  • Bronchoplasty:  Our physicians use balloons similar to those used in angioplasty for heart disease to make airways bigger so that breathing is easier.  This is often used for tumors, scarring after radiation treatment, or other conditions.
  • Bronchial thermoplasty:  This unique treatment for asthma is offered in collaboration with the Yale Center for Asthma and Airways disease.
  • Endobronchial valves:  Currently approved for prolonged airleaks after a surgery, research is investigating their use in emphysema or COPD.
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  • Thoracentesis: Rather than having this procedure performed by a radiologist that doesn’t follow the patient, we provide ultrasound-guided thoracentesis and determine the next steps needed for patients with pleural effusions.  We provide unique, ongoing care to help prevent this fluid from returning.
  • Medical thoracoscopy (pleuroscopy):  Rather than needing to go to the operating room, we perform biopsies of the lining of the lungs (pleura) when pleural effusions recur and the cause is unknown.  We also offer pleurodesis for recurrent effusions to prevent them from returning.
  • Tunneled pleural catheter placement:  We can place a pleurx® or similar catheter so that a patient does not need to have repeated thoracentesis if the pleural effusion recurs.
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In collaboration with thoracic surgery as well as the physicians of the Thoracic Oncology Program (TOP), the interventional pulmonologists of TIP provide unmatched services in bronchoscopic and pleural procedures.  Furthermore, we continue to perform research to ensure the most advanced care possible.  

We also participate in multi-center trials that include drainage of tunneled pleural catheters (ASAP trial), genetic biomarkers of lung cancer (Allegro), and the use of endobronchial devices for COPD (PneumRx).

Patient Information

Patients do not have to leave the state for world-renowned care and the latest technological advances to improve the diagnosis and treatment of chest diseases.  For an appointment, please call (203) 688-LUNG or (203) 737-5699.

Additional information can be found on our web page:
http://yalecancercenter.org/patient/programs/thoracic/specialties/thoracic.aspx

Our Physicians

Michaud, Gaetane Celine

Associate Professor of Medicine (Pulmonary) and of Anesthesiology

Pisani, Margaret Ann

Associate Professor of Medicine (Pulmonary)
Program Director, Pulmonary and Critical Care Medicine Fellowship
Co-Director Sleep in the ICU Task Force

Puchalski, Jonathan Thomas

Assistant Professor of Medicine (Pulmonary)
Director, Thoracic Interventional Program (TIP)
Co-Director, Pediatric Aerodigestive Program
Director, Interventional Pulmonary Fellowship