We reach the lesion without opening the chest.
A dedicated interventional pulmonology service in Coimbatore for lung nodules, suspected lung cancer, airway obstruction and pleural disease. Majority of procedures done as day care
What interventional pulmonology does
It uses flexible and rigid bronchoscopes, ultrasound guidance and thoracoscopy to reach lesions inside the airways, lungs and pleural space — through the mouth, or through a single small incision.
For most patients this means a tissue diagnosis, an airway reopened, or a recurrent effusion controlled in one session, under sedation or short general anaesthesia, with same-day or next-day discharge.
It replaces mediastinoscopy, open lung biopsy and thoracotomy in a large proportion of cases — and where surgery genuinely is the better option, we say so and refer you to thoracic surgery after multi disciplinary discussion.
The procedure depends on where the lesion sits
Referrals are easiest to make when the anatomy is the starting point. This is the map of the airway from trachea to pleural space, and what we can do at each depth.
- Tumour debulking
- Airway stenting — silicone, metallic, hybrid
- Balloon dilatation for stenosis
- Foreign body removal
- Airway control in massive haemoptysis
- Endobronchial biopsy and brushings
- Bronchoalveolar lavage
- Thermal ablation — APC, electrocautery, laser
- Cryotherapy and cryo-recanalisation
- Custom spigots for persistent air leak
- EBUS-TBNA of mediastinal and hilar nodes
- Radial EBUS with guide sheath
- Cone-beam CT-guided sampling
- Transbronchial lung biopsy
- Transbronchial lung cryobiopsy for ILD
- Medical thoracoscopy with pleural biopsy
- Talc poudrage and chemical pleurodesis
- Indwelling tunnelled pleural catheter
- Thoracoscopic adhesiolysis for empyema
- Image-guided drainage, small and large bore
When to consider an interventional opinion
If any of the following applies, a referral is usually worth making early — before a second non-diagnostic procedure.
Nodules & suspected cancer
- Solitary or multiple nodules found on CT
- Peripheral lesions out of reach of routine bronchoscopy
- Suspected lung cancer needing tissue for molecular and PD-L1 testing
- Mediastinal or hilar lymphadenopathy of unknown cause
- Mediastinal staging of known or suspected lung cancer
Airway disease
- Central airway obstruction — malignant or benign
- Post-intubation and post-tracheostomy tracheal stenosis
- Tracheobronchomalacia
- Inhaled foreign body, adult and paediatric
- Haemoptysis, including massive haemoptysis
- Tracheo-oesophageal and broncho-pleural fistula
Pleural disease
- Exudative effusion undiagnosed after thoracentesis
- Malignant effusion needing definitive control
- Empyema and complicated parapneumonic effusion
- Pneumothorax and persistent air leak
- Pleural thickening, suspected mesothelioma
Diffuse lung disease
- Interstitial lung disease needing a tissue diagnosis
- Suspected sarcoidosis
- Pulmonary alveolar proteinosis
Critical care airway
- Difficult airway and tube-related complications
- Lobar collapse and secretion clearance
- Diffuse lung disease
Everything we perform
- Flexible bronchoscopy with BAL, brushings and endobronchial biopsy
- EBUS-TBNA — the guideline-recommended first test for mediastinal staging in lung cancer, ahead of surgical staging
- EBUS-guided intranodal forceps and cryo-nodal biopsy for lymphoma and sarcoidosis
- Radial EBUS with guide sheath for peripheral pulmonary lesions
- Cone-beam CT-guided bronchoscopy for peripheral pulmonary lesions — real-time confirmation of tool-in-lesion, with augmented fluoroscopy, in the same setting as radial EBUS
- Transbronchial lung biopsy
- Transbronchial lung cryobiopsy for ILD — an accepted alternative to surgical lung biopsy in experienced centres
- Rapid on-site evaluation (ROSE) with cytopathology support
- Medical thoracoscopy with pleural biopsy
- Rigid bronchoscopy
- Airway tumour debulking
- Balloon bronchoplasty and dilatation
- Airway stenting — silicone, metallic and hybrid
- Electrocautery, argon plasma coagulation and laser
- Cryotherapy and cryo-recanalisation
- Foreign body removal, adult and paediatric
- Custom-made silicone spigots for persistent air leak and bronchopleural fistula
- Whole lung lavage for pulmonary alveolar proteinosis
- Emergency airway management in haemoptysis and critical obstruction
- Ultrasound-guided pleural aspiration and biopsy
- Small-bore and large-bore intercostal drainage
- Thoracoscopic adhesiolysis for empyema and complicated effusion
- Chemical pleurodesis
- Indwelling tunnelled pleural catheter — reduces hospital days and is a guideline-endorsed first-line option alongside talc pleurodesis
- Medical thoracoscopy with talc poudrage
Not every chest problem needs a scope
The same three consultants run the general pulmonology, allergy and sleep clinic in this hospital — with a full lung function laboratory and sleep study on site. If the question is medical rather than procedural, that is the page you want.
What a dedicated unit adds
Procedural volume is the single strongest signal of capability for a referring physician — and the strongest predictor of diagnostic yield and complication rates in the published literature.
The suite
Dedicated bronchoscopy suite with fluoroscopy and C-arm, rigid bronchoscopy capability, and cardiothoracic surgery and anaesthesia backup on site for complex airway work.
The pathway
On-site cytopathology and histopathology, with molecular and PD-L1 testing pathways for lung cancer, and a weekly multidisciplinary tumour board with thoracic surgery, medical and radiation oncology and radiology.
Out of hours
Round-the-clock availability for critical airway obstruction, massive haemoptysis and inhaled foreign body. Most diagnostic work is completed as day care.
Three consultants, three areas of focus
Three consultants with distinct procedural focus, covering the airway, the mediastinum and the pleural space between them — so a referral is matched to the operator who performs that procedure most often.
Dr. V. R. Pattabhi Raman
MD, DNB — Pulmonary MedicineCore interest: endobronchial ultrasound and airway interventions — EBUS-TBNA for mediastinal staging and nodal diagnosis, rigid bronchoscopy, airway stenting, debulking and dilatation.
Dr. S. Mahadevan
MD — Pulmonary MedicineCore interest: diagnostic airway and pleural interventions — flexible bronchoscopy and biopsy techniques, thoracic ultrasound, and diagnostic pleural sampling including medical thoracoscopy.
Dr. Arjun Srinivasan
MD (Internal Medicine), DM (Pulmonary & Critical Care Medicine)Core interest: therapeutic pleural interventions and the lung nodule — thoracoscopic adhesiolysis, pleurodesis and indwelling pleural catheters, with peripheral nodule sampling by radial EBUS and cone-beam CT guidance.
Publications from the group
Twenty-six peer-reviewed papers, and co-authorship on five national guidelines and position statements — including the documents that set the Indian standard for EBUS-TBNA, pleural procedures and lung cryobiopsy. The unit did not simply adopt those standards; it helped write them.
Guidelines for EBUS-TBNA
Indian Chest Society / Indian Association for Bronchology, 2023The national standard for endobronchial ultrasound sampling — the procedure this unit performs most often.
Pleural effusion guidelines, Section 1
Indian Chest Society / NCCP, 2024Basic principles, laboratory tests and pleural procedures.
Bronchoscopic lung cryobiopsy
Indian Association for Bronchology position statement, 2019The position statement underpinning cryobiopsy as an alternative to surgical lung biopsy in ILD.
Flexible bronchoscopy during the COVID pandemic
Indian Association for Bronchology consensus statement, 2021Consensus on safe bronchoscopy under airborne-infection conditions.
Bronchial thermoplasty for severe asthma
Indian Chest Society position statement, 2020Accompanied by a multicentre study of thermoplasty safety and efficacy. This is a research contribution — thermoplasty is not offered here as a routine service.
All 26 publications
Newest first. Group members are shown in bold; each entry links to its PubMed record.
- Madan K, Agarwal S, Shrikanta JT, Mehta R, Devi K, Pattabhiraman VR, Srinivasan A, Mittal S, Hadda V, Tiwari P, Jat KR, Dhochak N, Mohan A, Guleria R, Kabra SK. Therapeutic Bronchoscopic Interventions for Non Foreign-Body Removal Indications in Children. Pediatr Pulmonol. 2025 Jan;60(1):e27462. PubMed 39739345
- Christopher DJ, Gupta R, Thangakunam B, Daniel J, Jindal SK, Kant S, Chhajed PN, Gupta KB, Dhooria S, Chaudhri S, Chaudhry D, Patel D, Mehta R, Chawla RK, Srinivasan A, Kumar A, Bal SK, James P, Roger JS, Nair AA, Katiyar SK, Agarwal R, Dhar R, Aggarwal AN, Samaria JK, Behera D, Madan K, Singh RB, Luhadia SK, Sarangdhar N, Souza G, Nene A, Paul A, Varghese V, Rajagopal TV, Arun M, Nair S, Roy DA, Williams BE, Christopher SA, Subodh DV, Sinha N, Isaac B, Oliver AA, Priya N, Deva J, Chandy ST, Kurien RB. Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures. Lung India. 2024 May 1;41(3):230-248. PubMed 38704658
- Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur V, Maturu VN, Srinivasan A, Sethuraman N, Sibia RPS, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Sehgal IS, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Gandra RR, Sistla SK, Padaki PA, Ramar D, Panigrahi MK, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Prevalence of co-existent COVID-19-associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID-19-associated pulmonary mucormycosis (CAPM). Mycoses. 2024 May;67(5):e13745. PubMed 38767273
- Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur V, Maturu VN, Srinivasan A, Sethuraman N, Sibia RPS, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Sehgal IS, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Gandra RR, Sistla SK, Padaki PA, Ramar D, Panigrahi MK, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Computed tomography findings of COVID-19-associated pulmonary mucormycosis: Data from a multicenter retrospective study (Mucovi2), India. Lung India. 2024 May 1;41(3):221-224. PubMed 38687235
- Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur V, Maturu VN, Srinivasan A, Sethuraman N, Singh Sibia RP, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Sehgal IS, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Gandra RR, Sistla SK, Padaki PA, Ramar D, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicentre retrospective study from India. Clin Microbiol Infect. 2024 Mar;30(3):368-374. PubMed 38081413
- Srinivasan A, Vallandaramam P, Sivaramakrishnan M. Rigid Bronchoscopic Management of Tracheobronchial Rhinosporidiosis Report of 5 Cases and Systematic Review of Literature. J Bronchology Interv Pulmonol. 2024 Jan 1;31(1):98-104. PubMed 37280739
- Mohan A, Madan K, Hadda V, Mittal S, Suri T, Shekh I, Guleria R, Khader A, Chhajed P, Christopher DJ, Swarnakar R, Agarwal R, Aggarwal AN, Aggarwal S, Agrawal G, Ayub II, Bai M, Baldwa B, Chauhan A, Chawla R, Chopra M, Choudhry D, Dhar R, Dhooria S, Garg R, Goel A, Goel M, Goyal R, Gupta N, Manjunath BG, Iyer H, Jain D, Khan A, Kumar R, Koul PA, Lall A, Arunachalam M, Madan NK, Mehta R, Loganathan N, Nath A, Nangia V, Nene A, Patel D, Pattabhiraman VR, Raja A, Rajesh B, Rangarajan A, Rathi V, Sehgal IS, Shankar SH, Sindhwani G, Singh PK, Srinivasan A, Talwar D, Thangakunam B, Tiwari P, Tyagi R, Chandra VN, Sharada V, Vadala R, Venkatnarayan K. Guidelines for endobronchial ultrasound- transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations. Lung India. 2023 Jul-Aug;40(4):368-400. PubMed 37417095
- Chhajed PN, Nene A, Abhyankar N, Akkaraju J, Agarwal R, Arora S, Bhat R, Chawla R, Christopher DJ, Chowdhary SR, Dhar R, Dhooria S, Goyal R, Gupta R, James P, Koul PA, Khader AKA, Madan K, Marwah V, Mehta R, Mohan A, Nangia V, Patel D, Pattabhiraman VR, Sehgal IS, Singh S, Srinivasan A, Swarnakar R, Tampi S. Conventional flexible bronchoscopy during the COVID pandemic: A consensus statement from the Indian Association for Bronchology. Lung India. 2021 Mar;38(Supplement):S105-S115. PubMed 33686993
- Madan K, Suri TM, Mittal S, Maturu VN, Pattabhiraman VR, Mohan A, Srinivasan A, Sivaramkrishnan M, Prasad KT, Agarwal R, Tiwari P, Hadda V, Mehta R, Guleria R. A multicenter study on the safety and efficacy of bronchial thermoplasty in adults with severe asthma. Lung India. 2021 Nov-Dec;38(6):524-528. PubMed 34747733
- Madan K, Mittal S, Suri TM, Jain A, Mohan A, Hadda V, Tiwari P, Guleria R, Talwar D, Chaudhri S, Singh V, Swarnakar R, Bharti SJ, Garg R, Gupta N, Kumar V, Agarwal R, Aggarwal AN, Ayub II, Chhajed PN, Dhamija A, Dhar R, Dhooria S, Gonuguntla HK, Goyal R, Koul PA, Kumar R, Maturu N, Mehta RM, Parakh U, Pattabhiraman V, Raghupathi N, Sehgal IS, Srinivasan A, Venkatnarayan K. Bronchial thermoplasty for severe asthma: A position statement of the Indian chest society. Lung India. 2020 Jan-Feb;37(1):86-96. PubMed 31898635
- Agarwal R, Dhooria S, Sehgal IS, Mehta R, Pattabhiraman V, Aggarwal AN, Bal A, Srinivasan A, Madan K, Mohan A, Chhajed P, Goyal R, Akkaraju J, Patel D. Transbronchial Lung Cryobiopsy in Diffuse Interstitial Lung Diseases . . . Bent but Not Broken. Am J Respir Crit Care Med. 2019 Oct 1;200(7):940-941. PubMed 31442072
- Dhooria S, Agarwal R, Sehgal IS, Aggarwal AN, Goyal R, Guleria R, Singhal P, Shah SP, Gupta KB, Koolwal S, Akkaraju J, Annapoorni S, Bal A, Bansal A, Behera D, Chhajed PN, Dhamija A, Dhar R, Garg M, Gopal B, Hibare KR, James P, Jindal A, Jindal SK, Khan A, Kishore N, Koul PA, Kumar A, Kumar R, Lall A, Madan K, Mandal A, Mehta RM, Mohan A, Nangia V, Nath A, Nayar S, Patel D, Pattabhiraman V, Raghupati N, Sarkar PK, Singh V, Sivaramakrishnan M, Srinivasan A, Swarnakar R, Talwar D, Thangakunam B. Bronchoscopic lung cryobiopsy: An Indian association for bronchology position statement. Lung India. 2019 Jan-Feb;36(1):48-59. PubMed 30604705
- Pattabhiraman VR, Yadav P, Srinivasan A, Sivaramakrishnan M, Shankar A. Interventional management of extensive pulmonary metastasis in adamantinoma. Lung India. 2019 Mar-Apr;36(2):166-168. PubMed 30829256
- Srinivasan A, Sivaramakrishnan M, Pattabhiraman VR, Vinod VG. Medical thoracoscopic cryoevacuation: A novel technique to manage retained hemothorax. Lung India. 2019 Jul-Aug;36(4):356-359. PubMed 31290425
- Dhooria S, Mehta RM, Srinivasan A, Madan K, Sehgal IS, Pattabhiraman V, Yadav P, Sivaramakrishnan M, Mohan A, Bal A, Garg M, Agarwal R. The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases. Clin Respir J. 2018 Apr;12(4):1711-1720. PubMed 29105361
- Mehta RM, Biraris PR, Pattabhiraman V, Srinivasan A, Singla A, Kumar S, Cutaia M. Defining expanded areas in EBUS sampling: EBUS guided trans- and intra-pulmonary artery needle aspiration, with review of transvascular EBUS. Clin Respir J. 2018 May;12(5):1958-1963. PubMed 29330908
- Singh A, Mahadevan S, Pattabhiraman VR, Srinivasan A. Multimodality multistaged management of large endobronchial carcinoid causing respiratory failure: A case report with review of literature. Lung India. 2018 Sep- Oct;35(5):411-416. PubMed 30168461
- Singh A, Pattabhiraman VR, Srinivasan A, Mahadevan S. Dumbbell posterior mediastinal schwannoma invading trachea: Multidisciplinary management - weight off the chest. Lung India. 2018 May-Jun;35(3):269-272. PubMed 29697092
- Dhooria S, Madan K, Pattabhiraman V, Sehgal IS, Mehta R, Vishwanath G, Srinivasan A, Sivaramakrishnan M, Mohan A, Mathew JL, Kabra SK, Guleria R, Behera D, Agarwal R. A multicenter study on the utility and safety of EBUS-TBNA and EUS-B-FNA in children. Pediatr Pulmonol. 2016 Oct;51(10):1031-1039. PubMed 27142997
- Srinivasan A, Sivaramakrishnan M, Vallandramam PR, Yadav P. Whistle lower- better late than never. Lung India. 2016 May-Jun;33(3):310-2. PubMed 27185996
- Srinivasan A, Sivaramakrishnan M, Vallandramam PR, Yadav P. Response to assessment of spontaneous pneumothorax in adults in a tertiary care hospital. Lung India. 2015 Jul-Aug;32(4):415. PubMed 26180403
- Vallandramam PR, Sivaramakrishnan M, Srinivasan A. EUS-B-FNA: Pulmonologist's viewpoint: Whose tube is it anyway? Lung India. 2015 May-Jun;32(3):285-6. PubMed 25983420
- Agarwal R, Srinivasan A, Aggarwal AN, Gupta D. Adaptive support ventilation for complete ventilatory support in acute respiratory distress syndrome: a pilot, randomized controlled trial. Respirology. 2013 Oct;18(7):1108-15. PubMed 23711230
- Srinivasan A, Agarwal R, Gupta N, Aggarwal AN, Gupta D. Initial experience with real time endobronchial ultrasound guided transbronchial needle aspiration from a tertiary care hospital in north India. Indian J Med Res. 2013 Apr;137(4):803-7. PubMed 23703351
- Agarwal R, Srinivasan A, Aggarwal AN, Gupta D. Efficacy and safety of convex probe EBUS-TBNA in sarcoidosis: a systematic review and meta-analysis. Respir Med. 2012 Jun;106(6):883-92. PubMed 22417738
- Srinivasan A, Agarwal R. Cardiovocal syndrome. Monaldi Arch Chest Dis. 2011 Dec;75(4):241-2. PubMed 22462312
Before your procedure
Will I need surgery?
For most patients referred to us, surgery is not required. Interventional pulmonology allows us to establish a diagnosis or relieve an airway obstruction using minimally invasive techniques—either through the natural airway or a small incision. If surgery is the best option, your case will be reviewed by our multidisciplinary team and referred to a thoracic surgeon.
Is bronchoscopy painful?
The procedure is done under sedation or general anaesthesia, so you will not feel pain during it. A sore throat or mild cough for a day afterwards is common.
How long will I need to stay?
Most diagnostic bronchoscopies, EBUS procedures and pleural aspirations are day care — you come in the morning and go home the same day. Rigid bronchoscopy, airway stenting and thoracoscopy usually need a short stay of few days.
A CT scan has shown a nodule in my lung. What happens next?
We assess the size, position and appearance of the nodule alongside your risk factors. Depending on those, the options are surveillance with a repeat CT, a PET-CT, or a biopsy — using radial EBUS, cone-beam CT-guided bronchoscopy or a percutaneous CT-guided approach, whichever reaches your lesion most safely.
My pleural fluid keeps coming back. What can be done?
Repeated drainage is not a long-term answer. We can perform thoracoscopy to establish the cause, then either seal the pleural space with talc pleurodesis or place an indwelling pleural catheter that lets you drain fluid at home without repeated hospital visits.
How soon will I get a diagnosis?
The final histopathology report is usually available within 5-7 working days, with molecular testing following where it is indicated.
Do I have to stop blood thinners?
Some blood thinners may need to be temporarily stopped, depending on the medication, the planned procedure and why you take it. Please tell us about all blood thinners and antiplatelet medicines during consultation before procedure. Never stop them without medical advice.
I have asthma or COPD — do I need a scope?
No. Asthma, COPD, bronchiectasis and sleep apnoea are managed in our general pulmonology and sleep clinic with breathing tests, imaging and medication review. A bronchoscopy is only considered if the diagnosis remains unclear, if there is bleeding or an unexplained shadow, or if a specific intervention is being planned.
Can children have these procedures?
Yes. We perform paediatric bronchoscopy, including foreign body removal, with paediatric anaesthesia support.
Book an interventional pulmonology consultation
Send the request and the unit will confirm a slot. For an obstructed airway, massive haemoptysis or an inhaled foreign body, do not use this form — call the hospital directly.
Most diagnostic procedures are completed as day care, and you are told at the consultation which procedure is planned, what it involves and how long you will be in hospital.
Get a clear diagnosis, sooner
An unexplained shadow on a CT, an effusion that keeps returning, or breathlessness from a narrowed airway — a focused interventional assessment can answer it without major surgery.
