Interventional Pulmonology is an emerging surgical subspecialty of pulmonary medicine. With a combination of technology, skill and devices physicians can view and navigate within the pulmonary system. This technology allows better care for patients; physicians can diagnose lung disease sooner than in the past. Treatment options are also less invasive which makes healing time shorter and less risk for infection.

lung image

Dr. Karim offers a full range of advanced diagnostic and therapeutic services, everything from first evaluation or endobronchial treatment of early lung disease to palliative management of complicated airways disease.

Dr. Karim completed his medical
residency at the University of
Missouri-Kansas City. He completed
an additional three years of
fellowship (and is board certified)
in Pulmonary, Critical Care and
Sleep Medicine (also at University
of Missouri-Kansas City).

Dr. Karim is affiliated with several hospitals in Michigan where he performs the following procedures (click a procedure below for more information):


Bronchoscopy is a procedure during which your physician uses a viewing tube to evaluate a patient's lung and airways including the voice box and vocal cord, trachea and many branches of bronchi. Although a bronchoscope does not allow for direct viewing and inspection of the lung tissue itself, samples of the lung tissue can be biopsied through the bronchoscope and sent off to a laboratory for further diagnosing.

There are two types of bronchoscopes - a flexible fiberoptic bronchoscope and a rigid bronchoscope. In most cases, conscious sedation "twilight sleep" is utilized with the flexible fiberoptic bronchoscopy. However, rigid bronchoscopy requires general anesthesia and the services of an anesthesiologist. During the bronchoscopy, the physician can see the tissues of the airways either directly by looking through the instrument or by viewing on a TV monitor.

Depending on the indication your physician will choose between the flexible fiber optic bronchoscope or the rigid bronchoscope. For example, if a patient were coughing up large amounts of blood, a rigid bronchoscope is used since it has a large suction channel and allows for the use of instruments that can better control bleeding. The vast majority of bronchoscopies are performed using the flexible fiberoptic scope because of the improved patient comfort and reduced use of anesthesia.

Bronchial Thermoplasty (BT)

Bronchial thermoplasty (BT) is a noninvasive procedure used to treat asthma patients who do not respond to conventional inhaler treatment. It uses radiofrequency energy to heat the smooth muscle walls of the airway, which thins the smooth airway wall muscles without scarring or damaging them.

During this procedure your physician uses a bronchoscope to gain access to the area he is treating, within the lungs. Once he has advanced the bronchoscope to the area of treatment the catheter is introduced through the bronchoscope. The tip of the catheter is inflated to the point that it touches the bronchial walls. It is then heated up to, just under 150° F. This will thin the muscle walls without burning them.

View Brochure   |   Learn more...

Endobronchial Electrosurgery

Endobronchial electrosurgery is used to remove lesions in the trachea and bronchi. This is done, by your physician, with a bronchoscope. During this procedure, an electrical current is used to destroy tissue. It can also be used to stop bleeding during procedures.

Endobronchial Stent Placement

Stents are small, cylindrical, expandable tubes very similar to those cardiologists use to open up arteries in the heart. Your physician uses them to open bronchial tubes (airways) that are occluded or narrowed due to infection, tumors or scar tissues.

Stents(s) are implanted in the airway via a bronchoscope. Your physician will check the suspected airways to identify the area(s) that are occluded or narrowed and measure the proposed stent to fit. The stent is placed in the airway via bronchoscope.

Super Dimension Bronchoscopy (Super D, Electromagnetic Navigation)

By using this advanced imaging system allows minimally invasive biopsies of lesions anywhere in the lungs. This procedure is non-invasive and replaces the old needle biopsy done formally through the chest or open surgery where a slice of lung tissue would be taken and sent off to a lab for diagnosing. The old approach is both painful and stressful not to mention the time factor in early detection of lung cancer.

The superDimension procedure is painless and only takes 20-30 minutes. By using this technology your physician can follow a three-dimensional map into even the tiniest areas of the tracheobronchial tree (the farthest reaching branches of the lungs, where traditional diagnostics cannot reach) to perform a quick biopsy.

Learn more...

Endobronchial Ultrasound (EBUS)

Endobronchial ultrasound (EBUS) is a procedure used in the diagnosis of lung cancer (and staging), lung infections and other diseases that cause the lymph nodes to become enlarged or masses in the chest. If a suspicious area is seen, such as enlarged lymph nodes, a hollow needle can be passed through the bronchoscope and guided by ultrasound into the abnormal structures to obtain a biopsy.

EBUS is a minimally invasive procedure, so patients can have it can be performed on an outpatient basis. This new technology allows your physician to look in areas that were unable to be seen via bronchoscopy, previously. He can sample lung masses and lymph nodes with the help of ultrasound guidance this eliminates the need of surgery to perform the biopsy. This is known as a technique called transbronchial needle aspiration (TBNA) to obtain tissue samples from the lungs and surrounding lymph nodes without conventional surgery.

The samples can be used for diagnosing and staging lung cancer, detecting infections and identifying inflammatory diseases that affect the lungs.

Spiration Valve Placement (for persistent pneumothorax/airleak)

During the Spiration Valve Placement, Spiration valve(s) are implanted in the airway via a bronchoscope. Your physician will check the suspected airways to identify the leak and measure the airway. He does this with a tiny balloon that he inserts through the bronchoscope. He uses this information to determine the correct size of the valve(s). Then he will place the valve(s) into the selected airway(s). He places them by passing them through the bronchoscope with a catheter. Once he places the valve (it is implanted), it opens up like a small umbrella blocking the airflow in to the leaking lung tissue. This will decrease the air flow and/or stop the air leak allowing the tissue to heal. It usually takes 3-4 valves per target lobe.

Learn more...

Floroscopy Guided Transbronchial Biopsy

A transbronchial biopsy usually takes less than half an hour. Your doctor will pass a flexible bronchoscope through your nose and down into your lungs. Sometimes he will pass the bronchoscope through your mouth instead of your nose. Your doctor will use the bronchoscope to examine your airways (bronchi). As he moves deeper into the lung, an X-ray machine called a fluoroscopy is used. The fluoroscopy allows your physician to visually see where he is within the lung. The image is sent to a monitor so that the nodule and any motion can be seen live and in detail. He will then gently insert a small device that pinches, similar to tweezers, called forceps down one of your airways (a bronchus) into your lung. Once he reaches the nodule, your doctor will use the forceps to take samples of lung tissue.

Medical Pleuroscopy

A pleuroscopy is a medical procedure in which your physician can examine the pleural cavity, the space between the 2 layers of tissue that line the lungs.

During a pleuroscopy, a tube called a pleuroscope is inserted into the pleural cavity through a small incision in the chest wall. Your physician can then visualize the pleural cavity with a special camera. A pleuroscopy can be a minimally invasive way to inject medications into the pleural space for people suffering from pleural effusions (the build up of fluid in the pleural space). Biopsies can also be performed for abnormalities.

PleurX® Catheter Placement (tunneled pleural catheter)

The PleurX® catheter is a semi permanent plastic tube which is placed through the skin and into the pleural space. This is usually placed when there is a need for repeated drainages of pleural fluid (pleural effusion). This is primarily used for malignancy related effusions. It is usually done only under local anesthesia. Once the effusion is located (using ultrasound guidance). Then the skin is completely numbed with lidocaine. A small incision is made and the catheter is inserted into the pleural space. The tube is secured by “tunneling” in the skin and suturing.


Ultrasound guided Thoracentesis

Ultrasound guided thoracentesis is a procedure which your physician inserts a needle into your chest to remove fluid from the pleural space (the space between the inner and outer lining of the lung). By doing this, you physician can determine the cause of the excess fluid as well as relieve the symptoms caused by it. Using ultrasound guidance, the fluid is located. The area is cleansed and numbed with anesthetic. A needle is inserted into the pleural space, where the fluid is located, the fluid is then collected and sent to a lab for further evaluation. A bandage or small dressing is then placed over the thoracentesis site. A chest x-ray may be taken.

Chest Tube Placement

A chest tube placement involves the surgical placement of a hollow, flexible drainage tube into the chest. Chest tubes are inserted to drain blood, fluid or air. By doing this, allows the lungs to fully expand. Your physician places the tube between the ribs and into the space between the inner and outer lining of the lung (pleural space). The chest tube is inserted through a one-inch cut in the skin between the ribs into the chest. It is connected to a bottle or canister that contains sterile water. Suction is attached to the system for drainage. A stitch (suture) and adhesive tape keep the tube in place. A chest x-ray will be done to make sure it is in the right place.

When the chest tube is no longer needed, your physician will remove it by:

  1. Loosening the suture or tape
  2. You will take a deep breath
  3. He will remove the tube

The area may be sutured or bandaged. Another x-ray will be taken.

Fibro-Optic Laryngoscopy

Fibro-Optic laryngoscopy provides a magnified view of the voice box while the patient produces sound (speaking, singing, etc.). Viewing is done through a flexible viewing-tube passed through the patient's nose to the back of the throat, thus allowing your physician to view the voice box while the patient speaks, sings, coughs, sniffs, etc.

Foreign body retrieval

Foreign body retrieval is a procedure needed when a foreign object is located in the airway or lung. This is performed via bronchoscopy. The bronchoscope is advanced into the airway and the foreign body is located. Once it is located your physician will use other instruments for the retrieval. (depending on the type of foreign body). After it is removed, your physician will double check for any remnants that may be remaining and remove those, if needed.

Dr. Karim specializes in treating patients with…

  • Lung mass
  • Pulmonary Nodules
  • Asthma
  • Pleural effusion
  • Lung cancer
  • Pneumothorax
  • Pleural diseases