Benefits of Open Lung Biopsy in Patients with Previous Nondiagnostic Transbronchial Lung Biopsy

Abstract

In a 17-month period, 20 immunosuppressed patients underwent transbronchial biopsy of the lung for diagnostic evaluation of a pulmonary infiltrate of unknown etiology. In 19 patients, the fransbronchial biopsy was nondiagnostic. Thirteen of the 19 patients were critically ill and were referred for an open lung biopsy. Eleven (85 percent) of these 13 patients left the hospital after open lung biopsy and appropriate medical treatment. Two patients who were receiving mechanical ventilation at the time of open biopsy succumbed to the combination of their underlying disease and respiratory failure. �he initial evaluation of pulmonary infiltrates of unknown etiology generally begins with noninvasive tests such as cytologic study and cultures of the sputum. Thereafter, a transbronchial biopsy of the lung using a fiberoptic bronchoscope’ or guided flexible catheter2 is indicated. If no diagnosis is established, an open lung biopsy should be performed for definitive diagnosis and treatment.’� Proceeding with open lung biopsy in the immunosuppressed patient with a pulmonary infiltrate of unknown etiology offers a more challenging therapeutic problem, since these patients frequently have associated problems which increase their surgical risks. These problems include abnormal bleeding factors, reduced granulocyte reserve, and poor healing of tissue. This report evaluates the benefits of proceeding with open lung biopsy after a nondiagnostic transbronchial lung biopsy in critically ill immunosuppressed patients who had pulmonary infiltrates of