DIAGNOSTIC OPEN LUNG BIOPSY IN CHILDREN

Abstract

Lung biopsy is often required to establish the cause of diffuse infiltrative pulmonary disease. While open lung biopsy permits better tissue sampling, controversy exists concerning potential risks of the procedure. Over a 4-year period, 35 patients ages 3 months to 18 years with diffuse pulmonary disease underwent diagnostic open lung biopsy. In 28 patients, a preexisting malignancy was present. All biopsy procedures were performed in the operating room, with general anesthesia used in all but 1 case. Lingular biopsies were performed in the 26 patients with bilateral disease. A specific etiology was identified in 24 patients: 17 had pneumocystis carinii pneumonia; 1 fungal pneumonia; 1 bacterial pneumonia; 2 desquamative interstitial pneumonia; 1 pulmonary hemosiderosis; 1 pulmonary histiocytosis, and 1 methotrexate pneumonitis. The remaining 11 patients had non-specific pneumonitis. One patient subsequently demonstrated to have pneumocystis carinii pneumonia had a falsely negative biopsy. The only significant complications were 2 pneumothoraces requiring prolonged chest tube drainage. There were no deaths directly attributable to the operative procedure. One patient with a brain tumor died 18 hours after biopsy due to cerebellar herniation. Open lung biopsy is a safe and reliable diagnostic technique in seriously ill pediatric patients with diffuse pulmonary disease.