INVASIVE PROCEDURES FOR DIAGNOSING PULMONARY INFECTION: A Critical Review

Abstract

SUMMARY AND CONCLUSIONS Several diagnostic modalities are available to the clinician seeking the cause of pulmonary infiltrates in either the immunocompromised or nonimmunocompromised patient. The four procedures discussed herein should be regarded as complementary. For example, bronchoscopy is done for more central lesions, aspiration lung biopsy for more peripheral lesions or focal pulmonary processes, and bronchoscopy or open lung biopsy for more diffuse processes. Clearly, the immunocompromised patient is at great risk from diffuse or focal lung disease, and a rapid, specific etiologic diagnosis is vital. There is disagreement regarding the question of whether outcome is influenced by invasive diagnostic procedures. Until prospective data are available indicating which circumstances, if any, clearly do not warrant an aggressive approach to diagnosing lung infection in immunosuppressed patients, we suggest that a sequential series of steps be carried out to attempt to diagnose specifically the cause of pulmonary infiltrates in these patients. Which procedures are chosen should be based upon the diagnostic yield at the institution treating patients with suspected lung infection.