Video-Assisted Thoracoscopic Lung Biopsy as a Possible Cause of Acute Interstitial Pneumonia in a Patient with Nonspecific Interstitial Pneumonia

D Jeffrey Moore,Yannick Cartier,Colm P Mcparland,Martin J Bullock,Paul Hernandez

doi:10.1155/2004/805742

Abstract

The present case report describes a 44-year-old woman who presented with dyspnea due to diffuse interstitial lung disease. High-resolution computed tomography showed features of usual interstitial pneumonia, but the lung biopsy obtained by video-assisted thoracoscopy was consistent with a histological pattern of nonspecific interstitial pneumonia. Following the procedure, the patient developed progressive respiratory distress and died on postoperative day 13 with a clinical picture of acute interstitial pneumonia. The autopsy showed evidence of diffuse alveolar damage superimposed on the background pattern of nonspecific interstitial pneumonia. The present case report supports the notion that patients with a variety of subtypes of idiopathic interstitial pneumonias may be at risk of exacerbation of their underlying disease following thoracic procedures, including video-assisted thoracoscopic lung biopsy.

Highlights

We present the case of a 44-year-old woman with nonspecific interstitial pneumonia (NSIP) who deteriorated rapidly following video-assisted thoracoscopic surgery (VATS) lung biopsy, and was subsequently found at autopsy to have developed acute interstitial pneumonia (AIP)
We propose that the VATS procedure was responsible for the exacerbation of this patient’s underlying, previously stable NSIP
It is becoming recognized that VATS and other invasive thoracic procedures may exacerbate underlying interstitial pneumonias (IIP)

Summary

CASE REPORT

D Jeffrey Moore MD FRCPC1, Colm P McParland MB FRCPC2, Martin J Bullock MD FRCPC3, Yannick Cartier MD FRCPC4, Paul Hernandez MDCM FRCPC2. The present case report supports the notion that patients with a variety of subtypes of idiopathic interstitial pneumonias may be at risk of exacerbation of their underlying disease following thoracic procedures, including videoassisted thoracoscopic lung biopsy. We present the case of a 44-year-old woman with nonspecific interstitial pneumonia (NSIP) who deteriorated rapidly following video-assisted thoracoscopic surgery (VATS) lung biopsy, and was subsequently found at autopsy to have developed acute interstitial pneumonia (AIP). Figure 2) Pathology (hematoxylin and eosin stain, original magnification 100×) from the video-assisted thoracoscopic lung biopsy showing thickening and fibrosis of alveolar walls with patchy chronic interstitial inflammation and a small muscular pulmonary artery with a thick wall, which is consistent with nonspecific interstitial pneumonia. The patient was started on ceftriaxone sodium for possible nosocomial pneumonia

Lung biopsy as a cause of acute interstitial pneumonia

DISCUSSION

Findings

Desquamative interstitial pneumonia Lymphoid interstitial pneumonia

CONCLUSIONS