Technique and use of transbronchial biopsy in children and adolescents.
Since July 1988, a total of 92 transbronchial biopsies (TBB) have been performed in 18 patients (aged 3-16 years). Twelve patients (67%) were heart-lung transplant (HLT) recipients undergoing surveillance for pulmonary graft rejection and infection. The remainder included immunocompromised patients at risk of opportunistic infections (n = 4), patients with fibrosing alveolitis (n = 1) and a collagen vascular disorder with suspected lung involvement (n = 1). TBB was performed through either a fiberoptic (n = 50) or a rigid (n = 41) bronchoscope, all under general anesthesia. On one occasion a cardiac bioptome was used through an endotracheal stent. The sensitivity of TBB for diagnosing acute and chronic rejection in HLT patients was 88% and 60%, respectively (specificity, 91% and 100%). Definitive diagnoses were made in 4 (67%) of the non-HLT group. Bronchoalveolar lavage (BAL) was performed during each procedure for microbiological and cytological examination. Thirty-four pathogenic organisms including Pseudomonas aeruginosa (16/34), Staphylococcus aureus (8/34), and Candida albicans (5/34) were isolated from BAL culture. Complications included pneumothorax (8%), transient pyrexia (7%), and dyspnea (2%).
Whitehead
B
B
Hospital for Sick Children, London, United Kingdom.
Scott
J P
JP
Helms
P
P
Malone
M
M
Macrae
D
D
Higenbottam
T W
TW
Smyth
R L
RL
Wallwork
J
J
Elliott
M
M
de Leval
M
M
D000163:Acquired Immunodeficiency Syndrome / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D001424:Bacterial Infections / Q000209:etiology / Q000473:pathology / Q000601:surgery; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D006084:Graft Rejection; D006801:Humans; D008168:Lung / Q000473:pathology / Q000601:surgery; D008171:Lung Diseases / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008172:Lung Diseases, Fungal / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D011014:Pneumonia / Q000209:etiology / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology