title: Technique and use of transbronchial biopsy in children and adolescents.
abstract: 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%).
authors.affiliation: Hospital for Sick Children, London, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Whitehead
authors.forename: J P
authors.initials: JP
authors.lastname: Scott
authors.forename: P
authors.initials: P
authors.lastname: Helms
authors.forename: M
authors.initials: M
authors.lastname: Malone
authors.forename: D
authors.initials: D
authors.lastname: Macrae
authors.forename: T W
authors.initials: TW
authors.lastname: Higenbottam
authors.forename: R L
authors.initials: RL
authors.lastname: Smyth
authors.forename: J
authors.initials: J
authors.lastname: Wallwork
authors.forename: M
authors.initials: M
authors.lastname: Elliott
authors.forename: M
authors.initials: M
authors.lastname: de Leval
mesh_terms: 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