Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy.
BACKGROUND
Children with chronic infectious interstitial lung disease often have to undergo open lung biopsy to establish a final diagnosis. Open lung biopsy is an invasive procedure with major potential complications. Transthoracic lung biopsy (TLB) guided by computed tomography (CT) is a less-invasive well-established procedure in adults.


OBJECTIVE
Detailing the role of low-dose CT-guided TLB in the enhanced diagnosis of chronic lung diseases related to infection in children.


METHODS
A group of 11 children (age 8 months to 16 years) underwent CT-guided TLB with a 20-gauge biopsy device. All investigations were done under general anaesthesia on a multidetector CT scanner (SOMATOM Volume Zoom, Siemens, Erlangen, Germany) using a low-dose protocol (single slices, 120 kV, 20 mAs). Specimens were processed by histopathological, bacteriological, and virological techniques.


RESULTS
All biopsies were performed without major complications; one child developed a small pneumothorax that resolved spontaneously. A diagnosis could be obtained in 10 of the 11 patients. Biopsy specimens revealed chronic interstitial alveolitis in ten patients. In five patients Chlamydia pneumoniae PCR was positive, in three Mycoplasma pneumoniae PCR was positive, and in two Cytomegalovirus PCR was positive. The average effective dose was 0.83 mSv.


CONCLUSIONS
Low-dose CT-guided TLB can be a helpful tool in investigating chronic infectious inflammatory processes in children with minimal radiation exposure. It should be considered prior to any open surgical procedure performed for biopsy alone. In our patient group no significant complication occurred. A disadvantage of the method is that it does not allow smaller airways and vessels to be assessed.
Heyer
Christoph M
CM
Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Ruhr-University of Bochum, Germany. christoph.heyer@ruhr-uni-bochum.de
Lemburg
Stefan P
SP
Kagel
Thomas
T
Mueller
Klaus-Michael
KM
Nuesslein
Thomas G
TG
Rieger
Christian H L
CH
Nicolas
Volkmar
V
D000293:Adolescent; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D023521:Chlamydophila Infections / Q000175:diagnosis; D016993:Chlamydophila pneumoniae / Q000502:physiology; D002908:Chronic Disease; D003586:Cytomegalovirus Infections / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000382:microbiology*; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis; D011019:Pneumonia, Mycoplasma / Q000175:diagnosis; D011024:Pneumonia, Viral / Q000175:diagnosis; D011030:Pneumothorax / Q000209:etiology; D011650:Pulmonary Alveoli / Q000473:pathology; D011829:Radiation Dosage; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed