Acute exacerbation of interstitial pneumonia following surgical lung biopsy.
OBJECTIVE
Surgical lung biopsy (SLB) plays an important role in the diagnosis of interstitial pneumonia, however, the occurrence of acute respiratory failure following SLB remains largely unreported. We evaluated the incidence, clinical features, therapy and prognosis of acute exacerbation of interstitial pneumonia following SLB.


METHODS
Retrospective study of consecutive patients who underwent SLB to establish a diagnosis of diffuse lung disease between May 1989 and April 2000. Patients with an acute exacerbation following lung biopsy were studied, and the HRCT images of the chest before and after surgery were reviewed.


RESULTS
Among the 236 consecutive patients with interstitial pneumonia who underwent a surgical lung biopsy, five (2.1%) (IPF, 3; NSIP, 1; COP, 1) developed acute exacerbation of the diffuse lung disease in the course of 1-18 days after SLB. The extent of parenchymal involvement on HRCT before surgery was not significantly different between operated and contralateral nonoperated lung. Significantly increased regions of parenchymal involvement on HRCT were seen postoperatively compared with the preoperative CT in both the operated (20.7+/-12.5% versus 38.2+/-10.8%, P = 0.0431) and nonoperated lung (22.7+/-13.8% versus 70.5+/-24.4%, P = 0.0431), but the extent of the parenchymal involvement was significantly greater on the nonoperated side (P = 0.0251). Two of the 3 IPF patients died from the acute exacerbation.


CONCLUSIONS
It is important to be aware of the possibility of acute exacerbation of interstitial pneumonia following SLB even after an apparently uneventful immediate postoperative course. The asymmetric image findings suggest that intraoperative respiratory management is a possible etiologic factor.
Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi 489-8642, Japan. konyasu2003@yahoo.co.jp
Yasuhiro
Y
Kondoh
Hiroyuki
H
Taniguchi
Masanori
M
Kitaichi
Toyoharu
T
Yokoi
Takeshi
T
Johkoh
Takashi
T
Oishi
Tomoki
T
Kimura
Osamu
O
Nishiyama
Keisuke
K
Kato
Roland M
RM
du Bois
D000208:Acute Disease; D000368:Aged; D001706:Biopsy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000009:adverse effects; D008168:Lung / Q000473:pathology*; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods