TREPHINE AIR DRILL, BRONCHIAL BRUSH, AND FIBEROPTIC TRANSBRONCHIAL LUNG BIOPSIES IN IMMUNOSUPPRESSED PATIENTS

Abstract

Nonthoracotomy lung and bronchial biopsy procedures (79) were performed [to investigate opportunistic pulmonary infection] in 52 immunosuppressed patients: 22 renal transplants, 24 lymphoreticular malignancies and 6 other disorders. The total diagnostic yield was 74% (23 of 31) of the forceps transbronchial biopsy procedures, 82% (14 of 17) of the percutaneous trephine lung biopsies and 28% (9 of 31) of the bronchial brush biopsies. An etiologic diagnosis, including a variety of viral, fungal and parasitic diseases, was obtained in 42% (13 of 31) of the transbronchial biopsy procedures and 65% (11 of 17) of the percutaneous trephine lung biopsies. The etiologic diagnostic yield was increased to 48% when bronchial brushing was combined with forceps transbronchial biopsy. Hemorrhage complicated 26% of the transbronchial biopsy procedures and 17% of the percutaneous trephine biopsies; pneumothorax occurred in 19% and 60%, respectively. Hemorrhagic complications in patients undergoing transbronchial biopsy occurred 3 times as frequently among the uremic patients (5 of 11, 45%) as among the nonazotemic patients (3 of 20, 15%). Patients with thrombocytopenia, when corrected by platelet infusion, presented no increased risk. Of the 52 patients, 19 (36%) died 2-60 days after biopsy, but no fatalities were related to the biopsy procedure.