Transbronchial lung biopsy in the compromised host

Abstract

Immunocompromised patients (38) underwent transbronchial lung biopsy via the fiberoptic bronchoscope as part of a diagnostic evaluation for fever and roentgenographic evidence of a new pulmonary infiltrate. Diagnostic information was obtained from lung biopsy in 29 patients (76%), with infection accounting for 10 cases and a nonspecific interstitial pneumonitis in 13 patients. Concomitant bronchial brushings were diagnostic in only 3 patients (all with infections). Diffuse roentgenographic infiltrates were especially amenable to bronchoscopic lung biopsy diagnosis (84%), while in localized infiltrates, there was only a 43% diagnostic yield. Although thrombocytopenia and hypoxemia were common in these patients, morbidity was low (4 patients had pneumothoraces with no noteworthy bleeding) and there were no deaths resulting from this procedure. Prebiopsy platelet transfusions were used in five patients with severe thrombocytopenia (platelet count, < 50,000/mm3). The diagnostic efficiency and low morbidity associated with transbronchial lung biopsy indicate that this procedure can safely play a role in the evaluation of pneumonia in the compromised host.