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Open lung biopsy--successful diagnostic tool with therapeutic implication in the critically ill paediatric population
R Steinberg1, E Freud, J Ben-Ari
1Department of Paediatric Surgery, Schneider Children's Medical Centre of Israel, Beilinson Campus, Petah Tiqva.
Insights
Open lung biopsy (OLB) is a safe and effective diagnostic tool for critically ill children with lung disease. It accurately identifies causes and guides treatment, improving patient outcomes.
Area of Science:
- Pediatric Pulmonology
- Thoracic Surgery
- Diagnostic Pathology
Background:
- Children with immune deficiency or chronic lung disease often present with diffuse pulmonary compromise.
- Accurate diagnosis is crucial for tailored therapy in these fragile patients to avoid adverse effects of incorrect treatment.
Purpose of the Study:
- To evaluate the diagnostic yield and safety of open lung biopsy (OLB) in pediatric patients with diffuse pulmonary compromise.
- To assess the impact of OLB findings on therapeutic management.
Main Methods:
- Retrospective review of 41 open lung biopsies performed between 1991 and 1995 in 26 pediatric patients.
- Analysis of patient demographics, clinical presentation, biopsy results, and treatment changes.
Main Results:
- Open lung biopsy was diagnostic in 96% of cases (25/26 patients).
- A specific infectious etiology was identified in 35% of immunocompromised patients.
- Therapeutic management was altered based on biopsy findings in 69% of patients (18/26).
- The procedure was associated with a low complication rate (prolonged pleural leak in 2 patients).
Conclusions:
- Open lung biopsy is a safe and valuable diagnostic procedure in critically ill children with undiagnosed pulmonary conditions.
- OLB provides essential information for guiding therapy and improving outcomes when conventional methods fail.
Abstract:
Open lung biopsy (OLB) is an important diagnostic tool in children with immune deficiency and/or chronic lung disease with diffuse pulmonary compromise. These patients require a tailored therapeutic approach owing to their fragile status and the side effects of unnecessary or inadequate treatment. Twenty-six patients of mean age 5.6 y underwent 41 open lung biopsies in our centre between 1991 and 1995. Seventeen (65%) were immunocompromised (including 13 with malignancy) and 9 had other lung diseases. The biopsies were diagnostic in 25 patients (96%), and complete clinical-pathological correlation was found in 11 (42%). A specific infectious aetiology was detected in nine patients (35%), all of them immunocompromised. Therapeutic changes were instituted on the basis of the biopsy findings in 18 patients (69%). Two patients had postoperative complications (prolonged pleural leak). We conclude that OLB is a safe diagnostic procedure even in the critically ill child and should be employed without hesitation when conventional methods fail to provide a definitive diagnosis to help redirect therapy.