Objective: To determine the character of open lung biopsy in immunocompetent patients with community-acquired pneumonia who require hospitalization.
Objective: To determine the character of open lung biopsy in immunocompetent patients with community-acquired pneumonia who require hospitalization.
Design: A form into groups of 1,118 patients with exact community-acquired pneumonia that required hospitalization were enlisted in the study. Of the patients, 26 underwent exhibit lung biopsy. Another 18 of these patients were immunocompromised and were exclud from this portion of the study.
Setting: Tertiary care 800-bed hospital from November 1981 to May 1989
Results: Progressive diffuse pulmonary infiltrates and negative conventional tillages were the indications for biopsy in chiefly of these patients. Eighteen (69 percent) were immunocompromised. The eight immunocompetent patients underwent a retrospective review of their course in hospital. Three patients died. The diagnostic yield from exhibit lung biopsy was 25 percent A specific histologic diagnosis was made in single in kind patient--lipoid pneumonia. The pulmonary histologic finding were nonspecific in the remaining patients, on the contrary in four, in combination with the clinical data, gave useful information and be the effected in therapy change. Culture of a pulmonary tissue yielded cytomegalovirus in single other patient. Serologic testing had a gentle yield in this group with three patients having a positive result
Conclusions: expand lung biopsy is rarely necessary in immunocompetent patients with community-acquired pneumonia. In a small form into groups of patients where it is necessary, however, the couple positive and negative results are important in directing therapy.
(Chest 1994; 106:23-27) CMV = cytomegavirus; CT = comput tomography
The character of open lung biopsy in the diagnosis of diffuse pulmonary infiltrates has been the bring under rule of many studies in immunocompromised patients,(1) and in general, an aggressive diagnostic approach has been advocated in as it was patients.(2) However, there is little information in succession the role of open lung biopsy in community-acquired pneumonias in patients who are immunocompetent. During a large 8-year prospective meditation of community-acquired pneumonia, we noted that 26 patients underwent exhibit lung biopsy as part of the diagnostic work-up. We retrospectively reviewed the issue of the eight who were immunocompetent.
MATERIALS AND METHODS
Identification and Investigation of Patients With Pneumonia
Criteria for enrollment of patients in our consideration and the diagnostic work-up have been given elsewhere.(3) In brief, all patients admitted with a diagnosis of penumonia were interviewed by way of a study nurse and the chest radiograph was reviewed by way of one of the authors. Patients were chronicleed in the study if they had a of the present day pulmonary opacity, acute onset of respiratory symptoms, and had not been hospitalized in the previous 10 days.
house and sputum cultures were aggregateed at the discretion of the attending staff and courseed according to conventional techniques.
An acute phase kin sample was obtained on admission, and whenever possible a convalescent phase sample was obtained 2 to 6 weeks later. The serum samples were proofed for antibodies: Legionella pneumophila serogroup 1 to 4; adenovirus group; Chlamydia group; influenza viruses A and B; para-influenza viruses 1 2 and 3; Mycoplasma pneumoniae; Coxiella burnetii; and cytomegalovirus (CMV)(3)
Immune status was determined clinically. Immunosuppressed patients were exclud from this portion of the study
Six patients underwent bronchoscopy before lay open lung biopsy. Cultures from bronchoalveolar lavage were obtained, however cell counts were not. Transbronchial lung biopsy was performed forward three patients--those not receiving ventilatory support.
render free of access Lung Biopsy
The decision to perform an lay open lung biopsy was made according to the attending staff. Biopsy was performed because of progressive pneumonia with diffuse pulmonary infiltrates, negative findings from conventional agricultures and negative bronchoscopy results in six of the eight patients. Patients 1 and 2 had focal radiographic abnormalities in addition to diffuse parenchymal opacities. The tissue obtained at surgery was divided into pair portions--one for culture and the other for histologic examination. Samples were cultur for aerobic and anaerobic bacteria, mycobacteria, fungi, and respiratory tract viruses using standard technique.(3) Histologic examination was carried not at home after fixation and preparation with a variety of stains including hemotoxylin-eosin, Gomori's methenamine-silver, Giemsa, Ziehl-Neelsen, and Gram's.
Chest Radiography
Frontal and, in greatest in quantity cases, lateral chest radiographs were obtained forward all patients at the time of hospital admission. Frontal radiographs were also obtained at the time of unclose lung biopsy (within 24 h of biopsy). Radiographs obtained after biopsy were not analyzed for the meaning of this study. All material was reviewed by means of two radiologists independently and in the absence of clinical information. A differential diagnosis was prompted for each patient with three entities listed in decreasing order of probability. sum of two units patients were excluded from this portion of the inquiry due to technically unsatisfactory microfilm copies.
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