Spectrum of diffuse parenchymal lung diseases using medical thoracoscopic lung biopsy: An experience with 55 patients during 2013–2015

Abstract

Background: Diffuse parenchymal lung diseases (DPLD) constitute a heterogeneous group of lung diseases characterized by varying degrees of inflammation and fibrosis. In some DPLD, significant morbidity and unfavorable evolution, comparable to those of neoplastic diseases, are seen. Therefore, an efficient and safe method for the diagnostic confirmation of DPLD is needed. Currently, thoracoscopic lung biopsy is widely used for this purpose. Aim of work: The objective of the present study was to analyze the role of medical thoracoscopic lung biopsy, in the diagnosis of different types of diffuse parenchymal lung diseases. Patients and methods: This study included 55 patients with undiagnosed DPLD who were selected from Chest Department inpatients, Kasr Alaini Hospital during the period from June 2013 to August 2015. All patients were subjected to written informed consent, full medical history, detailed clinical examination, coagulation profile, echocardiography, immune and collagen profile, arterial blood gases analysis, spirometry, high resolution computed tomography (HRCT) of the chest and medical thoracoscopic lung biopsy. Results: Out of the 55 patients included in the study, 32 (58.2%) were females, 23 (41.8%) were males, 14 (25.5%) were smokers, 12 (21.8%) had history of raising birds and 12 (21.8%) had positive collagen profile. The mean age was 39.96 years (range, 10–67). HRCT showed different patterns of parenchymal affection in addition to mediastinal lymph node enlargement in 8 (14.5%) patients, and pleural effusion in 11 (20%) patients. Definitive diagnosis was made in 54 patients (98.18%) and idiopathic interstitial pneumonia was the predominant diagnosis (43.64%) followed by DPLD of known cause (36.36%) then granulomatous DPLD (12.7%) and lastly other rare forms of DPLD (5.45%). The most common diagnoses were the usual interstitial pneumonia in 9 (16.4%), metastatic adenocarcinoma in 8 (14.8%), desquamative interstitial pneumonia in 7 (12.7%), hypersensitivity pneumonitis in 5 (9.1%), non specific interstitial pneumonia, sarcoidosis and pneumoconiosis each in 4 (7.3%) cases. The mean duration of intercostal tube insertion was 3.4 days. No reported mortality and complications included prolonged air leak in 4 patients, residual pneumothorax after removal of intercostal tube in 1 patient, and subcutaneous emphysema in 2 patients. Conclusions: Lung biopsy through medical thoracoscopy is a safe, effective and viable procedure for the diagnosis of diffuse parenchymal lung diseases.

Keywords

• Medical thoracoscopic lung biopsy
• Diffuse parenchymal lung diseases