Elsevier

Respiratory Medicine

Volume 100, Issue 10, October 2006, Pages 1753-1759
Respiratory Medicine

Acute exacerbation of interstitial pneumonia following surgical lung biopsy

https://doi.org/10.1016/j.rmed.2006.02.002Get rights and content
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Summary

Study objectives

Surgical lung biopsy (SLB) plays an important role in the diagnosis of interstitial pneumonia, however, the occurrence of acute respiratory failure following SLB remains largely unreported. We evaluated the incidence, clinical features, therapy and prognosis of acute exacerbation of interstitial pneumonia following SLB.

Design

Retrospective study of consecutive patients who underwent SLB to establish a diagnosis of diffuse lung disease between May 1989 and April 2000. Patients with an acute exacerbation following lung biopsy were studied, and the HRCT images of the chest before and after surgery were reviewed.

Measurements and results

Among the 236 consecutive patients with interstitial pneumonia who underwent a surgical lung biopsy, five (2.1%) (IPF, 3; NSIP, 1; COP, 1) developed acute exacerbation of the diffuse lung disease in the course of 1–18 days after SLB. The extent of parenchymal involvement on HRCT before surgery was not significantly different between operated and contralateral nonoperated lung. Significantly increased regions of parenchymal involvement on HRCT were seen postoperatively compared with the preoperative CT in both the operated (20.7±12.5% versus 38.2±10.8%, P=0.0431) and nonoperated lung (22.7±13.8% versus 70.5±24.4%, P=0.0431), but the extent of the parenchymal involvement was significantly greater on the nonoperated side (P=0.0251). Two of the 3 IPF patients died from the acute exacerbation.

Conclusions

It is important to be aware of the possibility of acute exacerbation of interstitial pneumonia following SLB even after an apparently uneventful immediate postoperative course. The asymmetric image findings suggest that intraoperative respiratory management is a possible etiologic factor.

Keywords

Acute exacerbation
Interstitial pneumonia
Surgical lung biopsy
Idiopathic pulmonary fibrosis
Nonspecific interstitial pneumonia

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