Pulmonary complications are frequent in immunocompromised patients. In antibiotic resistant fever or persistent infiltrates bronchoscopy is performed. In a considerable number of cases VATS or OLB is needed to achieve a definitive diagnosis. We assessed the diagnostic yield in 115 immunocompromised patients (mean age 49.5 Â± 11.1 years) undergoing diagnostic surgery from 2000 2009. Underlying diseases consisted of hematologic malignancy (74), rheumatologic disorder/vasculitis (18), solid organ transplantation (9), interstitial pneumopathy (4), carcinoma (5) and others (5). 78 patients underwent VATS biopsy and 37 OLB. Histological diagnoses revealed an infectious agent in 37 (32%), malignancy in 7 (6%), diffuse interstitial pneumopathies in 61 (53%) and vasculitis in 7 (6%) patients. Infections included invasive pulmonary aspergillosis (21), Rhizopus (2), Hormographiella (2), mucormycosis (1), aspergilloma (2), bacterial pneumonia/abscess (4), tuberculosis (2), pneumocystis (2), echinococcus (1). Malignancy was documented in 7 cases. 6 biopsies showed vasculitis, one a rheumatoid nodule. The 61 diffuse interstitial pathologies consisted of: bronchiolitis obliterans (24), organizing pneumonia (6), diffuse alveolar damage (5), fibrosing alveolitis (9), respiratory-bronchiolitis interstitial lung disease (3), usual interstitial pneumonitis (4), non-specific interstitial pneumonitis (2), exogen allergic alveolitis (1). Overall a histological diagnosis could be made in 99% of cases. Summary and conclusion: The diagnostic yield of lung biopsy in immunocompromised patients with pulmonary infiltrates is very high with a broad variety of diagnoses directly affecting patient management.
Full conference title:
20th European Respiratory Society conference
- ERS 20th (2010)