Lung Biopsy

Pediatric Lung Biopsy

Overview

Lung biopsy in pediatric patients is a specialized diagnostic procedure used to obtain lung tissue samples for histological examination. This procedure is crucial for diagnosing various pulmonary conditions and guiding therapeutic decisions in complex respiratory cases.

Key Points

Essential diagnostic tool for diffuse lung diseases
Multiple approaches available based on lesion location and patient condition
Requires careful risk-benefit assessment
Diagnostic yield varies by technique and pathology
Specialized pediatric centers show better outcomes

Biopsy Approaches

Transbronchial Biopsy
- Performed via flexible bronchoscopy
- Less invasive option
- Smaller tissue samples
- Better for focal lesions
Video-Assisted Thoracoscopic Surgery (VATS)
- Minimally invasive surgical approach
- Excellent visualization
- Larger tissue samples
- Multiple sampling sites possible
Open Lung Biopsy
- Traditional surgical approach
- Larger incision
- Maximum tissue access
- Reserved for specific cases

Primary Indications

Diffuse Lung Disease
- Interstitial lung disease
- Unexplained pulmonary infiltrates
- Suspected alveolar proteinosis
Focal Lesions
- Suspicious pulmonary nodules
- Mass lesions
- Persistent infiltrates
Specific Clinical Scenarios
- Immunocompromised patients with infiltrates
- Suspected malignancy
- Transplant evaluation
- Unexplained respiratory failure

Absolute Contraindications

Severe coagulopathy
Severe pulmonary hypertension
Inability to tolerate single-lung ventilation
Significant hemodynamic instability

Relative Contraindications

Moderate coagulation disorders
Severe respiratory compromise
Recent acute respiratory infection
Significant pleural adhesions
Mechanical ventilation requirements

Pre-procedure Evaluation

Laboratory Studies
- Complete blood count
- Coagulation profile
- Arterial blood gases
- Type and cross-match
Imaging Studies
- Chest CT with contrast
- Chest radiograph
- Pulmonary function tests when possible
Anesthesia Assessment
- Airway evaluation
- Cardiopulmonary status
- Risk stratification

VATS Procedure Steps

Positioning and port placement
Single-lung ventilation establishment
Thoracoscopic exploration
Biopsy site selection
Tissue sampling with endoscopic staplers
Hemostasis confirmation
Chest tube placement
Wound closure

Major Complications

Pneumothorax requiring intervention
Significant bleeding
Prolonged air leak
Respiratory failure
Infection/Empyema

Minor Complications

Transient air leak
Minor bleeding
Post-procedure pain
Atelectasis
Low-grade fever

Complication Prevention Strategies

Careful patient selection
Optimal surgical technique
Proper tissue handling
Adequate post-operative care

Immediate Post-operative Care

Intensive Care Monitoring
- Continuous vital sign monitoring
- Respiratory status assessment
- Pain management
- Chest tube management
Chest Tube Management
- Air leak assessment
- Drainage monitoring
- Suction requirements
- Removal criteria

Recovery Phase

Pain Control Protocol
Respiratory Physiotherapy
Mobilization Plan
Wound Care Instructions

Discharge Planning

Activity restrictions
Wound care instructions
Follow-up schedule
Warning signs review
Emergency contact information