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Diagnostic profitability and therapeutic interest of the pulmonary biopsies in diffuse interstitial pneumopathies

S. Benbouzid , A. Paye-Jaouen, N. Beydon , A. Kheniche , D. Berrebi , A. El Ghoneimi , A. Bonnard

Robert Debré Hospital, Paris, France

 

ABSTRACT

Objective: Diffuse interstitial pneumopathies of unknown aetiologies in children can require pulmonary biopsies when noninvasive explorations were not contributive. The profitability of these biopsies is discussed and sometimes it is not indicated because of the clinical state of the child and because of its morbidity-mortality. The purpose of the study is to evaluate the benefit risk compared to the diagnosis profitability of the pulmonary biopsies.

Material and methods: All the children having had a pulmonary biopsy for exploration of a diffuse interstitial syndrome at the Robert Debré Hospital were included retrospectively. Eleven children were treated between 1990 and 2008. The pulmonary biopsies were carried out under thoracotomy or thoracoscopy. The pre and postoperative ventilation mode, the complications, the anatomopathology results and the therapeutic impact were noted.

Results: The average age of the patients was 12 months (17 years -1month and half). There were 6 boys and 5 girls with average weight at the time of the intervention of 8 kg (1,310 kg - 46 kg), the average timing of the interventions was 60 min (55 min-180 min), and there was no peroperative complication. One or several pulmonary biopsies were performed with average size of 25mm (4 mm - 45 mm). Four children were already intubated peroperatively, 6 postoperative. 5 patients presented complications (45%): 3 without vital danger (pneumothorax, pleural effusion, parietal infection) and 2 with aggravated respiratory status leading to death (mortality: 18%). The aetiology of diffuse interstitial pneumopathy was determined in 9/11 cases due to the pulmonary biopsy, meaning 82%. In 6/11 cases the peroperative treatment was continued; in 2/11 cases the biopsy result modified the therapeutic management.

Conclusion: The pulmonary biopsies in diffuse interstitial pneumopathies have good diagnosis profitability in our series. Morbidity was 45%. Therapy was modified in 18% of the cases.

 

Key words: diffuse interstitial pneumopathie, pulmonary biopsy, aetiology