Procedures: Fellow Case Report Poster - Procedures |

Transbronchial Cryobiopsy: An Option to Diagnose Interstitial Lung Disease in the Setting of Pulmonary Hypertension FREE TO VIEW

Victor Kha, DO; Houssein Youness, MD; Jordan Metcalf, MD; Ahmed Awab, MD; Ranjana Gottipati, MD
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University of Oklahoma Health Sciences Center and Oklahoma City VA Health Care System, Oklahoma City, OK

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):990A. doi:10.1016/j.chest.2016.08.1096
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SESSION TITLE: Fellow Case Report Poster - Procedures

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Interstitial lung diseases (ILDs) are a heterogeneous group of nonneoplastic disorders that include clinicopathologic entities that differ in prognosis and treatment options. Although clinical, radiological, and bronchoalveolar lavage (BAL) findings can be helpful, in many cases, lung tissue is needed to confirm a diagnosis.

CASE PRESENTATION: A 55 year-old African American female presented with six months of worsening dyspnea, shortness of breath, and fatigue. One year prior, she had been diagnosed with pulmonary hypertension after a right heart catheterization (MPAP 71 mmHg, PCWP 14 mmHg). At that time, she was started on home oxygen and oral sildenafil. High-resolution computed tomography (HRCT) showed findings of extensive bibasilar ground-glass opacities, subpleural reticulation, and intraseptal thickening (Fig. 1). Pulmonary function tests showed reduced diffusing capacity. An extensive rheumatology work-up was notable only for a mildly elevated rheumatoid factor. A video-assisted thorascopic surgical (VATS) lung biopsy was requested but was declined by thoracic surgery due to operative risk. Therefore, a transbronchial cryobiopsy of the left lower lobe was performed under general anesthesia. The patient remained intubated in the intensive care unit for 1 day and was discharged 5 days later on high-dose oral steroids and inhaled trepostinil. Pathology was consistent with non-specific interstitial pneumonia (NSIP) (Fig. 2). She was continued on steroids with improvement in her symptoms and later switched to oral azathioprine.

DISCUSSION: Surgical lung biopsy is the gold standard for tissue sampling. However, patients with comorbidities such as hypoxemic respiratory failure and pulmonary hypertension may have higher perioperative complications precluding surgery1. Compared to forceps biopsy, cryobiopsy provides a larger specimen size, more alveolar parts, and superior diagnostic yield2.

CONCLUSIONS: Cryobiopsy is a safe alternative to surgical lung biopsy and is adequate for an accurate diagnosis of ILD to make disease-modifying therapeutic decisions.

Reference #1: Hagmeyer, L., et al. (2015). The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease. Clin Respir J. Advance online publication. doi:10.1111/crj.12261.

Reference #2: Ganganah, O., et al. (2016). Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta-analysis. Respirology. Advance online publication. doi:10.1111/resp.12770.

DISCLOSURE: The following authors have nothing to disclose: Victor Kha, Houssein Youness, Jordan Metcalf, Ahmed Awab, Ranjana Gottipati

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