VIDEO-ASSISTED THORACOSCOPIC BIOPSY FOR INTERSTITIAL LUNG-DISEASE

At the University of Maryland Medical Systems, 356 consecutive thoraco scopic procedures were performed including 147 lung resections for var ious indications. Forty-nine patients underwent thoracoscopy for the d iagnosis of interstitial lung disease. Two patients underwent bilatera l procedures after a gap of more than six months for suspected maligna ncy. There were 28 females and 21 males. Age ranged from 23 to 75 year s. The mean length of operation was 45 minutes and the mean length of chest tube duration 1.3 days. There were no deaths, no re-explorations or need to convert to an open thoracotomy. Staphylococcal pneumonia d eveloped in one patient postoperatively requiring admission and intrav enous antibiotics. One patient with systemic pulmonary hypertension wa s ventilator dependent for 48 hours. All patients, except two ventilat or dependent patients, were intubated with a double lumen tube. CO2 in sufflation at the rate of 2 L/min and pressure of 10 mmHg was used in all patients. Biopsy of at least two lobes was performed in all patien ts with resection of grossly abnormal lung. A single chest tube was le ft at the end of the procedure. The tissue diagnosis was interstitial fibrosis in 19 patients. Bronchiolitis obliterans with organizing pneu monitis (BOOP) was seen in 7 patients. Foreign body granulomas were se en in 8 patients. Allergic alveolitis was diagnosed in 4 patients. Emp hysematous changes with pneumonitis was observed in 3, nonspecific pne umonitis in 2. Anthracosis, connective tissue disorder, leukemic infil trate with interstitial fibrosis and CMV pneumonitis were observed in one patient each. The clinical diagnosis correlated with pathological diagnosis and intraoperative findings. Thoracoscopy is a safe and effe ctive method for diagnosis of interstitial lung disease.