Transbronchial biopsy in chronic hypersensitivity pneumonitis.

INTRODUCTION: The diagnosis of chronic hypersensitivity pneumonitis (CHP) is based on relevant exposure, tomographic findings and, in some cases, pathological data. The role of bronchoscopy is uncertain, especially in the fibrotic form of CHP. AIM: To analyze the yield of transbronchial biopsy (TBBx) in patients with CHP according to tomographic findings and to evaluate the importance of bronchoalveolar lavage (BAL) in the diagnostic approach. METHODS: This retrospective study analyzed patients with CHP who underwent TBBx in São Paulo, Brazil. The TBBx findings were classified as characteristic (granulomas and/or multinucleated giant cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and supportive (data indicative of small airway injury: peribronchiolar metaplasia, organizing pneumonia, and intra-alveolar foamy macrophages). RESULTS: One hundred nine patients were included. The presence of characteristic findings of HP was seen in 16 patients (14.7%), and supportive findings were seen in 32 patients (29.4%), with a total yield of 44%. Pathological characteristic findings were more common in cases without fibrosis on high-resolution computed tomography (HRCT) (27.3% vs. 9.2%, p= 0.014), whereas the presence of supportive findings was more common in fibrotic HP (38.1% vs. 9.1%, p= 0.002). Fifty-two patients had differential cytology in BAL fluid. Lymphocytosis (> 20%) was present in 51.9% of the patients. There was no difference in the median lymphocyte count according to nonfibrotic and fibrotic tomographic findings on HRCT. CONCLUSION: TBBx and BAL fluid cytology have a role in CHP diagnosis.

Padräo radiológico das afecçöes pulmonares em pacientes com síndrome de imunodeficiência adquirida (AIDS) / Chest X-rays pattern in lung affections in patients with acquired immunodeficiency syndrome (AIDS)

O pulmäo é o órgäo mais acometido na AIDS, evidenciado em geral nos estádios iniciais da doença. O comportamento pulmonar pode ser devido tanto às afecçöes oportunistas, que na maioria das vezes decorre de reativaçäo de infecçöes latentes, como a neoplasias ou outras doenças näo-infecciosas. Com o objetivo de determinar o padräo radiológico das afecçöes pulmonares que acometem os pacientes portadores de HIV acompanhados no Serviço de Doenças Infecciosas e Parasitárias do Hospital Säo Paulo/Escola Paulista de Medicina, foram realizadas 82 broncoscopias com biópsia transbrônquica (BTB) e coleta de lavado bronquíolo-alveolar (LBA) em 81 pacientes no período de julho de 1989 a dezembro de 1990. Infiltrado interstício-nodular difuso, com ausência de derrame pleural, cavitaçäo ou condensaçäo, foi o achado radiológico mais freqüente, sendo encontrado em 43// doa pacientes com micobacteriose, 43// dos pacientes com pneumonia por Pneumocystis carinii (PPC), 64// dos pacientes com pneumonite intersticial inespecífica (PII) e 73// dos pacientes com pneumonia bacteriana. O diagnóstico de PPC foi estabelecido em apenas 11// dos pacientes que apresentavam somente infiltrado interstício-nodular difuso à radiografia de tórax. Nossos dados permitiram concluir que o infiltrado interstício-nodular difuso (HND) e o padräo radiológico mais freqüente nas principais afecçöes pulmonares que acometem pacientes com AIDS e que apenas uma pequena porcentagem dos pacientes que apresentam sinais e sintomas pulmonares inespecíficos, com HND à radiografia de tórax, tem o diagnóstico confirmado de PPC