Cone Beam CT Guidance Improves Transbronchial Lung Cryobiopsy Safety.

INTRODUCTION: Determining the cause of diffuse parenchymal lung disease (DPLD) is challenging. While surgical lung biopsy has been the standard approach, transbronchial lung cryobiopsy (TBLC) represents a minimally invasive alternative with an acceptable safety profile and reasonable accuracy. In this study, we prospectively assessed whether the use of cone beam CT (CBCT) coupled with a novel bronchoscope holder and prophylactic administration of vasoconstricting medications decreases potential complications and improves diagnostic accuracy when performing TBLC. METHODS: 33 patients presenting for evaluation of newly diagnosed DPLD were enrolled. Demographic data, pulmonary function values, chest imaging pattern, procedural information, and diagnosis were recorded. RESULTS: Mean patient age was 67, with the majority Caucasian (n = 26, 79%) and male (n = 20, 61%). Mean pulmonary function values revealed restrictive lung disease (76 ± 14% predicted) and diffusing capacity impairment (52 ± 16%). A non-usual interstitial pneumonia imaging pattern was commonly seen (n = 20, 61%). CBCT guided TBLC was performed in one lobe (n = 29, 88%) or two lobes (n = 4, 12%) with mean probe-to-pleura distance of 4.2 ± 1.3 mm. No peri or post procedural complications occurred. 32 patients (97%) received a histological diagnosis with a final multidisciplinary conference diagnosis possible for 32 (97%). CONCLUSION: CBCT guided TBLC coupled with a novel articulating scope holder and prophylactic phenylephrine administration has the potential to increase safety and diagnostic yield for patients with newly identified DPLD. Future studies comparing different aspects of this approach in isolation and with other modalities have the potential to refine this procedure to improve patient care.

Pleural effusion in hospitalized patients with Coccidioidomycosis.

INTRODUCTION: Coccidioidomycosis is a common fungal infection primarily affecting the lungs. The prevalence and the characteristics of pleural effusion in Coccidioidomycosis are not well described. Therefore, a retrospective analysis of data from patients admitted to a teaching hospital with a diagnosis of Coccidioidomycosis and pleural effusion was done. METHODS: All patients admitted with a diagnosis of Coccidioidomycosis were identified using ICD 9 from 114 to 114.9 from computerized medical records. Epidemiological, clinical and laboratory data were transcribed from medical records of all inpatients. Pleural effusion was identified using reports of chest radiography, ultrasound and CT scan of chest. RESULTS: Pleural effusion occurred in 22 of 146 (15%) patients hospitalized for Coccidioidomycosis. The proportion of patients with pleuritic chest pain, cough and dyspnea were significantly higher in patients with effusion than without effusion (p<0.01). There was a tendency for pleural effusions to occur more often on the left side (p=0.064). Empyema occurred in 22.7% of pleural effusions. Pleural fluid chemistry showed that all effusions were exudates with a mean (+/-S.E.M.) pleural fluid eosinophil count of 10.3+/-4.65. CONCLUSION: Pleural effusions are common in hospitalized patients with Coccidioidomycosis. Pleural fluid eosinophilia should alert clinician to Coccidioides immitis as a possible etiological agent especially in an endemic area. Empyema occurred in a quarter of pleural effusions and resolution required thoracotomy.