Chest
Volume 77, Issue 5, May 1980, Pages 614-625
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Lung Biopsy Specimens in the Evaluation of Pulmonary Vascular Disease

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Open lung biopsy specimens in 72 patients were submitted for evaluation of pulmonary vascular disease. In nine instances, the specimens were inadequate for this purpose. Essentially, there were three indications for taking a lung biopsy specimen. The first was unexplained pulmonary hypertension with 40 patients in this category; plexogenic pulmonary arteriopathy was diagnosed in 14, and chronic pulmonary thromboembolism in 12. Others included pulmonary venoocclusive disease in two patients; two other patients had pulmonary vascular lesions in their lung biopsy specimens, indicative of chronic hypoxic pulmonary hypertension; and ten patients had severe arterial as well as venous alterations that could have been caused by obstruction to pulmonary venous flow as well as by fibrosis of lung tissue. Since we realized this possible source of error, we have submitted these two alternative possibilities to the clinician. In a heterogeneous group of eight patients, the nature of acquired or congenital heart disease remained doubtful in spite of extensive clinical investigation. In several instances, the biopsy specimen contributed to establishing the diagnosis of the cardiac condition. Finally, in a group of 15 patients with known congenital cardiac disease and pulmonary hypertension, whose state of pulmonary vasculature was considered borderline as far as the possibility of corrective surgery of the cardiac defect was concerned, lung biopsy specimens helped to determine the feasibility of surgery. The results show that in a restricted group of patients with pulmonary vascular disease, a biopsy of the lung has a place in establishing the nature and severity of the vascular alterations.

Section snippets

MATERIAL AND METHODS

The lung biopsy specimens were derived from 72 patients varying in age from 8 weeks to 63 years. In six instances, these biopsy specimens were taken during cardiac surgery, but they are included in this study because even at operation, the nature of the congenital or acquired defects remained in doubt, so that the surgical procedure had to be terminated without benefit for the patient, but in the hope that the nature of the pulmonary vascular changes in the biopsy specimen might give a clue to

RESULTS

In nine instances, no diagnostic contribution could be made because the biopsy specimens were either inadequate in size with insufficient numbers of vessels or because the vascular changes were too nonspecific for a diagnosis.

The results from the other 63 biopsy specimens have to be dealt with in relation to the problems the patients presented to the clinicians. There were essentially three indications for doing these biopsies of the lung. One group of patients suffered from unexplained

DISCUSSION

The need for preoperative morphologic evaluation of pulmonary vascular disease is limited. The cardiologist commands a wide array of clinical, hemodynamic, ECG, and echocardiographic methods for diagnosing acquired or congenital cardiac disease and for establishing the involvement of the pulmonary vasculature. Moreover, the procedure of taking an open lung biopsy specimen is not without risk, certainly not in patients with pulmonary hypertension, although in the patients of the present study,

ACKNOWLEDGMENT

The technical help of Mrs. H. J. Dijk and Mr. E. M. Heeren, and the secretarial assistance of Mrs. G. A. I. Luiting, is gratefully acknowledged.

REFERENCES (13)

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Manuscript received March 6; revision accepted July 2.

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