Background: Interstitial lung disease in the non immunocompromised patient is often a difficult challenge for the clinician ,especially when no diagnostic clues are present after a thorough clinical assessment ,laboratory examination including serology for specific connective tissue disease ,chest radiography and high resolution computed tomography. .A clear diagnosis confirmed by biopsy allow clinicians and patients to discuss fully the implications of the disease, to develop a clear plan of treatment and to weigh up the advantages and disadvantages of treatment .
Aim of the work: To evaluate the role of medical thoracoscopic lung biopsy in diagnosis of patients with diffuse parenchymal lung diseases .
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Subjects and methods: The study included 15 patients with diffuse parenchymal lung diseases of unknown aetiology. They undergone full history taking, complete clinical examination, ABG analysis, HRCT chest, coagulation profile, platelet count and thoracoscopic lung biopsy by medical thoracoscopy for histopathologic examination.O2 saturation was monitored during thoracoscopy. Follow up of the patients in the inpatient unit including chest x ray for confirmation of lung expansion, observation of the intercostal tube for any complications after the procedure was done.
Results: The sensitivity (No. of cases diagnosed properly) of the procedure was 100 % (15 out of 15) . one patient (6.7%) had pneumothorax after ICT removal due to improper closure of the wound .the patient returned to the hospital after 2 days of removal of ICT by acute dyspnea after an attack of severe coughing CXR was done and revealed pneumothorax and was associated by sub cutaneous emphysema anew ICT was inserted for 5 days till complete resolution of the subcutaneous emphysema and pneumothorax then the patient was discharged home. three patients (20%) had subcutaneous emphysems that had resolved by supplementary high flow oxygen.The duration of the intercostal tube drainage was 3.1 + 2.6 days. There was no wound infection,no bleeding ,no persistant air leak after more than 24H from ICT insertion, no respiratory failure requiring ICU admission and no mortality occurred in the study sample.
Conclusion: Thoracoscopic lung biopsy by medical thoracoscopy is useful in diagnosis of cases with diffuse lung infiltrates of unknown aetiology when lung biopsy is needed for accurate diagnosis. The procedure is safe. The procedure carries some complications that are not life threatening and can be minimized by good selection of patients.
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