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.

Subacute and chronic hypersensitivity pneumonitis: histopathological patterns and survival.

BACKGROUND: In hypersensitivity pneumonitis (HP), survival can be predicted on the basis of the severity of fibrosis in surgical lung biopsy, but few data are available on the influence of clinical, functional, tomographic and histologic findings on prognosis. OBJECTIVES: To describe the impact on survival of clinical data, histological patterns, and HRCT findings in subacute/chronic HP. METHODS: A retrospective analysis of 103 patients diagnosed with HP submitted to surgical lung biopsy. Chronic HP was characterized by HRCT findings indicative of fibrosis (n=76). RESULTS: The most relevant exposures were to molds and birds. Lung biopsies revealed typical HP with granulomas in 46 patients, bronchiolocentric interstitial pneumonia in 27, and non-specific interstitial pneumonia (NSIP) in 16. By univariate analysis, several findings were predictors of mortality: older age, male sex, velcro crackles, higher FEV(1)/FVC ratio, lower oxygen saturation during exercise, and absence of mosaic pattern/air trapping and presence of fibrosis on HRCT. By multivariate analysis, remained significant: age (p=0.007), oxygen saturation during exercise (p=0.003), and mosaic pattern/air trapping on HRCT (p=0.004). Patients with NSIP had a greater survival than did those with typical histology and those with bronchiolocentric pneumonia (p=0.033). CONCLUSIONS: A wide range of histological features are found in HP. Typical findings are seen in 45% of cases. Other common patterns are NSIP and centriacinar lesions. Survival is better in patients with NSIP and worse in those with older age, desaturation during exercise, and absence of mosaic pattern/air trapping on HRCT.

Pneumonia em organizaçäo secundária ao uso de amiodarona / Organized pneumonia secondary to amiodarone use

A pneumonia em organizaçöes secundária ao uso de amiodarona é rara, com apenas oito casos relacionados na literatura. No presente relato uma paciente de 75 ano, com uso cumultativo de 43g, apresentou tosse produtiva, dispnéia progressiva e infiltrados bilaterais na radiologia do tórax. A biópsia transbrônquica confirmou o diagnóstico. Com a retirada da droga houve melhora clínica e funcional.

Bronquiolite obliterante com pneumonia em organizaçäo (BOOP) aguda / Bronchiolitis obliterans with organizing pneumonia (BOOP)

A maioria das doenças intersticiais pulmonares säo de início indolente, produzindo sintomas subagudos ou crônicos, que usualmente progridem por meses ou anos até que o diagnóstico seja estabelecido. Este relato descreve um caso com início fulminante e com risco de vida de bronquiolite obliterante com pneumonia em organizaçäo (BOOP). Suspeita precoce, com a confirmaçäo histológica, e início da corticoterapia säo importante na prevençäo da mortalidade.