Rendimiento diagnóstico y morbimortalidad de las biopsias pulmonares quirúrgicas en enfermedad pulmonar intersticial difusa

Introducción: Se denomina Enfermedad Pulmonar Intersticial Difusa (EPID) a un conjunto heterogéneo de patologías caracterizadas por inflamación y fibrosis pulmonar. El diagnóstico basado en patrones clínicos o radiológicos puede, ocasionalmente, ser insuficiente para iniciar un tratamiento. La biopsia pulmonar quirúrgica es una alternativa cuando se requiere aumentar la precisión diagnóstica luego de discusión multidisciplinaria. Objetivo: Describir el rendimiento diagnóstico, morbilidad y mortalidad de las biopsias quirúrgicas pulmonares en un hospital público chileno. Pacientes y Método: Cohorte retrospectiva de todos los pacientes a quienes se realizó biopsia quirúrgica por diagnóstico de EPID entre los años 2010 y 2020, indicada por un comité multidisciplinario. Se excluyen procedimientos similares o biopsias con diagnóstico de EPID como hallazgo incidental. Resultados: 38 pacientes intervenidos, mediana de edad de 63 años, 47% femenino. Solo 1 (2,6%) paciente operado de urgencia, y 34 (89,5%) por videotoracoscopía. 5 (13,1%) pacientes presentaron morbilidad, en 4 de ellos fuga aérea, ninguno requiriendo intervención adicional. No hubo rehospitalización, reoperación ni mortalidad a 90 días. En el 95% de los casos se alcanzó un diagnóstico preciso de la EPID tras discusión multidisciplinaria. Discusión: Se observa un alto rendimiento diagnóstico y una baja morbimortalidad en los pacientes estudiados. La baja frecuencia de procedimientos de urgencia y la adecuada indicación en comité multidisciplinario puede haber contribuido a la baja morbilidad. Conclusión: La biopsia pulmonar quirúrgica en un hospital general tiene un alto rendimiento diagnóstico cuando se discute en comité multidisciplinario para precisar el diagnostico en EPID, con una baja morbimortalidad si se seleccionan adecuadamente los pacientes.

Background: Interstitial Lung Disease (ILD) is a heterogeneous group of diseases characterized by inflammation and fibrosis of the lung. Diagnosis based exclusively on clinical or radiologic patterns may be inaccurate, and if a reliable diagnosis cannot be made, surgical lung biopsy can be strongly considered to increase the diagnostic yield after multidisciplinary committee. Objective: To review the diagnostic results, morbidity, and mortality of surgical biopsies in a chilean public health institution. Patients and Method: Retrospective cohort of patients operated for diagnostic purposes for ILD between 2010 - 2020. Surgical biopsies done for other diagnoses were excluded. Results: 38 patients were included, with a median age of 63 years, 47% were female. Only 1 patient (2.6%) underwent emergency surgery and 89.5% underwent minimally invasive surgery techniques. 5 patients had some morbidity (13.1%), 4 of them being air leak. All complications were successfully managed conservatively. We had no readmission, reoperations, or 90-day mortality in this cohort. In 95% of the cases an accurate diagnosis of ILD was reached after multidisciplinary discussion. Discussion: In our experience surgical lung biopsy has a high diagnostic yield and a low morbidity and mortality. A low number of emergency procedures and accurate surgical indication by an expert committee could explain the low morbidity. Conclusion: Surgical lung biopsy in a general hospital reach a high diagnostic performance when discussed in a multidisciplinary committee to specify the diagnosis in ILD, with low morbidity and mortality if patients are properly selected.

Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

ABSTRACT: Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

RESUMO: A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Thoracoscopy pulmonary biopsy by two portals with a novel pre-tied loop ligature device in rabbits: an experimental study / Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

A toracoscopia está substituindo as biópsias pulmonares abertas por ser menos invasiva. Usualmente a técnica é feita utilizando três portais e ligaduras feitas intra corporalmente. O objetivo deste estudo foi descrever a viabilidade e eficácia de uma nova ligadura com alça pré-amarrada e propor uma estratégia de acesso toracoscópico com dois portais para realizar biópsia pulmonar em pacientes com menos de 5kg. Dez coelhos foram posicionados em decúbito dorsal. A biópsia pulmonar por toracoscopia total foi feita pela abordagem combinada transdiafragmática e abordagem intercostal direita. Uma nova ligadura pré-amarrada foi colocada para realizar uma biópsia do lobo pulmonar caudal. Não foi realizada insuflação da cavidade torácica. O tempo total de cirurgia foi de 41,4 ± 14,5 min. Os procedimentos foram realizados sem complicações que impedissem o escorregamento ou aperto do nó ou que o soltassem após a biópsia pulmonar; não houve nenhuma intercorrência grave durante o procedimento cirúrgico. As amostras coletadas tinham tamanho médio 1x0,64x0,45 cm e foram consideradas satisfatórias de acordo com a avaliação histopatológica. As radiografias de tórax feitas antes e depois das cirurgias foram comparadas e não mostraram pneumotórax ou hemotórax. A necropsia confirmou que não ocorreu falha do nó no local da biópsia. Conclui-se que uso da nova ligadura com alça pré-amarrada é uma técnica segura e eficaz, evitando problemas com o tamanho limitado da cavidade torácica em pacientes pequenos.

Radiological and histological characteristics of patients with interstitial lung disease undergoing lung biopsy in a reference institution from eastern Colombia / Características radiológicas e histológicas de pacientes con enfermedad pulmonar intersticial llevados a biopsia pulmonar en una institución del oriente colombiano

Abstract Introduction: Interstitial lung disease (ILD) diagnosis requires a mukidisciplinary approach and, in some cases, lung biopsy. Objective: To describe the sociodemographic and clinical characteristics, as well as the radiological and histological findings, of patients with ILD who required lung biopsy after a mukidisciplinary board (pneumology, radiology, and pathology) of a reference center for respiratory diseases in Bucaramanga, Colombia, failed to reach the ILD diagnosis. Materials and methods: Cross-sectional study. The medical records of 56 patients treated at the Instituto Neumológico del Oriente who underwent lung biopsy between 2015 and 2019 were reviewed. Measures of central tendency and dispersion were calculated for demographic and clinical variables, respectively, to characterize them. A bivariate analysis was performed using Fisher's exact test to determine whether there were differences in the distribution of the sociodemographic and clinical variables according to the radiological patterns and the final histological diagnosis. Results: Participants' median age was 67 years (IQR: 59-72) and 55.35% were men. 43 patients had a radiological pattern inconsistent with usual interstitial pneumonia (UIP); 4 had a pattern consistent with possible UIP; and 9 had a pattern consistent with UIP. The most common histologic diagnoses were hypersensitivity pneumonitis (HP) (32.14%), nonspecific interstitial pneumonia (NSIP) (17.86%), and UIP (19.64%). Conclusion: In the study population, the primary reason for performing a lung biopsy was the presence of a radiologic pattern inconsistent with UIP, with HP being the predominant histopathological diagnosis. This is the first study to characterize patients with ILD who underwent lung biopsy in eastern Colombia, making a significant contribution to our understanding of the disease's epidemiology in the country.

Resumen Introducción. El diagnóstico de la enfermedad pulmonar intersticial (EPI) requiere un enfoque multidisciplinar y, en ocasiones, de una biopsia pulmonar. Objetivo. Describir las características sociodemográficas y clínicas, y los hallazgos radiológicos e histológicos de pacientes con EPI que requirieron biopsia pulmonar luego de no lograrse un diagnóstico de esta enfermedad por la junta médica multidisciplinar (neumología, radiología y patología) de un centro de referencia en enfermedades respiratorias de Bucaramanga, Colombia. Materiales y métodos. Estudio transversal. Se revisaron las historias clínicas de 56 pacientes atendidos en el Instituto Neumológico del Oriente y que fueron remitidos a biopsia pulmonar entre 2015 y 2019. Se analizaron variables demográficas y clínicas, calculando medidas de tendencia central y de dispersión para su respectiva caracterización. Se realizó un análisis bivariado mediante test exacto de Fisher para determinar si existían diferencias en la distribución de las variables sociodemográficas y clínicas de acuerdo con los patrones radiológicos y el diagnóstico histológico definitivo. Resultados. La mediana de edad fue 67 años (RIC: 59-72), 55.35% fueron hombres. 43 pacientes presentaron patrón radiológico inconsistente con neumonía intersticial usual (NIU); 4, patrón de posible NIU y, 9, patrón de NIU. Los diagnósticos histológicos más frecuentes fueron neumonitis por hipersensibilidad (NH) (32.14%), neumonía intersticial no específica (17.86%) y NIU (19.64%). Conclusión. La principal razón para realizar biopsia pulmonar en la población de estudio fue la presencia de un patrón radiológico inconsistente con NIU, siendo la NH el principal diagnóstico histopatológico. Este es el primer trabajo que caracteriza a pacientes con EPI del oriente colombiano llevados a biopsia pulmonar, lo que representa un importante aporte al conocimiento de la epidemiología de esta enfermedad en Colombia.

Nuevos factores de riesgo de hemorragia pulmonar que complican la biopsia pulmonar guiada por TC en técnica coaxial / Novel risk factors of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial technique

Objetivos: Evaluar la frecuencia y gravedad de la hemorragia parenquimatosa pulmonar tras la biopsia pulmonar con aguja transtorácica coaxial, según factores de procedimiento, aún no descritos en la literatura. El objetivo de este estudio fue determinar si la elección de la tecnología de biopsia coaxial, el posicionamiento del paciente y la dignidad de la lesión son tres nuevas variables que influyen en el riesgo de hemorragia parenquimatosa tras biopsias coaxiales de pulmón. Métodos: Se revisaron retrospectivamente los registros de 117 pacientes que se sometieron a biopsias con aguja transtorácica del pulmón entre enero de 2018 y abril de 2020. El resultado primario fue la hemorragia pulmonar. Se ha utilizado un sistema de clasificación para clasificar la hemorragia parenquimatosa pulmonar: Grado 0 - Grado 3. Se evaluaron tres variables novedosas relacionadas con el paciente, la técnica y la lesión como predictores de hemorragia pulmonar: tecnología de biopsia coaxial, posición del paciente y dignidad de la lesión. Resultados: De los 117 pacientes, 18 (15,4%) pacientes con tecnología de biopsia coaxial de corte, versus 29 (24,8%) pacientes con tecnología coaxial de núcleo completo mostraron hemorragia significativa en las exploraciones de control posteriores a la biopsia. (IC del 95% 0,06-0,33, p <0,0001). No hubo diferencias significativas en la hemorragia pulmonar entre el diagnóstico histológico benigno y maligno (IC 95% 0,84-4,44, p = 0,1199) y la posición del paciente en decúbito prono o supino (IC 95%: 0,57-2,57, p = 0,6232). Conclusiones: La incidencia y gravedad de la hemorragia pulmonar depende de la tecnología de biopsia coaxial utilizada; siendo mayor en pacientes sometidos a una biopsia con tecnología full-core y menor después del uso de tecnología de corte. En este estudio de pronóstico no se estableció una correlación significativa entre la hemorragia pulmonar parenquimatosa y la posición del paciente o la dignidad de la lesión

Objectives: To evaluate the frequency and severity of pulmonary parenchymal hemorrhage after coaxial transthoracic needle biopsy of the lung, according to procedural factors, not yet described in literature. The aim of this study was to determine whether the choice of the coaxial biopsy technology, patient positioning and the lesion dignity are three new variables influencing the risk of parenchymal hemorrhage after coaxial biopsies of the lung. Methods: Records from 117 patients who underwent transthoracic needle biopsies of the lung between January 2018 and April 2020 have been retrospectively reviewed. The primary outcome was pulmonary hemorrhage. A grading system has been used to classify pulmonary parenchymal hemorrhage: Grade 0 ­ Grade 3. Three novel patient, technique and lesion-related variables were evaluated as predictors of pulmonary hemorrhage: coaxial biopsy technology, patient positioning and lesion dignity. Results: Out of the 117 patients, 18 (15,4%) patients with cutting coaxial biopsy technology, versus 29 (24,8%) patients with full core coaxial technology showed significant hemorrhage on the post-biopsy control scans. (95% CI 0,06-0,33, p<0,0001). No significant difference in pulmonary hemorrhage between benign and malignant histological diagnosis (95% CI 0,84-4,44, p=0,1199) and prone or supine patient positioning (95% CI: 0,57-2,57, p= 0,6232) was found. Conclusions: The incidence and severity of pulmonary hemorrhage depends on the coaxial biopsy technology used; being higher in patients undergoing a biopsy with full-core technology and lower after the use of cutting technology. No significant correlation between parenchymal pulmonary hemorrhage and patient positioning or lesion dignity was established in this prognostic study.

Etiological profile and main imaging findings in patients with granulomatous diseases who underwent lung biopsy.

BACKGROUND: Granulomatous Lung Diseases (GLD) encompasses a wide range of infectious and non-infectious conditions characterized by chronic inflammatory response. However, different GLD may share similar imaging findings. In this context, the purpose of this study was to outline the etiological profile and their imaging features in patients with GLD who underwent lung biopsy. METHODS: Patients with granulomatous lesions in lung biopsies and previous chest CT performed from 2014 to 2017 at our institution had imaging data reviewed by three blinded radiologists. The imaging features were analyzed according to the Fleischner Society glossary. Categorical data were represented by absolute (n) and relative (%) frequency. The contingency matrices were analyzed by Pearson's Chi-square test. Interreader agreement was assessed by calculating the intraclass correlation coefficient, using kappa (κ) statistic. RESULTS: Thirty-eight of 75 (50.7%) patients were women with a mean age of 59 ± 39 years. Infection was the most common cause of GLD (47/75, 62.7%) and Histoplasma capsulatum (27/75, 36%) was the most prevalent etiology. Nodular pattern was the most common imaging feature in histoplasmosis cases (25/27, 92.6%), whereas it occurred in half of cases (24/48) of GLD of other causes (p < 0.05). Among patients with tuberculosis, the second etiology of GLD in our study population, the most common imaging pattern was centrilobular micronodules (3/7, 42.9%), significantly more frequent than in other causes of GLD (6/68, 8.8%). Interreader agreement in detecting imaging features was almost perfect (κ = 0.88-1.00), except the nodular pattern, which had substantial agreement (κ = 0.73). CONCLUSIONS: In our study population, the main etiologies found in patients with granulomatous disease who underwent lung biopsy were fungal or mycobacterial disease, specially histoplasmosis and tuberculosis, and nodular pattern with focal distribution was the most common imaging finding which was detected with substantial interreader agreement.

Tissue Yields for Epidermal Growth Factor Receptor Analysis in Non-Small Cell Lung Cancer Patients in Trinidad and Tobago.

Introduction Patients with unresectable non-small cell lung cancer (NSCLC) may benefit from chemotherapy, tyrosine kinase inhibitor (TKI) therapy, or both. TKI therapy may be administered to the subset of patients who harbor the epidermal growth factor receptor (EGFR) mutation. EGFR mutation testing now plays a vital role in the diagnostic work-up of advanced NSCLC patients to determine which patients are more likely to benefit from TKI therapy. The role of surgery in these patients is mostly limited to obtaining an adequate biopsy for histological, immunohistochemical, and EGFR analysis using the least invasive methods possible. It is thought that larger volume samples, such as those obtained from traditional surgical lung biopsies (SLBs), have better yield than small volume samples, such as those obtained from transthoracic needle lung biopsies (TTNLBs), for EGFR analysis. Aim The aim of this was to determine which biopsy procedures provide superior yield for EGFR mutation analysis among primary NSCLC patients at the Eric Williams Medical Sciences Complex (EWMSC) and whether these tissue yields are in keeping with international recommendations. Methods This is a retrospective, observational study using patient data obtained from the Lung Malignancy Unit, which is based at the EWMSC. The study population was limited to primary NSCLC patients presenting to the EWMSC from January 2014 to June 2017 whose biopsy samples were sent for EGFR testing. Relevant patient data were entered onto a spreadsheet using Microsoft Excel. Patients were classified as having had either an SLB, bronchial biopsy (BB), TTNLB, or some other biopsy procedure. All samples were sent for histological analysis, followed by immunohistochemistry and finally EGFR testing. All EGFR mutation analysis was performed at a single laboratory in the USA. A minimum of 200 tumor cells or 10% tumor content defined an adequate sample for EGFR mutation analysis. Samples that yielded a positive or negative result were considered adequate samples in this study. The number of adequate and inadequate samples for each procedure group was tabulated and the yield was determined as the percentage of adequate samples obtained for each procedure group. Results SLBs had superior yield (95.6%) compared to BBs (88.5%) and TTNLB (85%) in obtaining adequate samples for EGFR analysis. Conclusion SLBs demonstrated superior yield in attaining adequate tissue samples for EGFR mutation analysis compared to BBs and TTNLBs.

Biopsia pulmonar en la enfermedad pulmonar difusa por minitoracotomía o cirugía torácica videoasistida / Lung Biopsy in Diffuse Lung Disease by Minithoracotomy or Video-Assisted Thoracic Surgery

RESUMEN Introducción: La enfermedad pulmonar intersticial difusa constituye un grupo heterogéneo de lesiones con varias características comunes entre las cuales resaltan la inflamación y cicatrización del órgano. Por lo general, se requiere la obtención de tejido parenquimatoso para el diagnóstico definitivo. Objetivos: Describir los resultados obtenidos, según el método de minitoracotomía o cirugía torácica videoasistida, para obtener las muestras hísticas para estudio histopatológico. Métodos: Se realizó un estudio observacional, longitudinal y prospectivo de 52 pacientes consecutivos, con diagnóstico de enfermedad pulmonar intersticial difusa, a quienes se les practicó la toma de muestras tisulares obtenidas mediante cirugía torácica videoasistida o minitoracotomía en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre el 2001 y el 2018. Se estudió la edad y el sexo de los pacientes, la técnica quirúrgica empleada y las complicaciones y mortalidad. Los resultados se exponen en tablas, en números absolutos y relativos. Resultados: Predominó el sexo femenino (59,6 por ciento). La técnica quirúrgica más utilizada fue la minitoracotomía (75,0 por ciento) en pacientes entre 41-50 años, con 15 enfermos. La afección más frecuente fue la fibrosis pulmonar con un 78,8 por ciento. En dos enfermos intervenidos mediante cirugía torácica videoasistida no fue posible obtener tejido para biopsia (15,4 por ciento). Hubo dos complicaciones en pacientes operados mediante minitoracotomía. Conclusiones: La cirugía torácica videoasistida permite una amplia exploración de la superficie pulmonar, pero la biopsia abierta puede tener la misma efectividad para la obtención de muestras hísticas pulmonares, con un mínimo por ciento de complicaciones y bajo índice de mortalidad(AU)

ABSTRACT Introduction: Diffuse interstitial lung disease makes up a heterogeneous group of lesions with several common characteristics, among which inflammation and scarring of the organ stand out. Generally, obtaining parenchymal tissue is required for definitive diagnosis. Objectives: To describe the outcomes of using the method of minithoracotomy or video-assisted thoracic surgery to obtain tissue samples for histopathological study. Methods: An observational, longitudinal and prospective study was carried out with 52 consecutive patients with a diagnosis of diffuse interstitial lung disease. Tissue samples obtained by video-assisted thoracic surgery or mini-thoracotomy were taken at Hermanos Ameijeiras Clinical-Surgical Hospital, between 2001 and 2018. The age and sex of the patients, the surgical technique used, and complications and mortality were studied. The results are presented in tables, in absolute and relative numbers. Results: The female sex predominated (59.6 percent). The most widely used surgical technique was minithoracotomy (75.0 percent) in patients between 41-50 years (15 patients). The most frequent condition was pulmonary fibrosis, accounting for 78.8 percent. In two patients who underwent video-assisted thoracic surgery, it was not possible to obtain any tissue for biopsy (15.4 percent). There were two complications in patients operated on by minithoracotomy. Conclusions: Video-assisted thoracic surgery allows wide exploration of the lung surface, but open biopsy can be just as effective in obtaining lung tissue samples, with a minimum percentage of complications and a low mortality rate(AU)

Clinical diagnosis of patients subjected to surgical lung biopsy with a probable usual interstitial pneumonia pattern on high-resolution computed tomography.

BACKGROUND: Usual interstitial pneumonia can present with a probable pattern on high-resolution computed tomography (HRCT), but the probability of identifying usual interstitial pneumonia by surgical lung biopsy in such cases remains controversial. We aimed to determine the final clinical diagnosis in patients with a probable usual interstitial pneumonia pattern on HRCT who were subjected to surgical lung biopsy. METHODS: HRCT images were assessed and categorized by three radiologists, and tissue slides were evaluated by two pathologists, all of whom were blinded to the clinical findings. The final clinical diagnosis was accomplished via a multidisciplinary discussion. Patients with a single layer of honeycombing located outside of the lower lobes on HRCT were not excluded. RESULTS: A total of 50 patients were evaluated. The most common final clinical diagnosis was fibrotic hypersensitivity pneumonitis (38.0%) followed by idiopathic pulmonary fibrosis (24.0%), interstitial lung disease ascribed to gastroesophageal reflux disease (12.0%) and familial interstitial lung disease (10.0%). In the group without environmental exposure (n = 22), 10 patients had a final clinical diagnosis of idiopathic pulmonary fibrosis (45.5%). Irrespective of the final clinical diagnosis, by multivariate Cox analysis, patients with honeycombing, dyspnoea and fibroblastic foci on surgical lung biopsy had a high risk of death. CONCLUSIONS: The most common disease associated with a probable usual interstitial pneumonia pattern on HRCT is fibrotic hypersensitivity pneumonitis followed by idiopathic pulmonary fibrosis and interstitial lung disease ascribed to gastroesophageal reflux disease. In patients without environmental exposure, the frequencies of usual interstitial pneumonia and a final clinical diagnosis of idiopathic pulmonary fibrosis are not sufficiently high to obviate the indications for surgical lung biopsy.

Video-Assisted Thoracoscopic Lung Biopsy in Critically Ill Patients With Hematologic Malignancy and Acute Respiratory Distress Syndrome: A Case Series Report.

Pulmonary complications are prevalent among patients with hematologic malignancies, who are at high risk of developing acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is considered the diagnostic hallmark of ARDS, there are plenty of other non-diffuse alveolar damage etiologies that can mimic ARDS and benefit from a specific therapy, therefore correcting the underlying cause. When the etiology remains unclarified despite noninvasive procedures, a surgical lung biopsy (either open via thoracotomy or video-assisted thoracoscopic surgery [VATS]) may be warranted. However, the role of surgical lung biopsy has not been extensively studied in patients with hematologic malignancy and ARDS and so doubt exists about the risk-benefit relationship of such procedures. In this article, we report a series of 8 critically ill patients with hematologic malignancies and ARDS, who underwent VATS lung biopsy, in a specialized institution in Cali, Colombia, from 2015 to 2019, with special emphasis on its diagnostic yield, modifications in treatment protocol, and safety. VATS lung biopsy is a minimally invasive procedure that appears to be a relatively safe with few postoperative complications and minimal perioperative mortality. It has a high diagnostic yield, resulting in a modification of treatment in a nondepreciable percentage of patients. However, this subset of patients was critically ill, with a high risk of mortality, and the lung biopsy did not appear to affect in this aspect. Future randomized controlled trials are needed to further clarify this topic.

[Childhood Interstitial Lung Disease in Infancy. Classification, diagnosis and management]. / Enfermedades del intersticio pulmonar en niños menores de 2 años. Clasificación, diagnóstico y tratamiento.

Childhood interstitial lung diseases, which some authors refer to as diffuse diseases of the lung, constitute a group of entities that are characterized by remodeling of the interstitium and distal airspaces that cause disturbances of gas exchange in the lungs. While some entities have few symptoms and naturally evolve favorably, others are potentially lethal. Its etiology is very varied, including forms of genetic cause, infectious origin, associated with systemic diseases, drugs and some remain of unknown origin. At present, the development of genetic testing allows diagnosing a group of pathologies, avoiding sometimes a lung biopsy. Its treatment includes different immunosuppressive and immunomodulatory drugs, mainly corticosteroids and hydroxychloroquine, which aim to reduce inflammation, stabilize the disease and prevent the phenomena of remodeling and fibrosis. This consensus is focused on children under 2 years of age, because most of the new entities recently described are manifested at this age.

Las enfermedades intersticiales pulmonares en la infancia, a las que algunos autores se refieren como enfermedades difusas del pulmón, constituyen un grupo de entidades que se caracteriza por la remodelación del intersticio y de los espacios aéreos distales. Mientras algunas entidades tienen pocos síntomas y evolucionan naturalmente en forma favorable, otras pueden ser letales. Su etiología es muy variada e incluye formas de causa genética, origen infeccioso, asociadas a enfermedades sistémicas, fármacos y algunas son de causa desconocida. El desarrollo de estudios genéticos permite, actualmente, diagnosticar un grupo de patologías y, en ocasiones, evitar la biopsia pulmonar. Su tratamiento incluye diferentes drogas inmunosupresoras e inmunomoduladores, sobre todo, corticoides e hidroxicloroquina, que tienen el objetivo de reducir la inflamación y prevenir los fenómenos de remodelación y la fibrosis. Este consenso está enfocado en los niños menores de 2 años, debido a que la mayoría de las nuevas entidades descritas recientemente se manifiestan a esta edad.

Neumonía eosinofílica en pediatría, a propósito de dos casos clínicos / Pneumonia eosinofilic in pediatrics, clinical cases

INTRODUCCIÓN: La Neumonía Eosinofílica (NE) es una entidad muy poco frecuente en pediatría y se caracteriza por infiltración de eosinófilos en el intersticio pulmonar y alveolar, pudiendo ser primaria o secundaria, así como también presentar un curso agudo o crónico. OBJETIVO: Presentar dos casos clínicos de NE diagnosticados en el período 2014-2017 en una Unidad de Cuidados Intensivos pediátricos. CASOS CLÍNICOS: Dos lactantes mayores, ambos con antecedente de madre asmática, hospitalizados por in suficiencia respiratoria y diagnóstico de neumonía viral en Clínica Indisa, Santiago, Chile. Ambos presentaron síndrome febril, imágenes de condensación persistentes en la radiografía de tórax y eosinofilia periférica en el transcurso de su enfermedad. Uno de ellos con requerimiento de oxígeno por más de un mes, sin eosinofilia en el lavado broncoalveolar (LBA), al que se le hizo el diagnóstico de NE por biopsia pulmonar. El otro niño requirió ventilación mecánica por 28 días y se hizo diag nóstico de NE por eosinofilia mayor a 20% en LBA. Los dos casos presentaron excelente respuesta a corticoides sistémicos. CONCLUSIÓN: La NE se debe sospechar en el niño con diagnóstico de neumonía con síntomas persistentes sin respuesta al tratamiento, habiéndose descartado otras causas, sobre todo si se asocia a eosinofilia periférica. El diagnostico de NE en pediatría se confirma por eosinofilia mayor a 20% en LBA y en algunos casos es necesaria la biopsia pulmonar.

INTRODUCTION: Eosinophilic Pneumonia (EP) is a very rare disorder in Pediatrics. It is characterized by the infiltra tion of eosinophils in the pulmonary and alveolar interstitium, and may be primary or secondary as well as present an acute or chronic progress. OBJECTIVE: to present 2 pediatric EP clinical cases which were diagnosed at the pediatric intensive care unit of Clinica Indisa in Santiago, Chile between 2014 and 2017. CLINICAL CASES: Two older infants, who were hospitalized due to respiratory failure with a diagnosis of viral pneumonia. Both have asthmatic mothers. Additionally, they both had febrile syn drome, persistent condensation images in the chest x-rays, and peripheral eosinophilia throughout the course of the disease. One of the infants required oxygen for more than one month, and there was no eosinophilia in the bronchoalveolar lavage (BAL). In this case, the diagnosis of EP was reached via pulmonary biopsy. The other infant required mechanic ventilation for 28 days, and was diagnosed due to eosinophilia greater than 25% in the bronchoalveolar lavage. Both patients had excellent res ponse to systemic corticosteroids. CONCLUSION: After ruling out other causes, EP should be suspected in children with pneumonia diagnosis, and persistent symptoms that do not respond positively to treatment, especially if associated with peripheral eosinophilia. The diagnosis of EP in pediatrics is confirmed with eosinophilia greater than 20% in BAL and, in some cases, it is necessary to perform a lung biopsy.

Videotoracoscopía con anestesia peridural en paciente despierto / Epidural anesthesia for videoassisted thoracic surgery in awake patient

Video-assisted thoracic surgery (VATS) is traditionally performed under general anesthesia and endotracheal intubation with a double lumen tube. In recent years, a growing trend towards these procedures being performed under loco regional anesthesia, particularly under epidural block with or without sedation in patients in spontaneous ventilation has appeared. It can be used to perform procedures that include pneumothorax management, wedge resection, lobectomy and surgical reduction of lung volume. The most attractive reason is to eliminate the side effects related to general anesthesia looking for a lower perioperative risks and shorter hospital stays, especially in elderly patients and those with compromised respiratory function. The thoracic epidural anesthesia has been effective allowing an adequate surgical approach, guaranteeing an idoneus level of analgesia, an optimal oxygenation, and facilitating an early postoperative recovery. We present a case of a patient undergoing to lung biopsy performed by VATS patient under epidural block and Ramsay scale sedation level III in spontaneous ventilation, who was discharged 48 hours after the surgical procedure.

La cirugía torácica asistida por vídeo se realiza tradicionalmente bajo anestesia general e intubación endotraqueal con tubo de doble luz. En los últimos años ha existido una corriente creciente hacia la realización de estos procedimientos en pacientes bajo anestesia locorregional, particularmente con bloqueo epidural con o sin sedación y en ventilación espontánea, para procedimientos que incluyen manejo de neumotórax, resección en cuña, lobectomía y cirugía de reducción de volumen pulmonar. La razón más atractiva es evitar los efectos secundarios relacionados con la anestesia general en búsqueda de menor riesgo perioperatorio y menor estancia hospitalaria, especialmente en pacientes mayores y en aquellos con función respiratoria comprometida. La anestesia epidural torácico (AET) ha sido efectiva para permitir un adecuado abordaje quirúrgico, garantizando un idóneo nivel de anestesia, una correcta oxigenación y facilitando la recuperación posoperatoria precoz]. Se presenta el caso clínico de una biopsia pulmonar realizada mediante toracoscopia en un paciente bajo AET con sedación escala Ramsay III y en ventilación espontánea, quien fue dado de alta a las 48 horas posterior a la cirugía.

Lung biopsy with guillotine cutting needle and biopsy forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations / Biópsia pulmonar com agulha cortante guilhotinada e pinça de biopsia por toracoscopia transdiafragmática em cães com alterações pulmonares

Lung diseases are common in small animal clinical routine. Diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides a precise diagnosis. Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared with thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to wound closure and surgical complications were reported. The dogs were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedure in any patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications. Both devices provided good quality samples for histopathological analysis of lung abnormalities. However the cutting guillotine needle was more efficient especially in larger pulmonary nodules. The transdiaphragmatic access provided optimal approach for both hemithoraces.(AU)

As afecções pulmonares são comuns na rotina clínica de pequenos animais, todavia, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar pode possibilitar um diagnóstico específico da doença. A toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. O presente estudo teve como objetivo avaliar as técnicas de biópsia pulmonar por meio da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia, pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães, independente de raça, sexo, idade e peso corporal. Somente caninos com nódulos visíveis na radiografia torácica e que apresentaram condições clínicas e laboratoriais de serem anestesiados foram incluídos no estudo. Os cães foram posicionados em decúbito dorsal e foram realizados dois acessos à cavidade torácica: um primeiro portal intercostal, para introdução dos dispositivos de biopsia; e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. Posteriormente as amostras foram encaminhadas para exame histopatológico. O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, etodas as informações foram registradas. No pós-operatório os cães foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos caninos. Concluiu-se tratar de uma técnica segura, rápida sem complicações trans e pós-operatórias. Ambos dispositivos permitiram aquisição de material suficiente para análise histopatológica das alterações pulmonares, no entanto a agulha cortante guilhotinada apresentou maior eficácia, principalmente, em nódulos pulmonares de maior diâmetro. O acesso transdiafragmático mostrou-se eficiente para exploração de ambos os hemitórax.(AU)

Lung biopsy with guillotine cutting needle and biopsy forceps though transdiaphragmatic thoracoscopy in dogs with pulmonary alterations / Biópsia pulmonar com agulha cortante guilhotinada e pinça de biopsia por toracoscopia transdiafragmática em cães com alterações pulmonares

Lung diseases are common in small animal clinical routine. Diagnosis is usually affected due to nonspecific symptoms. Imaging features such as radiography and chest ultrasound are acceptable screening tests, although lung biopsy can provides a precise diagnosis. Thus thoracoscopy provides a minimally invasive diagnostic assessment for chest diseases and offers the benefits such as improved illumination and magnification of the image when compared with thoracotomy. In this study we evaluated the transdiaphragmatic thoracoscopic-assisted techniques of lung biopsy with a the guillotine cutting needle and biopsy forceps, in dogs presenting radiographic suspicion on pulmonary tumors. Fourteen dogs regardless of breed, gender, age and body weight admitted at the Hospital of Veterinary Clinics (HCV) of the Veterinary College (FAVET) of Universidade Federal do Rio Grande do Sul (UFRGS), were assessed. Inclusion criteria were presence of nodules on chest radiography and triage tests without changes that could hinder general anesthesia and surgical approach. The animals were positioned in dorsal recumbence and two thoracoscopic ports were established: the first port for working instruments; the second paraxyphoid port for the telescope. Three samples were collected using each sampling method from each lesion or from tumors macroscopically similar whenever their size was less than one centimeter. The samples were sent for histopathological examination in the Veterinary Pathology Laboratory of FAVET/UFRGS. Surgical time was recorded from first incision to wound closure and surgical complications were reported. The dogs were evaluated for the presence of subcutaneous emphysema, hematoma, seroma, local infection and dehiscence. No conversion to open surgery was necessary during the thoracoscopic procedure in any patient. Thoracoscopic assisted biopsy using guillotine needle and biopsy forceps was a safe and fast technique, without perioperative complications...(AU)

As afecções pulmonares são comuns na rotina clínica de pequenos animais, todavia, por apresentarem sintomas inespecíficos, muitas vezes o diagnóstico dessas doenças torna-se limitado. Recursos de imagem como a radiografia e a ultrassonografia torácica são válidos como exames de triagem, mas somente a biopsia pulmonar pode possibilitar um diagnóstico específico da doença. A toracoscopia fornece um meio minimamente invasivo de diagnóstico para as doenças torácicas e oferece os benefícios de melhor iluminação e ampliação da imagem, quando comparado com a toracotomia. O presente estudo teve como objetivo avaliar as técnicas de biópsia pulmonar por meio da agulha cortante guilhotinada e da pinça de biopsia, guiadas por toracoscopia, pelo acesso transdiafragmático em cães que apresentavam imagem sugestiva de nódulo pulmonar em exame radiográfico prévio. Foram utilizados 14 cães, independente de raça, sexo, idade e peso corporal. Somente caninos com nódulos visíveis na radiografia torácica e que apresentaram condições clínicas e laboratoriais de serem anestesiados foram incluídos no estudo. Os cães foram posicionados em decúbito dorsal e foram realizados dois acessos à cavidade torácica: um primeiro portal intercostal, para introdução dos dispositivos de biopsia; e outro portal paraxifoide transdiafragmático para introdução do endoscópio. Com cada instrumento de biopsia foram coletadas três amostras do mesmo nódulo ou de nódulos macroscopicamente semelhantes e próximos quando o tamanho destes era inferior a um centímetro. Posteriormente as amostras foram encaminhadas para exame histopatológico. O tempo cirúrgico foi cronometrado da incisão ao fechamento da ferida, e todas as informações foram registradas. No pós-operatório os cães foram avaliados quanto à presença de enfisema subcutâneo, hematoma, seroma, infecção local e deiscência de pontos. Não foi necessário converter os procedimentos toracoscópicos para cirurgia convencional em nenhum dos caninos...(AU)

Videotoracoscopia por vía subxifoidea: primera experiencia en Argentina / Videothoracoscopic subxiphoid access: first experience in Argentina

Introducción: En los últimos 30 años las técnicas quirúrgicas mínimamente invasivas en patología torácica modificaron el paradigma. Cada día más procedimientos son efectuados por esta vía desde el advenimiento de la cirugía videotoracoscópica. Objetivo: Demostrar el uso de la videotoracoscopia subxifoidea para biopsia pulmonar y bullectomía. Material y métodos: Vía subxifoidea por videotoracoscopia en 6 casos. Resultados: Se obtuvo diagnóstico histológico en 5 casos y resección de bullas subpleurales en uno sin complicaciones por el acceso subxifoideo. Conclusiones: Es la primera experiencia en un hospital universitario de Argentina con este acceso quirúrgico sin complicaciones, con rendimiento diagnóstico histológico y resultado terapéutico.

Introduction: In the last 30 years minimally invasive surgical techniques for thoracic pathology was changed the paradigm. Every day more procedures are performed in this way since the advent of videothorascopic surgery. Objective: Demonstrate the use of the subxiphoid videothorascopy for lung biopsy and pulmonary wedge resection for bulla. Material and methods: Subxiphoid access by videothorascopy in 6 clinic cases. Results: Histologic diagnosis in 5 cases and pulmonary wedge resection for bulla in another case without complications with subxiphoid access were obtained. Conclusions: Is the first experience in an Argentinian university hospital with this surgery access without complications and with performance histological diagnosis and therapeutic result.

The diagnostic yield and complications of open lung biopsies in kidney transplant patients with pulmonary disease.

BACKGROUND: The purpose of this study was to assess the efficacy of open lung biopsy (OLB) in determining the specific diagnosis and the related complications in patients with undiagnosed diffuse pulmonary infiltrates. METHODS: This single center, retrospective study included adult kidney transplant patients who underwent OLB. The patients had diffuse pulmonary infiltrates without definitive diagnoses and failed to respond to empiric antibiotic treatment. We analyzed the number of specific diagnoses, changes in treatment and the occurrence of complications in these patients. A logistic regression was used to determine which variables were predictors of hospital mortality. RESULTS: From April 2010 to April 2014, 87 patients consecutively underwent OLB. A specific diagnosis was reached in 74 (85.1%) patients. In 46 patients (53%), their therapeutic management was changed after the OLB results. Twenty-five (28.7%) patients had complications related to the OLB. The hospital mortality rate was 25.2%. Age, SAPS3 score and complications related to the procedure were independent predictors of all-cause mortality. CONCLUSIONS: OLB is a high-risk procedure with a high diagnostic yield in kidney transplant patients with diffuse pulmonary infiltrates who did not have a definitive diagnosis and who failed to respond to empiric antibiotic treatment. Complications related to OLB were common and were independently associated with intra-hospital mortality.

Systemic Air Embolism after Percutaneous Lung Biopsy: A Manageable Complication.

CT-guided percutaneous biopsy is a resourceful and widely used tool to evaluate pulmonary nodules that frequently avoids costly and unnecessary surgeries. Severe complications occur in less than 1% of cases and include gas embolism, which is rarely documented. We report a case of gas embolism after transthoracic biopsies and discuss the pathophysiology and the benefits of early diagnosis and proper management.

Aproximación diagnóstica a las enfermedades pulmonares difusas / Diagnostic approach to diffuse pulmonary diseases

Las enfermedades pulmonares difusas representan un grupo de enfermedades que comparten un mismo criterio radiológico, existiendo más de 200 entidades que se presentan como tal. La clínica es fundamental para aproximar el diagnóstico etiológico que muchas veces resulta complejo. Tos y disnea progresiva son los síntomas clínicos característicos de estas enfermedades y se acompañan de la radiografía de tórax con opacidades difusas como método radiológico inicial. El estudio en general es multi- disciplinario incluyendo patrones radiológicos de la tomografía axial de tórax, estudio de función pulmonar, lavado bronquioal- veolar y biopsia pulmonar en algunos casos.

The diffuse lung diseases are a group of conditions that share common radiological criteria. There are over 200 causes. The clinic skill is essential to approximate the etiologic diagnosis, often complicated. Cough and progressive dyspnea are the clinical features of these diseases and are accompanied by chest radiography with diffuse opacities as the initial radiological method. The study is generally multidisciplinary and including radiological patterns in computer tomography of the chest, lung function study, bronchoalveolar lavage and lung biopsy in some cases.

Uso del bisturí ultrasónico para la toma de biopsias pulmonares por toracoscopia en pacientes pediátricos con enfermedad pulmonar intersticial / Use of ultrasonic scalpel for pulmonary biopsy by thoracoscopy in pediatric patients with interstitial lung disease

Introducción. El diagnóstico de la enfermedad pulmonar intersticial en la infancia constituye un reto. La biopsia pulmonar a cielo abierto se ha considerado el mejor procedimiento para obtener tejido pulmonar en niños; sin embargo, la biopsia con toracoscopia puede ser igualmente eficaz y menos agresiva. El objetivo de este trabajo fue analizar los resultados del empleo del bisturí ultrasónico con tres trocares de 5 mm (uno para toracoscopio y dos puertos más de trabajo) para la toma de biopsias pulmonares por toracoscopia. Métodos. Se analizó, retrospectivamente, una serie de casos de niños a quienes se les tomaron biopsias pulmonares mediante toracoscopia, utilizando tres puertos de trabajo y el bisturí ultrasónico, durante el periodo comprendido de enero de 2011 a enero de 2012 en un hospital pediátrico de tercer nivel de atención. Resultados. Se registraron cinco pacientes con edades desde uno hasta 13 años. No se presentaron complicaciones durante el transoperatorio o postquirúrgicas en ningún caso. Al revisar los reportes histopatológicos, se encontró suficiente muestra en todos los casos. El sangrado transquirúrgico fue de 4.3 ml en promedio (de 0.5 a 10 ml). El tiempo quirúrgico varió de 2 a 3 horas. Dos casos ameritaron sondas pleurales, las cuales se retiraron a los dos o tres días después del evento quirúrgico, momento en que se dieron de alta del servicio sin complicaciones. Conclusiones. Se corroboró la factibilidad y la seguridad de una técnica para la toma de muestras mediante el uso del bisturí ultrasónico. Esta técnica es fácilmente reproducible en cualquier centro hospitalario que cuente con el recurso para realizar toracoscopias.

Background. Diagnosis of interstitial lung disease (ILD) in children is challenging. Open lung biopsy was long considered to be the best procedure to obtain lung tissue in children. Thoracoscopic biopsy may be equally effective and less aggressive. In this report we analyze the results of the use of ultrasonic scalpel with the placement of three 5-mm trocars (one for thoracoscope and two working ports) for lung biopsy through thoracoscopy. Methods. We present a retrospective case series of children undergoing lung biopsy through thoracoscopy using three working ports and ultrasonic scalpel. The study was carried out from January 2011 to January 2012 in a third-level pediatric hospital. Results. A total of five patients aged 1 to 13 years were included. There were no complications in the five cases analyzed. The sample obtained was sufficient in all cases for histopathological study. During surgery, bleeding was reported on average of 4.3 ml (range: 0.5-10 ml). Operative time ranged from 2 to 3 h. Two cases required chest tube placement. These were removed 2 to 3 days after the surgical event, and patients were discharged without complications. Conclusions. Feasibility is confirmed of a technique for lung biopsy using an ultrasonic scalpel, which is easily reproducible in any hospital with the necessary resources to perform thoracoscopy. In this series there were no complications, bleeding was low and there was opportune placement of transpleural chest tube.