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.

Right pneumonectomy syndrome: a late life-threatening complication of pneumonectomy.

BACKGROUND: Right pneumonectomy syndrome, a rare complication of pneumonectomy, is secondary to a shift of the mediastinum and remaining lung toward the pneumonectomy side, leading to extrinsic airway compression and stretching. CASE: A 6-year-old boy started with initial symptoms of dyspnea on exertion, wheezing, and recurrent pneumonia 6 months after his right pneumonectomy. He received treatment with bronchodilators and antibiotics during outpatient clinic visits. Two months later, he developed increased wheezing and productive cough. A pulmonary function test showed severe reduction in expiratory volumes. He had a cardiopulmonary arrest while a surgical intervention was being planned. Chest roentgenogram showed shift of the heart and mediastinal structures into the right hemithorax with left lung hyperexpansion and no fluid in the right hemithorax. A computed tomogram of the chest revealed marked narrowing of the proximal left mainstem bronchus. He underwent thoracotomy, and a silicone prosthesis was inserted into the right hemithorax, resulting in restoration of the structures to the midline. The child presented severe neurological sequelae. CONCLUSIONS: Postpneumonectomy syndrome is a rare but life-threatening complication after pneumonectomy. Because it may mimic other conditions and given the consequences can be devastating, early recognition and intervention are required to ensure a favorable outcome.