Anticoagulant Use as an Independent Risk Factor and Higher In-Hospital Mortality in Patients Showing Alveolar Hemorrhage in Diffuse Lung Disease

Background and objectives: Bronchoalveolar lavage (BAL) is commonly performed to evaluate diffuse lung disease and occasionally to identify alveolar hemorrhage. However, the clinical impact of alveolar hemorrhage and its risk factors in patients with diffuse lung disease have not been clarified. Materials and Methods: We retrospectively analyzed the medical records of all patients who underwent BAL to evaluate diffuse lung disease from January 2017 to December 2020. Alveolar hemorrhage was defined as progressive hemorrhagic BAL fluid or the presence of ≥20% hemosiderin-laden macrophages in the BAL fluid. Logistic regression analysis was performed to assess the association between alveolar hemorrhage and other factors. Results: Sixty subjects were enrolled in this study. Alveolar hemorrhage was observed in 19 subjects (31.7%) with idiopathic interstitial pneumonia, acute respiratory distress syndrome, interstitial pneumonia with autoimmune features, drug-induced lung injury, eosinophilic pneumonia, adenocarcinoma, and systemic lupus erythematosus. The use of anticoagulants was a significant risk factor for alveolar hemorrhage (odds ratio 7.57, p = 0.049). Patients with alveolar hemorrhage required intubated mechanical ventilation more frequently (63.2% vs. 24.4%, p = 0.005) and had higher in-hospital mortality rates (26.3% vs. 4.9%, p = 0.028) than those without alveolar hemorrhage. Conclusions: Alveolar hemorrhage was observed in various etiologies. The use of anticoagulants was a significant risk factor for alveolar hemorrhage. Patients with alveolar hemorrhage showed more severe respiratory failure and had higher in-hospital mortality than those without alveolar hemorrhage.

Childhood Interstitial and Diffuse Lung Disease in an Immunocompetent Patient Without Exposure

Childhood interstitial and diffuse lung disease (chILD) is a heterogeneous group of rare and chronic respiratory disorders with an estimated prevalence of 1.5 cases per million children aged 0-18 years. Presented is the case of an immunocompetent young girl who presented with symptoms of recurrent cough and clubbing

Clinical Analysis of Transbronchial Cryobiopsy in Diagnosis of Diffuse Lung Disease

Background: Rapid advances in TBCB in recent years have allowed its gradual acceptance as a diagnostic method for DLD, and an alternative to surgical lung biopsy . However, the various guidelines have yet to provide clear recommendations for TBCB. This study investigated the diagnostic value of transbronchial cryobiopsy (TBCB) for identifying diffuse lung disease (DLD) .Methods: The clinical data was reviewed of 34 patients who showed initial signs of diffuse lung lesions, interstitial pneumonia, bronchial asthma, lung cancer/infection, or pulmonary alveolar proteinosis; and underwent TBCB from December 2018 to March 2021. The safety and effectiveness of TBCB in identifying the etiology of DLD was analyzed.Results: Clear pathomorphological diagnoses were obtained for 27 (79.4%) patients, based on clinical characteristics and pathology: pulmonary fibrosis, adenocarcinoma, alveolar proteinosis, extrinsic allergic alveolitis, tuberculous granulomatous inflammation, and interstitial pneumonia. Four (11.8%) patients required multi-disciplinary discussion for diagnostic confirmation (of diffuse lesions, interstitial pneumonia, and lung infection). The etiology of 3 cases remained unknown. The rate of DLD diagnosis via TBCB was 91.2% (31/34). Associated with the TBCB procedure, 9 (26.5%) patients developed pneumothorax (6 mild, 3 moderate), and 29 (85.3%) post-biopsy bleeding (all grade 1, requiring suction and compression, but no other intervention or surgery). The average hospitalization cost and length of stay were 7988 RMB (1233 USD) and 5.48 days, respectively.Conclusion: TBCB is safe, cost-effective, requires a short hospitalization, and the diagnostic confirmation rate for DLD is high.

Application of Multi-Slice Spiral CT in the Evaluation of Diffuse Lung Diseases

This article analyzes the manifestations, characteristics, and significance of multi-slice spiral CT for diffuse lung disease, and evaluates the diagnostic value of multi-slice CT multi-directional reconstruction for diffuse lung disease. After performing multi-slice spiral CT examination on the patient and collecting relevant data, the characteristic multi-slice CT imaging findings of diffuse lung disease were determined by statistical analysis. Diffuse lung disease is representative in multi-slice spiral CT image imaging manifestations of the disease include multiple disseminated small nodules, multiple voids, ground glass shadows, and lung consolidation. And analyze the correlation of image performance, and then use statistical methods to analyze and evaluate the value of multi-slice spiral CT characteristic images in the diagnosis of diffuse lung disease, and analyze the characteristics of these characteristic multi-slice CT image appearances. The use of high-resolution CT to screen the characteristic CT imaging findings of the same research object, and then to perform a statistical analysis of the diagnostic differences with multi-slice spiral CT, further confirmed the importance of multi-slice CT for diffuse lung disease Diagnostic value. Studies have shown that multi-slice CT imaging technology is of great significance in the evaluation of diffuse lung diseases.

Combination of the Archimedes Navigation System and cryobiopsy in diagnosis of diffuse lung disease

Objective To evaluate the efficacy of the Archimedes Navigation System (Broncus Medical, San Jose, CA, USA) for guidance during transbronchial cryobiopsy and the incidence of complications in patients with diffuse lung disease. Methods High-resolution computed tomography and transbronchial cryobiopsy were used to evaluate eight patients with diffuse lung disease. The Archimedes Navigation System was used before cryobiopsy to obtain the best path with which to avoid large vessels. Three to five cryobiopsy specimens were taken from each sampled segment. Results Preoperative planning using the Archimedes Navigation System was successfully performed on all eight patients. The probe-to-pleura distance was approximately 10 mm. No cases of pneumothorax occurred, one patient developed moderate bleeding, two developed minor bleeding, and five developed minimal bleeding that stopped spontaneously. A final diagnosis was obtained for seven patients, and ongoing follow-up was being conducted for the last patient at the time of this writing. Conclusions This is the first report of combining navigation technology with cryobiopsy to diagnose diffuse lung disease. The Archimedes Navigation System, which provides real-time guidance, is helpful in pre-cryobiopsy planning and diagnosis of diffuse lung disease. Moreover, this system can reduce the pneumothorax rate and bleeding risk by avoiding large vessels.