Acute fibrinous and organizing pfneumonia: two case reports and literature review

Background Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern characterized by the intra-alveolar fibrin deposition and organizing pneumonia. Its clinical characteristics are still not well known and there is no consensus on treatment yet. Case presentation We report two female cases in their fifties diagnosed with AFOP confirmed by a second lung biopsy. Case 1 was idiopathic AFOP with manifestation of 6-week fever, dyspnea, and cough, while case 2 was secondary to systemic lupus erythematosus and fever was the major symptom. Their chest CT scans revealed bilateral multiple consolidations, predominantly in the lower lobes. Both cases were initially diagnosed with pneumonia, but did not improve after treatment with broad-spectrum antibiotics. In both cases, transbronchial biopsy and bronchoalveolar lavage fluid examination were inconclusive and the pathological diagnosis was confirmed by percutaneous lung biopsy. Both patients had a good clinical response to prednisone. Conclusions We report two rare AFOP cases to highlight the importance of awareness of this disease. We further perform the most comprehensive review to date in AFOP, including 150 patients since 2002. Consolidation was the most common imaging pattern, followed by ground-glass opacity and nodules. A lung biopsy is required for a definitive diagnosis. Corticosteroids is recommended as the most effective therapy, but treatment options should depend on the etiology and disease severity.

Pneumothorax after percutaneous transthoracic lung biopsy. Non-invasive management in order to avoid unnecessary hospitalizations.

BACKGROUND: Image-guided percutaneous transthoracic lung biopsy has become a widely used and less invasive diagnostic method. Pneumothorax is the most frequent complication after lung biopsy. The aim of the present study is to describe the experience with expectant management of asymptomatic small post-biopsy pneumothorax in order to reduce unnecessary hospital admissions. METHODS: A retrospective review was performed analyzing the results of subjects who underwent expectant and conservative treatment after presenting pneumothorax following percutaneous lung biopsy, in a period of 6 years (January 2013 - December 2019) RESULTS: 160 subjects who underwent diagnostic percutaneous lung biopsy of lung nodules were evaluated. Of these, 46 subjects (29%) presented pneumothorax, of which 36 were small. This group of subjects was managed expectantly, with a therapeutic success of 81% (7 subjects had to undergo percutaneous pleural drainage). CONCLUSION: Expectant management in subjects with pneumothorax following percutaneous lung biopsy is a useful tool and should be applied by surgeons in order to avoid hospitalizations and / or unnecessary and expensive procedures.

Biopince Full Core Biopsy Device for Percutaneous Lung Biopsy: A Retrospective Analysis of 184 Procedures Analyzing Complication Rates and Procedure Success

Background: Unlike fine needle aspiration, core needle biopsies allow the collection of intact tissue for pathological and molecular evaluation. In outpatient clinical practice, full core needle lung biopsy may be underused because of concerns that it might be too dangerous. We describe our experience using a full core device for percutaneous lung biopsy in a large cohort of patients. Research Question: Is percutaneous full core needle lung biopsy effective and safe in the outpatient setting? Study Design and Methods: The analyzed population comprised patients with lung masses >1.1 cm who underwent percutaneous lung biopsy with a full core device. Analyzed data included core mass dimensions, distance from pleural edge to mass, lobe location, type, outcomes, and complications. Biopsy success was defined as adequate tissue acquisition for pathological evaluation that yielded a diagnosis. Biopsy procedures with incomplete data were excluded from this analysis. Results: We analyzed data from 184 lung biopsies performed on 182 patients (mean age, 70±11.7 years). Most biopsies were parenchymal (54.9%). The overall diagnostic success rate was 98.4%. No complications were reported for 77.2% of biopsies. Minor complications occurred during 39 biopsies (21.2%) and were primarily pneumothorax (16.8%). Major complications occurred during 4 biopsies (2.1%): 3 patients with pneumothorax required emergency department (ED) management and 1 patient went to the ED for severe pain. All complications resolved within 24 hours without hospitalization or transfusion. Crosstabulation analyses showed no significant differences between the lung lobe locations in terms of rates of disposition and complications, and between the lesion types in terms of rates of disposition and complications. Interpretation: Percutaneous lung biopsy performed using a full core biopsy device demonstrated a high rate of diagnostic success and a low risk of clinically significant procedural complications in an outpatient setting.