Diagnosis of interstitial lung disease in children

Hilman, Bettina C.; Amaro-Galvez, Rodolfo

doi:10.1016/j.prrv.2004.01.001

Cited by 20 publications

(9 citation statements)

References 25 publications

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“…A classifi cation of pediatric diffuse lung disease is summarized in Table 1 , modifi ed from a classifi cation described by the Children's Interstitial Lung Disease group. 3 , 4 A number of excellent clinical reviews are available on the topic of diffuse lung disease in children , [5][6][7][8][9][10][11][12][13] and therefore diagnostic histopathologic criteria are emphasized in this review.…”

Section: Dishop 72mentioning

confidence: 99%

Diagnostic Pathology of Diffuse Lung Disease in Children

Dishop

2010

Pediatric Allergy, Immunology, and Pulmonology

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The pathologic classification of diffuse lung disease in children and adolescents has undergone revision in recent years in response to rapid developments and new discoveries in the field. A number of important advancements have been made in the last 10 years including the description of new genetic mutations causing severe lung disease in infants and children, as well as the description of new pathologic entities in infants. These recently described entities, including ABCA3 surfactant disorders, pulmonary interstitial glycogenosis, and neuroendocrine cell hyperplasia of infancy, are being recognized with increasing frequency. This review will include brief discussion of the etiology and pathogenesis of the major groups of diffuse lung disease in children. Histopathologic features are discussed for each of the major categories of diffuse lung disease in children, beginning with the genetic, developmental, and alveolar growth disorders common in infancy, followed by brief discussion of airway diseases, immunologic diseases, and pulmonary vascular diseases seen more commonly in older children. A protocol for handling pediatric wedge lung biopsies is also discussed, which optimizes the diagnostic yield of lung biopsies in this population.

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Section: Dishop 72mentioning

confidence: 99%

Diagnostic Pathology of Diffuse Lung Disease in Children

Dishop

2010

Pediatric Allergy, Immunology, and Pulmonology

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“…(22) Another difference found in one study (15) regarding the BAL cell profiles of asthma patients was that the is suspicion of pulmonary hemorrhage and hemosiderosis. (29) The diagnosis of pulmonary histiocytosis can be documented (in the BAL fluid) with the use of monoclonal antibodies revealing the presence of more than 5% CD1a+ cells. (3,30) This finding, associated with clinical and radiological findings, can contribute to reduce the indication for lung biopsy in a significant number of cases.…”

Section: Cystic Fibrosismentioning

confidence: 99%

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

2010

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The objective of this study was to review the literature on bronchoalveolar lavage fluid cell profiles in healthy children and adolescents, as well as on the use of BAL as a diagnostic and follow-up tool for lung disease patients in this age bracket. To that end, we used the Medline database, compiling studies published between 1989 and 2009 employing the following MeSH descriptors (with Boolean operators) as search terms: bronchoalveolar lavage AND cytology OR cell AND child. In healthy children, the cell profile includes alveolar macrophages (> 80%), lymphocytes (approximately 10%), neutrophils (approximately 2%) and eosinophils (< 1%). The profile varies depending on the disease under study. The number of neutrophils is greater in wheezing children, especially in non-atopic children, as well as in those with pulmonary infectious and inflammatory profiles, including cystic fibrosis and interstitial lung disease. Eosinophil counts are elevated in children/adolescents with asthma and can reach high levels in those with allergic bronchopulmonary aspergillosis or eosinophilic syndromes. In a heterogenous group of diseases, the number of lymphocytes can increase. Evaluation of the BAL fluid cell profile, when used in conjunction with clinical and imaging findings, has proven to be an essential tool in the investigation of various lung diseases. Less invasive than transbronchial and open lung biopsies, BAL has great clinical value. Further studies adopting standard international protocols should be carried out. Such studies should involve various age groups and settings in order to obtain reference values for BAL fluid cell profiles, which are necessary for a more accurate interpretation of findings in children and adolescents with lung diseases.Keywords: Bronchoalveolar lavage; Bronchoalveolar lavage fluid/cytology; Child; Adolescent. ResumoEste estudo teve como objetivo rever a literatura existente sobre a celularidade do LBA em crianças e adolescentes saudáveis, bem como sobre sua utilização como método propedêutico e de acompanhamento nas afecções pulmonares neste grupo etário. Para tanto, utilizamos o banco de dados médico Medline com a seleção de artigos publicados entre 1989 e 2009 utilizando os seguintes descritores MeSH com operadores boolianos: bronchoalveolar lavage AND cytology OR cell AND child. Em crianças saudáveis, a celularidade é composta por macrófagos alveolares (> 80%), linfócitos (cerca de 10%), neutrófilos (cerca de 2%) e eosinófilos (< 1%). O perfil celular sofre alterações de acordo com a doença estudada. Ocorre uma elevação no número de neutrófilos em sibilantes, especialmente os não atópicos, bem como em indivíduos com quadros infecciosos e inflamatórios pulmonares, incluindo fibrose cística e doenças intersticiais pulmonares. Os eosinófilos se elevam em crianças/adolescentes com asma e podem atingir níveis acentuados na aspergilose broncopulmonar alérgica e nas síndromes hipereosinofílicas. A elevação dos linfócitos pode ocorrer em um grupo heterogêneo de doenças. Conclui-se que a...

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“…Clinically, is most commonly characterized by tachydyspnea, cough, disordered gas exchange, a restrictive pattern in lung function tests, and abnormal opacities on plain chest radiography and/or computed tomography (CT). 1,19 The spectrum of DPLD ranges from DPLD of known association, idiopathic interstitial pneumonias including chronic pneumonitis of infancy, to interstitial pneumonias and congenital forms. 2 The approach to diagnosis includes various non-invasive and invasive steps.…”

Section: Discussionmentioning

confidence: 99%

“…Diffuse parenchymal lung disease (DPLD) in infants and children remains a clinical challenge. 1 The approach to diagnosis includes a detailed past medical history, physical examination, a variety of laboratory tests, noninvasive techniques, such as pulmonary function tests and imaging, and invasive techniques such as bronchoscopy with bronchoalveolar lavage (BAL) and pulmonary biopsy. 2,3 Open lung biopsy (OLB) has been shown to be a successful diagnostic tool with therapeutic implications even in critically ill pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic biopsy in children with diffuse parenchymal lung disease

Glüer

Schwerk

Reismann

et al. 2008

Pediatric Pulmonology

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Lung biopsy is necessary for establishing the diagnosis in patients with otherwise unclassified diffuse or localized parenchymal lung disease. This study aimed to assess the safety and accuracy of video-assisted thoracoscopic (VATS) lung biopsy in children with diffuse parenchymal lung disease (DPLD). In addition we aimed to evaluate the value of this technique with respect to the spectrum of diseases encountered, correlating histological diagnosis with treatment decisions and subsequent clinical outcome. Data from all patients (n = 21) who underwent surgical lung biopsy for suspected DPLD between March 2001 and August 2006 were collected prospectively. Median age was 3 years, 8 months (range 11 days to 15 years, 2 months). All lung biopsies were performed by VATS under general anesthesia. Median operative time was 45 min (range 25-100 min). Conversion to minithoracotomy due to cardiorespiratory difficulties was necessary in two young infants. There were no further intraoperative complications. In 8/21 children, a chest tube was inserted postoperatively for a median of 2 days (range 1-5 days). In one patient, prolonged air-leakage was managed thoracoscopically on postoperative day 9. There were no other postoperative complications. The specimens were of adequate volume and quality and a histopathological diagnosis was obtained for all patients. There was a broad spectrum of different diagnoses which led to specific therapeutic decisions. Subsequent medical treatment was beneficial in the majority of the patients. In conclusion, VATS is a safe and effective procedure for diagnosis of children with suspected DPLD. Diagnostic accuracy is high, morbidity rates are low, and patients may benefit from avoiding thoracotomy.

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Diagnosis of interstitial lung disease in children

Cited by 20 publications

References 25 publications

Diagnostic Pathology of Diffuse Lung Disease in Children

Diagnostic Pathology of Diffuse Lung Disease in Children

Celularidade do líquido de LBA em crianças e adolescentes saudáveis e com doenças pulmonares

Thoracoscopic biopsy in children with diffuse parenchymal lung disease

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