New Nodule-Newer Etiology

Abstract

Informed consent statement: Due to the retrospective nature of the study there was no need to obtain patient consent. Conflict-of-interest statement:We have no financial relationships to disclose. Abstract AIM: To evaluate frequency and temporal relationship between pulmonary nodules (PNs) and transbronchial biopsy (TBBx) among lung transplant recipients (LTR). METHODS:We retrospectively reviewed 100 records of LTR who underwent flexible bronchoscopy (FB) with TBBx, looking for the appearance of peripheral pulmonary nodule (PPN). If these patients had chest radiographs within 50 d of FB, they were included in the study. Data was compared with 30 procedures performed among non-transplant patients. Information on patient's demographics, antirejection medications, anticoagulation, indication and type of lung transplantation, timing of the FB and the appearance and disappearance of the nodules and its characteristics were gathered. RESULTS:Nineteen new PN were found in 13 procedures performed on LTR and none among nontransplant patients. Nodules were detected between 4-47 d from the procedure and disappeared within 84 d after appearance without intervention. Core tip: Transbronchial biopsy (TBBx) is routinely performed in lung transplant recipients (LTR). The development of pulmonary nodules (PNs) in this population is common. We investigated LTR who developed PNs post TBBx to determine the temporal relationship between the procedure and the timing of appearance and disappearance of these nodules. Our conclusion is that TBBx in LTR is associated with development of transient nodules at the site of TBBx in 13% of procedures. We hypothesize that these nodules are related to local hematoma and impaired lymphatic drainage. Close observation is a reasonable management approach. CONCLUSION: FB in LTR is

Electromagnetic navigational bronchoscopy for diagnosing peripheral lung lesions in lung transplant recipients: a single-center experience

“…Patient 7 was diagnosed with a lung nodule from prior hemorrhage related to transbronchial biopsy, as resolving focus of parenchymal hemorrhage was reported on pathology. When her images and history were reviewed, this site was found to be the location of a prior transbronchial lung biopsy (a finding described by others) (2). Her nodule had resolved on serial follow-up imaging.…”

“…Lung nodules are common in lung transplant recipients (1), but the immunosuppressed status of these patients means that diagnosing these nodules is urgent. Differential diagnoses in lung transplant recipients with lung nodules include infection (i.e., bacterial, fungal, mycobacterial), malignancy [e.g., bronchogenic, post-transplant lymphoproliferative disorder (PTLD), or metastatic malignancy], and hemorrhage after previous transbronchial biopsies (1,2). Infections from Pseudomonas and Aspergillus species are the most common causes of lung nodules in these patients (3).…”

“…Infections from Pseudomonas and Aspergillus species are the most common causes of lung nodules in these patients (3). Such lesions can drastically affect management of lung transplant recipients, especially when resistant infection, PTLD, or bronchogenic carcinoma is suspected (1,2,4). Making a timely diagnosis is of paramount importance.…”

The Role of Surveillance Bronchoscopy Following a Lung Transplantation

“…Mehta et al hypothesized that these nodules are related to local hematoma and impaired lymphatic drainage. In this retrospective study, PNs were detected in 13% of the procedures within 50 days and needed up to 86 days to resolve spontaneously [37]. These new PNs could be radiologically interpreted as malignancies, opportunistic infection, or post-transplant lymphoproliferative disorder.…”