DISCUSSION
Oyarzunvi et al published a series of 27 OLB's in 24 patients with HIV and pulmonary infiltrates from a cohort of 355 HIV positive patients between 1988-1994. Infectious pathologies were identified in 16 patients (PCP - 7 Bacterial - 5 CMV - 2) and non-infectious etiologies were identified in 27 (PLH/LIP - 9 DIP - 6 DAD - 7). A complication rate of 8.3% was reported with 2 of 27 patients requiring prolonged intubation for air leak (over 7 days). There was a 67% Mortality over the study period. Of note only 1 of the 4 patient with PCP was diagnosed on BAL.
Complication rates of 2 to 52% were reported in the cases. Daviesvii et al published a case series of 47 OLB's for undiagnosed pulmonary infiltrates including both immunocompromised and immunocompetent patients. 26 patients were in acute respiratory failure (55%). Complications were reported in 55% including in 21 patients (65%) with respiratory failure and 3 patients (14%) without respiratory failure. The complications included 15 patients with pneumothorax/prolonged air leak, 3 with lung collapse, as well as empyema, upper airway obstruction, bleeding and intra-operative fluid overload.
Video assisted thoracoscopic lung biopsies have been shown to have similar yields with lower complications rates in both adults and children. Although it has not been directly compared to OLB via thoracotomy in this population similar results would be expected. This literature is not reviewed here.
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