Email: tad2008@hotmail.com
To the Editor,
Diffuse alveolar hemorrhage syndrome (DAHS) is a life-threatening
clinical syndrome caused by a variety of etiological factors. The main
manifestations are hemoptysis, anemia, hypoxic dyspnea, and respiratory
failure, while diffuse infiltration shadows are observed on both lungs
on imaging [1]. DAHS can occur at different ages in children, and
there is great heterogeneity in its clinical manifestation and etiology.
Treatment options vary for different etiologies. The complex etiology of
DAHS means that any damage to the pulmonary microcirculation may lead to
alveolar hemorrhage. Thus, early identification and etiological
diagnosis, in particular, are both challenging and critically important.
Compared with procedures such as surgical lung biopsy (SLB), there are
several advantages to the use of transbronchial lung cryobiopsy (TBLC),
including less trauma, fewer complications, large and high-quality
specimens, and lower cost. This procedure is mainly used for the
etiological diagnosis of diffuse parenchymal lung diseases (DPLD)
[2] and its most common complications, including bleeding and
pneumothorax. Virtual bronchoscopy navigation (VBN) can assist
bronchoscopists in pinpointing the target area in the lung and designing
an appropriate navigation pathway to accurately reach the target lesion
[3]. Thus, VBN improves the rate of diagnosis and reduces the risk
of bleeding and pneumothorax. In this report, which we believe to be the
first of its kind, we performed TBLC guided by VBN.
An 8-year-old girl was admitted to the hospital after suffering from
intermittent hemoptysis for more than 1 year, accompanied by anemia.
Enhanced computed tomography (CT) scan of the chest and macrovascular
reconstruction suggested that the transparency of the lung field was
decreased. Diffuse pale shadows were seen in both lungs, which showed
intensification after enhancement, and some of the pulmonary vessels had
thick peripheral diameters (Figure1 A). A bronchoalveolar lavage fluid
smear showed increased numbers of hemosiderin-laden cells, while special
staining showed the presence of iron. Thus, an initial diagnosis of DAHS
was made. To further identify the pathogenic basis, we attempted to
obtain frozen lung tissue specimens by TBLC. To reduce the risk of
bleeding and pneumothorax and make the biopsy procedure safer, we
combined TBLC with VBN. Before the surgery, the respiratory physicians,
radiologists, anesthesiologists, and pathologists were brought together
to conduct a multidisciplinary discussion and jointly formulate a
surgical plan and risk prevention and control plan. The parents of the
child signed the informed consent for the surgery.