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.