weekly_question 15/10/2023

[Admin]

A 1 year old is being worked up for interstitial lung disease. The current recommended strategy for lung biopsies is:

A Multiple sliver biopsies.

B Target lingula or right middle lobe.

C Wedge specimens of at least 1 cubic cm. from two sites.

D 10-15 percutaneous core specimens obtained via CT guidance.

E Biopsy after initiation of steroids.

[Admin]

correct answer
C Wedge specimens of at least 1 cubic cm. from two sites.

Wedge specimens that are at least 1cm3 provide sufficient tissue volume in this age patient. Two areas of lung should be biopsied, focusing on any areas of disease identified on CT.Sliver, or “canoe shaped“, biopsies are insufficient in depth as distal airways need to be evaluated and biopsies should not be taken from the lingula or edge of the middle lobe as disproportionate changes can be seen in these areas.

Biopsies should be performed prior to initiation of steroids or any other medical therapy to get an accurate picture of the interstitial disease and appropriately guide management.

There is some controversy regarding whether percutaneous biopsies provide adequate tissue volume for diagnosis and the potential for complications from multiple passes makes a percutaneous approach less attractive.

[Ismailmohamed]

I think D but I will search

[Mumtaz]

Option C would be an appropriate choice.

[Masoud]

C

[Amal Adam]

I think C

[Aziza Elnaeema]

C

[Dr. Muhammad Amir]

C

[Admin]

correct answer
C Wedge specimens of at least 1 cubic cm. from two sites.

Wedge specimens that are at least 1cm3 provide sufficient tissue volume in this age patient. Two areas of lung should be biopsied, focusing on any areas of disease identified on CT.Sliver, or “canoe shaped“, biopsies are insufficient in depth as distal airways need to be evaluated and biopsies should not be taken from the lingula or edge of the middle lobe as disproportionate changes can be seen in these areas.

Biopsies should be performed prior to initiation of steroids or any other medical therapy to get an accurate picture of the interstitial disease and appropriately guide management.

There is some controversy regarding whether percutaneous biopsies provide adequate tissue volume for diagnosis and the potential for complications from multiple passes makes a percutaneous approach less attractive.