Open lung biopsy in children with diffuse pulmonary lesions.

During the period 1973-81, open lung biopsy was performed in 33 consecutive children, aged 1 month to 13 years, to exclude or diagnose Pneumocystis carinii pneumonia and to differentiate other interstitial pulmonary lesions. Twenty-one of the patients were undergoing immunosuppressive treatment because of their malignant disease. The clinical diagnosis was correct only in 55% of the patients, but open lung biopsy and histological examination gave the final answer in every patient. Pneumocystis carinii was the causative organism in 67% of the immunosuppressed patients. Nine patients had postoperative complications, 5 of which were mild in nature and resolved spontaneously. Three patients had to be reoperated on for postoperative sequelae. There was one death possibly caused by surgical intervention--tension pneumothorax 10 days after surgery. It is concluded that open lung biopsy is the most reliable method in the diagnosis of diffuse interstitial pneumonitis in children. The need of anaesthesia is no contra-indication and the benefits of the biopsy far outweight the risks of its complications.