Hepatic and Pulmonary Biopsy by Mini-Thoracotomy and Transdiaphragmatic Access

¹ From the Division of Thoracic Surgery, Hospital das Clínicas University of São Paulo Medical School (HC-FMUSP), São Paulo, Brazil
² From the Division of Infectious and Parasitic Diseases, Hospital das Clínicas University of São Paulo Medical School (HC-FMUSP), São Paulo, Brazil
³ From the Division of Pneumology, Hospital das Clínicas University of São Paulo Medical School (HC-FMUSP), São Paulo, Brazil

Frequently, immunodeficient patients have more than one organ or system affected by opportunistic infection or neoplasia, requiring quick and precise diagnostic investigation. In some situations, different invasive diagnostic procedures may be necessary. Open lung biopsy is sometimes necessary to clarify the pulmonary diagnosis. Laparoscopy may be useful to clarify liver or other peritoneal diseases. Some specific patients might require both procedures. In this way it is proposed that the surgeon, through a microthoracotomy used for the pulmonary biopsy, has access to the diaphragm. A small phrenotomy is performed and then a liver needle biopsy under direct vision. The described technique of simultaneous open lung and hepatic biopsy permits better handling of the needle and hemostasis of the hepatic lesion at the puncture site. This method has been used since 1994 on 16 HIV-positive patients, all having clinical and laboratory manifestations of lung disease associated with liver disease of unknown etiology. No complications related to the method were observed. It is significant that different etiologies for the lung and liver disease were found in 50% of the cases. We conclude that the presented technique is simple, useful, and safe.

Key Words: AIDS • hepatic biopsy • immunosuppressed patients • open lung biopsy

Submitted on February 28, 1996
Accepted on June 17, 2007