Welcome to Cross-Canada Paediatric - Respiratory Residency Rounds
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One of the main areas for discussion within our group was the benefits and side effects of each of the procedures listed below, and primarily whether to do a BAL or to proceed directly with an open lung biopsy.

CT-scan?
Not specific to detect infectious or neoplastic aetiologies.

Bronchoalveolar lavage (BAL)?
Not specific to detect neoplastic aetiologies.
Usefull to diagnose infection (virus as RSV, influenza A, parainfluenza 3 measles virus, pathogens and oportunistic infection (AIDS?), PCP, Herpes V).
But infection may be associated with the underlying disease that BAL cannot diagnose (lymphoproliferative disorders, lymhomas, or idiopathic pneumonia).

Node biopsy?
Probably an alternative option to or in addition to lung biopsy...

Lung biopsy?
Gold standard for the definitive diagnosis of neoplastic, proliferative and idiopathic diseases. Thoracoscopic vs open lung biopsy can be discussed.

An open lung biopsy was done in this case. Due to the severity of her state, it was felt that the risk of a BAL was very high, and would as well, not be as likely to give a prompt diagnosis.

I WILL NOW SHOW YOU THE PATHOLOGY SPECIMENS, AND REVEAL THE FINAL DIAGNOSIS.


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