Bronchoscopic Myths and Legends

Abstract

Pulmonologists are routinely called to evaluate and care for patients with pulmonary hypertension. Traditionally there has been a reluctance to perform transbronchial lung biopsies in this group of patients. We carried out a literature review to evaluate the myth that bronchoscopy is contraindicated in patients with pulmonary hypertension.Myth: Flexible bronchoscopy with transbronchial lung biopsy is contraindicated in patients with pulmonary hypertension. (Clin Pulm Med 2009;16: 281-283) P ulmonary Hypertension (PHTN) has been divided by the World Health Organization into 5 categories based on the underlying etiology. 1 This classification is important because of different treatment options for patients with different etiologies, however, irrespective of the etiology, the end result is an elevation of pressure in the pulmonary vasculature. Ohmichi et al 2 noted that chronic venous PHTN caused visually identifiable dilation of bronchial veins on flexible bronchoscopy (FB). Since then it has been proposed that the increased perfusion pressure in the capillary bed of PHTN patients may hypothetically lead to excessive bleeding after transbronchial lung biopsy (TBLB). 3 It is perhaps for this reason that the British Thoracic Society in their 2001 guidelines 4 on diagnostic FB regard PHTN patients as being high risk for bleeding complications. However, they did not comment on the role if any of TBLB in this group of patients. Historically, opinions have varied on the role of TBLB in PHTN patients. Zavala 5 considered PHTN to be a relative contraindication to performing TBLB, while Cordasco et al 6 felt that TBLB could be safely performed in patients with PHTN.Wahidi et al 3 performed a survey of 158 pulmonologists in the United States and noted that 28.7% of physicians felt presence of PHTN to be an absolute contraindication to performing TBLB and 58.6% felt it was a relative contraindication.We performed a PUBMED search of the literature for original articles that addressed the issue of safety of TBLB in patients with PHTN.