Discussion
To our knowledge, this is the first reported case of successful
transbronchial biopsy via RB in a 5-year-old patient. The sample
revealed a potential diagnosis, but more importantly, helped rule out an
active infectious process and avoided an open lung biopsy which was
being planned and would have otherwise been necessary to establish a
diagnosis. We believe this technology can be used to increase the
diagnostic yield of flexible bronchoscopy, particularly in the
immunocompromised population as there is already evidence supporting
image-guided bronchoscopy over conventional bronchoscopy in this
population (4). A notable limitation to RB is the size of the available
bronchoscopes for robotic platforms (4.5 and 3.5 mm OD). In children,
this may limit the capacity to sample more peripheral lesions via fine
needle aspiration, as more lung tissue (relative to chest size) may be
injured. In our case, the catheter tip was never as close to the lesion
as it has been described in adults (2). As the field of pediatric
interventional pulmonology continues to develop, RB will likely be one
of several options available for safe and high-yield diagnostic
procedures.
The patient was considered to have metastatic pulmonary calcifications.
These lesions are benign, and have been reported to self-resolve as
there are no available treatment options (5). This entity has been
described after infectious process, associated with renal failure and
severe calcium or phosphorus abnormalities (5) and as isolated findings
after liver or heart transplants (5). Follow-up imaging continues to
demonstrate the same lesions without evidence of progression, and the
patient remained asymptomatic.