الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Diagnosis of diffuse parenchymatous lung diseases (DPLD) in a large proportion of cases is achieved through clinical team work that consists of a pulmonologist, radiologist and pathologist working together, revising the history, exposures, clinical examination, radiological workup, detailed laboratory investigations and sometimes invasive diagnostic tools may be helpful e.g.: BAL and TBLB. But the sensitivity and specificity of this approach ranging between 40 to 60 % and about one third of the patients with diffuse lung disease will need a surgical biopsy for definite diagnosis.
The current guidelines emphasize on the significant role of surgical lung biopsy (SLB) for the definite diagnosis of ILDs. The decision to perform the lung biopsy in the evaluation of ILDs is based on the probability that this examination will yield a specific diagnosis, leading to a change in treatment plane e.g.: role out or diagnose malignant or infectious causes of ILDs.
VATS lung biopsy is considered as the golden approach to obtain lung biopsy when needed in the patients with ILDs, technical improvement in both equipments and the surgical skills as well as widespread use of the Endo-staplers markedly improves the quality of the biopsies that taken via VATS to give the same diagnostic yield of open lung biopsy with less complications and more convenience to the patients.
The incidence of post VATS lung biopsy complications is higher in the high risk patients (poor pulmonary functions, immunosuppression, dependence on oxygen therapy and extension of the disease in the lung parenchyma), while in low risk ambulatory patients when the procedure performed on electively the incidence of complications is markedly reduced and with rare post operative mortality.
Common post VATS biopsy complications include; atelectasis, pulmonary infection, air leak, pnuomothorax, haemothorax, need for prolonged mechanical ventilation and development of diffuse alveolar damage (DAD) which is the main cause of respiratory failure and post operative mortality in high risk patients.
We performed a prospective observational study on 20 adult patients with undiagnosed ILD and performed VATS lung biopsy to evaluate the role of VATS biopsy in the diagnosis of ILD.
They were (11 females and 9 males) with mean age 49.2 ys (Mean ± SD= 49.20 ± 10.36) All our patients were ambulatory low risk patients with accepted preoperative pulmonary functions.
In 17 patients (85%) there was a pre operative workup in trial to diagnose the disease in the form of BAL, CT guided biopsy, pleural fluid analysis and ZN staining of the sputum, and in the remaining 3 cases (15%) the biopsy was the first invasive trial to diagnose the disease.
We took our biopsies from the following sites: 9 cases from the lingula, 5 cases from left lower lobe, 3 cases from right lower lobe, 1 case from the right upper lobe, 1 case from the right middle lobe and 1 case from the left upper lobe.
The main determinant of our biopsy site