What are the lungs?
The lungs are a pair of elastic, air-filled organs. They are used for breathing, which involves the exchange of oxygen and carbon dioxide. They expand and contract in size every time your child breathes in and out. They are located on either side of the chest.
What is a lung biopsy?
A lung biopsy is a procedure where a tiny piece of tissue is taken from the lungs using a special needle. The tissue is then examined under a microscope in the laboratory.
Why is a lung biopsy performed?
The biopsy results help your child’s doctor to better advise you on your child’s lung condition and possible treatments, if required.
How is a lung biopsy performed?
Lung biopsies are performed by interventional radiologists or surgeons using image guidance. The interventional radiologist uses ultrasound and/or a CT scan to view the lungs and the area they want to biopsy. A small hollow needle is then guided into the lung, and a few small samples are taken. The samples are about as thin as of a piece of thread, and they are sent to the laboratory for examination.
A lung biopsy usually takes one to two hours. A small bandage will be put over the biopsy area, and it can be taken off 48 hours after the procedure. Your child will usually not need any stitches.
Risks of a lung biopsy for your child
Lung biopsies are usually a low-risk procedure. The risk may increase depending on your child’s condition, age and health.
The risks of a lung biopsy include:
- bleeding into the chest or lungs
- coughing up blood
- infection
- air leakage from the lungs
- needle injury to other nearby organs
- rupture of blood vessels
If bleeding or air leakage occurs, your child may require a small chest tube to drain out the blood or air.
Preparing for a lung biopsy
Visiting the interventional radiologist before the procedure
Your child will meet with the interventional radiologist before the procedure. During the visit, you should expect the following:
- A health assessment to make sure your child is healthy and that it is safe for them to have general anaesthesia.
- An overview of the procedure, and a review of the consent form with the interventional radiologist.
- Blood work to be taken, if needed.
Giving consent before the procedure
Before the procedure, the interventional radiologist will go over how and why the procedure is done, as well as the potential benefits and risks. They will also discuss what will be done to reduce these risks and will help you weigh the benefits against them. It is important that you understand all of these potential risks and benefits of the lung biopsy and that all of your questions are answered. If you agree to the procedure, you can give consent for treatment by signing the consent form. A parent or legal guardian must sign the consent form for young children. The procedure will not be done unless you give your consent.
How to prepare your child for the procedure
Before any treatment, it is important to talk to your child about what will happen. When talking to your child, use words they can understand. Let your child know that medicines will be given to them to make them feel comfortable during the procedure.
Children feel less anxious and scared when they know what to expect. Children also feel less worried when they see their parents are calm and supportive.
If your child becomes ill within two days before the procedure
It is important that your child is healthy on the day of the procedure. If your child starts to feel unwell or has a fever within two days before the lung biopsy, let your doctor know. Your child’s procedure may need to be rebooked.
Food, drink, and medicines before the procedure
- Your child’s stomach must be empty before and during sedation or general anaesthetic.
- If your child has special needs during fasting, talk to your doctor to make a plan.
- Your child can take their regular morning medicine with a sip of water two hours before the procedure.
Medicines such as acetylsalicylic acid (ASA), naproxen or ibuprofen, warfarin, or enoxaparin may increase the risk of bleeding. Do not give these to your child before the procedure unless they have been cleared first by your child’s doctor and the interventional radiologist.
On the day of the lung biopsy
Arrive at the hospital two hours before the planned time of your child’s procedure. Once you are checked in, your child will need to change into a hospital gown, and be weighed and assessed by a nurse. You will also be given an opportunity to speak to the interventional radiologist and the anaesthetist at this time. The interventional radiologist will be performing the lung biopsy, and the anaesthetist will be giving your child medication to make them comfortable for the procedure.
During the lung biopsy, you will be asked to wait in the waiting area.
Your child will have medicine for pain
It is important that your child is as comfortable as possible for the procedure. Your child will receive a general anaesthetic for the lung biopsy, so they will not hear or feel anything during the procedure.
After the lung biopsy
Once the lung biopsy is complete, your child will be moved to the recovery area. The interventional radiologist will come and talk to you about the details of the procedure. As soon as your child starts to wake up, a nurse will come and get you.
Your child will have a bandage on the biopsy site. This can be taken off after 48 hours.
Going home
Many children who have a lung biopsy as an outpatient go home the same day. This is usually about eight hours after the biopsy.
Your child will be observed closely during these hours before being discharged home. Your child will have a chest X-ray one to two hours after the biopsy to look for any bleeding or air leakage. A blood test may also be taken after the biopsy to identify any changes in blood levels. If your child’s hemoglobin drops, an ultrasound may be ordered. Your child may have to stay on bed rest or be admitted overnight for further observation if your child's doctor feels it necessary.
Caring for your child at home
Some children may feel pain or discomfort after the lung biopsy for the first day or two. If this happens, give your child acetaminophen as directed by your child's doctor.
For more details on how to care for your child after a lung biopsy, see, “Lung biopsy: Caring for your child at home after the procedure.”
Results
The doctor who ordered the procedure will receive the results of your child’s lung biopsy. You will need to make an appointment with them to discuss the results. Results can take a few weeks or longer to come back.
At SickKids
If you have any concerns in the first 48 hours, call the Image Guided Therapy (IGT) clinic at (416) 813- 7654 ext. 201804. Speak to the IGT clinic nurse during working hours or leave a non-urgent message.
If you have concerns and it is after working hours, see your family doctor or go to the nearest Emergency Department. You can also call the Hospital for Sick Children switchboard at (416) 813-7500 and ask them to page the interventional radiology fellow on call.
For more information on fasting, see, “Eating and drinking before surgery.”
For more information on preparing your child for their procedure, see “Coming for surgery.”