Diagnostic Approach to Respiratory Disease | Nelson Textbook of Pediatrics 22nd Edition | Flexible/Rigid Bronchoscopy, Bronchoalveolar Lavage (BAL), Transbronchial Biopsy, EBUS, Thoracoscopy, Lung Biopsy, Thoracentesis, Ciliary Studies, Genetic Testing.
🌐 paeds.online — Pakistan's Pediatric Platform| Procedure | Primary Indications | Key Diagnostic Yield |
|---|---|---|
| Flexible Bronchoscopy | Stridor, persistent atelectasis, suspected airway anomaly, BAL | Visualize dynamic airway collapse, infection, inflammation |
| Rigid Bronchoscopy | Foreign body aspiration, massive hemoptysis, tumor debulking | Airway control, therapeutic extraction |
| BAL (Bronchoalveolar lavage) | Immunocompromised host, hemosiderosis, alveolar proteinosis, PCP | Cytology (hemosiderin, lipid-laden macrophages), microbiology |
| Transbronchial Biopsy | Post-lung transplant rejection, diffuse ILD (older children) | Histopathology (granulomas, fibrosis, rejection) |
| EBUS-TBNA | Mediastinal lymphadenopathy (sarcoidosis, TB, lymphoma) | Real-time ultrasound-guided nodal sampling |
| Thoracoscopic/Open Lung Biopsy | Diffuse lung disease of unknown etiology, surfactant disorders | Gold standard for ILD, surfactant protein defects |
| Thoracentesis | Pleural effusion (exudate vs transudate), empyema | Cell count, protein, LDH, glucose, pH, culture, cytology |
| Nasal/ bronchial ciliary biopsy | Suspected primary ciliary dyskinesia (PCD) | Electron microscopy (dynein arms), genetic testing |