Pulmonary infiltrates and fever in patients with hematologic malignancy: assessment of transbronchial biopsy.

Pulmonary infiltrates associated with fever are frequently encountered in patients with acute leukemia or lymphoma; In this prospective series, we analyze 47 such episodes in 43 patients. Overall mortality was 45 per cent in patients with infiltrates and somewhat higher when they also had neutropenia (55 per cent) or acute leukemia (67 per cent). Pulmonary infiltrates could be categorized into three roentgenographic patterns: local consolidation (55 per cent); cavitary disease (13 per cent) and diffuse interstitial disease (32 percent). The exact etiology of the infiltrates could not be predicted by roentgenographic study. Microbiologic or histopathologic diagnosis was established during life in 57 per cent of the patients, with infection most commonly encountered. Twenty-one patients underwent lung biopsy procedures. Biopsy specimens were frequently diagnostic (n = 17) and often dictated therapeutic changes (n = 12). Transbronchial lung biopsy via the fiberoptic bronchoscope was utilized in 14 patients during the latter part of this study; diagnoses were obtained in nine patients. Morbidity was minimal with this procedure, and the need for thoracotomy was diminished when it was available.