OPEN biopsy of the lung through a limited thoracotomy incision deserves greater use in the diagnostic evaluation of patients with diffuse bilateral pulmonary disease, as is proven in the following examples: The pulmonary infiltrate may have been discovered only because of a routine chest roentgenogram in an otherwise asymptomatic patient. Even after careful history, physical examination, and extensive laboratory study, the diagnosis may remain obscure. Our observation has been that a patient in this category is subjected to a prolonged series of tests which are uncomfortable, expensive, and sometimes hazardous. As stated by Langston,1 the diagnostic evaluation depends upon whether the physician believes that multiple small procedures that might provide the diagnosis are better than a single major procedure that carries a high probability of establishing the diagnosis.
Open-lung biopsy is recommended for those patients with diffuse pulmonary disease in whom all other reasonable diagnostic studies have been exhausted.