The surgical approach to interstitial lung disease.

The thoracic surgeon can provide a valuable service to his referring physicians and patients in establishing a definitive pathologic and etiologic diagnosis of diffuse interstitial lung disease (see Fig. 1). The myriad of etiologic agents results in a diagnostic conundrum that cannot be solved in many cases on the basis of history, physical examination, chest roentgenograms, gallium scans, bronchial lavage, and transbronchial biopsy. For a patient who has respiratory symptoms with diffuse interstitial lung disease on chest radiogram or one who has significant respiratory insufficiency on the basis of pulmonary function studies but has a normal chest radiogram, open lung biopsy should be carried out with anticipation of a very high yield from a low-risk procedure. Establishing a correct diagnosis is now important in terms of the administration of, withdrawal of, or change in therapy; the use of corticosteroids; and the use of immunosuppressive agents or of cytotoxic agents. It is not enough to give a patient who is breathless an aminophylline derivative and place him on corticosteroids if he becomes sicker. There are many diseases with a specific etiology and with a specific, appropriate treatment, and the thoracic surgeon can provide this information.