Discussion
To our knowledge, this is the first reported case of successful transbronchial biopsy via RB in a 5-year-old patient. The sample revealed a potential diagnosis, but more importantly, helped rule out an active infectious process and avoided an open lung biopsy which was being planned and would have otherwise been necessary to establish a diagnosis. We believe this technology can be used to increase the diagnostic yield of flexible bronchoscopy, particularly in the immunocompromised population as there is already evidence supporting image-guided bronchoscopy over conventional bronchoscopy in this population (4). A notable limitation to RB is the size of the available bronchoscopes for robotic platforms (4.5 and 3.5 mm OD). In children, this may limit the capacity to sample more peripheral lesions via fine needle aspiration, as more lung tissue (relative to chest size) may be injured. In our case, the catheter tip was never as close to the lesion as it has been described in adults (2). As the field of pediatric interventional pulmonology continues to develop, RB will likely be one of several options available for safe and high-yield diagnostic procedures.
The patient was considered to have metastatic pulmonary calcifications. These lesions are benign, and have been reported to self-resolve as there are no available treatment options (5). This entity has been described after infectious process, associated with renal failure and severe calcium or phosphorus abnormalities (5) and as isolated findings after liver or heart transplants (5). Follow-up imaging continues to demonstrate the same lesions without evidence of progression, and the patient remained asymptomatic.