Interstitial lung disease in the immunocompetent patient is often a difficult challenge for the clinician, especially when no diagnostic clues are present after a thorough clinical assessment, laboratory examination including serology for specific connective tissue disease, chest radiography, and high-resolution computed tomography (HRCT). Bronchoalveolar lavage and transbronchial biopsy are usually the next step [1]. Thoracoscopy has been safely and successfully performed by well-trained pulmonologists for several decades [2]. The introduction of modern video equipment and more refined instrumentation has expanded the indications [3]. Medical thoracoscopic lung biopsy (MTLB) in the diagnosis of interstitial lung disease can be considered a second choice after failure of bronchoalveolar lavage (BAL) and trans bronchial lung biopsy (TBLB) to provide the diagnosis, and this technique has some advantages over surgical lung biopsy (SLB). The possibility to take several biopsies under visual guidance and lower morbidity are the most important advantages [4].