Chest
Volume 100, Issue 5, November 1991, Pages 1272-1276
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Clinical Investigations
Bilateral Bronchoalveolar Lavage in the Diagnosis of Opportunistic Pulmonary Infections

https://doi.org/10.1378/chest.100.5.1272Get rights and content

To further improve the diagnostic value of bronchoscopy in the immunosuppressed population presenting with diffuse pulmonary infiltrates, we prospectively investigated the utility of bilateral bronchoalveolar lavage (BAL). We performed 62 bronchoscopies on 52 immunosuppressed patients. Of the 52 patients, 33 had pulmonary infections. The yield for Pneumocystis carinii pneumonia on bilateral BAL was 94 percent (31/33), compared to the 84 percent (51/61) previously obtained with unilateral BAL in our institution. The recovery of P carinii was unilateral in four of five patients without AIDS and in four of 26 patients with AIDS. Transbronchial biopsy gave a yield of 85 percent (11/13). In ten patients with definitive cytomegalovirus (CMV) pneumonia, recovery of CMV by combined culture and cytology was 100 percent. Of nine bronchoscopies with positive cytology for CMV, five showed cytopathologic changes in the BAL from both sides and four in the BAL from one side only. No complications were seen in the 14 patients with thrombocytopenia or the five patients receiving mechanical ventilation. Our findings indicate that bilateral BAL significantly increases the yield for recovery of P carinii (p<0.02) and CMV (p<0.001) in immunosuppressed patients.

Section snippets

Patients

Patients were entered into the study if they were immunosuppressed and required bronchoscopy for evaluation of diffuse pulmonary infiltrates. Included in the study were patients with cancer who were treated with chemotherapy, patients receiving steroids, bone marrow transplant (BMT) recipients, and patients with or at high risk for developing acquired immunodeficiency syndrome (AIDS). The diagnosis of AIDS was based on criteria outlined by the Centers for Disease Control.13

Diagnostic Techniques

Bronchoscopy was

Results

Over an eight-month period, 62 bronchoscopic examinations were performed on 52 patients (45 men and 7 women) ranging in age from 21 to 65 years. In analyzing the data, culture and cytologic results were defined as positive or negative and the site of recovery as bilateral (both right and left lung) or unilateral (either right or left). Results were also compared to one of two previous study groups from this institution, which included 97 non-AIDS11 immunocompromised patients and 72 patients

Discussion

Bronchoalveolar lavage is a safe and effective method of diagnosing the cause of pulmonary infiltrates in the immunosuppressed host.11,12,18,20 In an attempt to improve the yield for diagnosing opportunistic infections, we investigated the usefulness and complications of bilateral BAL in patients with diffuse infiltrates, a method that theoretically doubles the sampling area of unilateral lavage.

The recovery of P carinii by bronchoscopy with bilateral BAL was 94 percent (31/33) in a combined

Conclusions

Bilateral BAL increases the yield over unilateral BAL for recovery of both Pneumocystis and CMV and can be performed safely in patients receiving mechanical ventilation and in those with correctable hypoxemia or thrombocytopenia. Bilateral BAL has been incorporated into routine practice at our institution. Because of the potential risk for hypoxemia during the procedure, continuous oximetric monitoring is recommended.

Acknowledgments

We recognize the secretarial assistance of Mrs. Vicky Franke, the statistical analysis of Dr. Elizabeth Tolley, and the editorial review of Dr. Barbara J. Kuyper.

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    Reprint requests: Dr. Stover, Pulmonary Division, Memorial Hospital, 1275 York Ave, New York 10021

    Manuscript received October 23; revision accepted March 7.

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