Chest
Clinical InvestigationsBilateral Bronchoalveolar Lavage in the Diagnosis of Opportunistic Pulmonary Infections
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.
REFERENCES (25)
- et al.
Pulmonary infiltrates and fever in patients with hematologic malignancy.
Am J Med
(1977) - et al.
Diffuse pulmonary infiltrates in immunosuppressed patients.
Am J Med
(1979) - et al.
Pulmonary infections in the immunocompromised patient.
Med Clin N Am
(1980) - et al.
Pulmonary infiltrates in leukemia.
Chest
(1980) - et al.
Spectrum of pulmonary disease associated with the acquired immune deficiency syndrome.
Am J Med
(1985) - et al.
Lung biopsy in immunocompromised hosts.
Am J Med
(1975) - et al.
Transbronchial forceps lung biopsy through the fiberoptic bronchoscope.
Chest
(1975) - et al.
Safety of fiberoptic bronchoalveolar lavage in evaluation of interstitial lung disease.
Chest
(1981) - et al.
Pulmonary complications of the acquired immune deficiency syndrome: report of a National Heart, Lung, and Blood Institute workshop.
N Engl J Med
(1984) - et al.
Trephine air drill, bronchial brush, and fiberoptic transbronchial lung biopsies in immunocompromised patients. Am Rev Respir Dis 1977; 115:213-20 9 Matthay RA, Farmer WC, Odero D. Diagnostic fiberoptic bronchoscopy in the immunocompromised host with pulmonary infiltrates.
Thorax
(1977)
The benefits of open lung biopsy in patients with previous non-diagnostic transbronchial lung biopsy.
Chest
Bronchoalveolar lavage in diagnosing diffuse pulmonary infiltrates in the immunocompromised host.
Ann Intern Med
Cited by (54)
Bronchoscopy and Lung Biopsy in Critically Ill Patients
2008, Critical Care Medicine: Principles of Diagnosis and Management in the AdultGood practices of diagnostic flexible bronchoscopy
2007, Revue des Maladies RespiratoiresBronchoscopy in paediatric intensive care
2003, Paediatric Respiratory ReviewsFlexible bronchoscopy in nosocomial pneumonia
2001, Clinics in Chest MedicineCitation Excerpt :The colony counts are calculated by the number visible on the agar plate in relation to the dilution and inoculation factors. The cut-offs for quantitative culture results were established relating colony counts known to be present in sputum samples of patients with pneumonia to the estimated amount of respiratory secretions retrieved by each bronchoscopic technique.41 These estimations were substantiated further by studies using a baboon model.28
Reprint requests: Dr. Stover, Pulmonary Division, Memorial Hospital, 1275 York Ave, New York 10021
Manuscript received October 23; revision accepted March 7.