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Diffuse Lung Disease pp 37–48Cite as

Bronchoalveolar Lavage

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Abstract

Bronchoalveolar lavage (BAL) explores large areas of the alveolar ­compartment. After the introduction as a research tool, BAL has been appreciated extensively for clinical applications in the field of opportunistic infections and diffuse interstitial lung diseases (DILDs). It is considered as a safe, minimally invasive procedure. In selected cases, BAL has become an accepted technique for establishing or ruling out a diagnosis with only a low risk of incorrect diagnosis. BAL fluid (BALF) analysis can be very helpful in the differential diagnosis. A grouping of features, an elevated total cell count, predominantly lymphocytes, together with a nearly normal percentage of eosinophils and polymorphonuclear neutrophils and the absence of plasma cells, distinguishes the most likely diagnosis of sarcoidosis from the most common DILD, extrinsic allergic alveolitis (EAA), nonspecific interstitial pneumonia, and idiopathic pulmonary fibrosis (IPF). Knowledge about disease presentation or activity at the time the BAL is performed as well as the smoking status and possible history of occupational and/or environmental exposures is crucial for adequate interpretation of individual BALF analysis results. In contrast, the usefulness of BAL in the management and prediction of the prognosis of a certain disorder is, so far, rather controversial.

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References

  1. Baughman RP, Drent M. Role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2001;22:331–41.

    Article  PubMed  CAS  Google Scholar 

  2. Reynolds HY. Diagnostic and management strategies for diffuse interstitial lung disease. Chest. 1998;113:192–202.

    Article  PubMed  CAS  Google Scholar 

  3. Meyer KC. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med. 2004;25:637–49.

    Article  PubMed  Google Scholar 

  4. Reynolds HY. Present status of bronchoalveolar lavage in interstitial lung disease. Curr Opin Pulm Med. 2009;15:479–85.

    Article  PubMed  Google Scholar 

  5. American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement. American Thoracic Society (ATS), and the European Respiratory Society (ERS). Am J Respir Crit Care Med. 2000;161:646–64.

    Google Scholar 

  6. Ward K, O’Connor C, Odlum C, et al. Prognostic value of bronchoalveolar lavage in sarcoidosis: the critical influence of disease presentation. Thorax. 1989;44:6–12.

    Article  PubMed  CAS  Google Scholar 

  7. Fireman E, Vardinon N, Burke M, et al. Predictive value of response to treatment of T-lymphocyte subpopulations in idiopathic pulmonary fibrosis. Eur Respir J. 1998;11:706–11.

    PubMed  CAS  Google Scholar 

  8. Drent M, Jacobs JA, de Vries J, et al. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis? Eur Respir J. 1999;13:1338–44.

    Article  PubMed  CAS  Google Scholar 

  9. du Bois RM. Diffuse lung disease: a view for the future. Sarcoidosis Vasc Diffuse Lung Dis. 1997;14:23–30.

    PubMed  Google Scholar 

  10. Bronchoalveolar lavage constituents in healthy individuals, idiopathic pulmonary fibrosis, and selected comparison groups. The BAL Cooperative Group Steering Committee. Am Rev Respir Dis. 1990;141:S169–S202.

    Google Scholar 

  11. Haslam PL, Baughman RP. Report of ERS Task Force: guidelines for measurement of acellular components and standardization of BAL. Eur Respir J. 1999;14:245–8.

    Article  PubMed  CAS  Google Scholar 

  12. Klech H, Pohl WR. Technical recommendations and guidelines for bronchoalveolar lavage (BAL): report of the European Society of Pneumonology Task Group on BAL. Eur Respir J. 1989;2:561–85.

    Google Scholar 

  13. Meyer KC, Raghu G, Baughman RP, et al. The clinical utility of bronchoalveolar lavage cellular analysis in interstitial lung disease: an international consensus statement. Am J Respir Crit Care Med 2011; in press.

    Google Scholar 

  14. Garcia JG, Wolven RG, Garcia PL, et al. Assessment of interlobar variation of bronchoalveolar lavage cellular differentials in interstitial lung diseases. Am Rev Respir Dis. 1986;133:444–9.

    PubMed  CAS  Google Scholar 

  15. De Brauwer EI, Jacobs JA, Nieman F, et al. Cytocentrifugation conditions affecting the differential cell count in bronchoalveolar lavage fluid. Anal Quant Cytol Histol. 2000;22:416–22.

    PubMed  Google Scholar 

  16. De Brauwer E, Jacobs J, Nieman F, et al. Test characteristics of acridine orange, Gram, and May-Grunwald-Giemsa stains for enumeration of intracellular organisms in bronchoalveolar lavage fluid. J Clin Microbiol. 1999;37:427–9.

    PubMed  Google Scholar 

  17. Drent M, Grutters JC, Mulder PG, et al. Is the different T helper cell activity in sarcoidosis and extrinsic allergic alveolitis also reflected by the cellular bronchoalveolar lavage fluid profile? Sarcoidosis Vasc Diffuse Lung Dis. 1997;14:31–8.

    PubMed  CAS  Google Scholar 

  18. Ando M, Konishi K, Yoneda R, Tamura M, et al. Difference in the phenotypes of bronchoalveolar lavage lymphocytes in patients with summer-type hypersensitivity pneumonitis, farmer’s lung, ventilation pneumonitis, and bird fancier’s lung: report of a nationwide epidemiologic study in Japan. J Allergy Clin Immunol. 1991;87:1002–9.

    Article  PubMed  CAS  Google Scholar 

  19. Welker L, Jorres RA, Costabel U, et al. Predictive value of BAL cell differentials in the diagnosis of interstitial lung diseases. Eur Respir J. 2004;24:1000–6.

    Article  PubMed  CAS  Google Scholar 

  20. Keicho N, Oka T, Takeuchi K, et al. Detection of lymphomatous involvement of the lung by bronchoalveolar lavage. Application of immunophenotypic and gene rearrangement analysis. Chest. 1994;105:458–62.

    Article  PubMed  CAS  Google Scholar 

  21. Jacobs JA, De Brauwer EI, Ramsay G, et al. Detection of non-infectious conditions mimicking pneumonia in the intensive care setting: usefulness of bronchoalveolar fluid cytology. Respir Med. 1999;93:571–8.

    Article  PubMed  CAS  Google Scholar 

  22. Drent M, Mansour K, Linssen C. Bronchoalveolar lavage in sarcoidosis. Semin Respir Crit Care Med. 2007;28:486–95.

    Article  PubMed  Google Scholar 

  23. Costabel U, Guzman J, Bonella F, et al. Bronchoalveolar lavage in other interstitial lung diseases. Semin Respir Crit Care Med. 2007;28:514–24.

    Article  PubMed  Google Scholar 

  24. Drent M, Jacobs JA, Cobben NA, et al. Computer program supporting the diagnostic accuracy of cellular BALF analysis: a new release. Respir Med. 2001;95:781–6.

    Article  PubMed  CAS  Google Scholar 

  25. Drake WP, Newman LS. Mycobacterial antigens may be important in sarcoidosis pathogenesis. Curr Opin Pulm Med. 2006;12:359–63.

    Article  PubMed  Google Scholar 

  26. Cormier Y, Belanger J, LeBlanc P, et al. Bronchoalveolar lavage in farmers’ lung disease: diagnostic and physiological significance. Br J Ind Med. 1986;43:401–5.

    PubMed  CAS  Google Scholar 

  27. Laviolette M, Cormier Y, Loiseau A, et al. Bronchoalveolar mast cells in normal farmers and subjects with farmer’s lung. Diagnostic, prognostic, and physiologic significance. Am Rev Respir Dis. 1991;144:855–60.

    Article  PubMed  CAS  Google Scholar 

  28. Camus P, Colby TV. The lung in inflammatory bowel disease. Eur Respir J. 2000;15:5–10.

    Article  PubMed  CAS  Google Scholar 

  29. Schnabel A, Reuter M, Gloeckner K, et al. Bronchoalveolar lavage cell profiles in Wegener’s granulomatosis. Respir Med. 1999;93:498–506.

    Article  PubMed  CAS  Google Scholar 

  30. Drent M, van Velzen-Blad H, Diamant M, et al. Relationship between presentation of sarcoidosis and T lymphocyte profile. A study in bronchoalveolar lavage fluid. Chest. 1993;104:795–800.

    Article  PubMed  CAS  Google Scholar 

  31. Drent M, Wagenaar S, van Velzen-Blad H, et al. Relationship between plasma cell levels and profile of bronchoalveolar lavage fluid in patients with subacute extrinsic allergic alveolitis. Thorax. 1993;48:835–9.

    Article  PubMed  CAS  Google Scholar 

  32. Drent M, van Velzen-Blad H, Diamant M, et al. Differential diagnostic value of plasma cells in bronchoalveolar lavage fluid. Chest. 1993;103:1720–4.

    Article  PubMed  CAS  Google Scholar 

  33. Nagai S, Kitaichi M, Itoh H, et al. Idiopathic nonspecific interstitial pneumonia/fibrosis: comparison with idiopathic pulmonary fibrosis and BOOP. Eur Respir J. 1998;12:1010–9.

    Article  PubMed  CAS  Google Scholar 

  34. Cobben NA, Jacobs JA, van Dieijen-Visser MP, et al. Diagnostic value of BAL fluid cellular profile and enzymes in infectious pulmonary disorders. Eur Respir J. 1999;14:496–502.

    Article  PubMed  CAS  Google Scholar 

  35. Allaouchiche B, Jaumain H, Dumontet C, et al. Early diagnosis of ventilator-associated pneumonia. Is it possible to define a cutoff value of infected cells in BAL fluid? Chest. 1996;110:1558–65.

    Article  PubMed  CAS  Google Scholar 

  36. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002;165:867–903.

    PubMed  Google Scholar 

  37. Newman Taylor A. Pulmonary eosinophilia: the eosinophilic pneumonias. In: Olivieri D, editor. Interstitial lung diseases. Sheffield: European Respiratory Monograph; 2000. p. 206–25.

    Google Scholar 

  38. Cordier JF. Pulmonary vasculitis. Rev Med Interne. 2002;23:547s–8.

    Article  PubMed  Google Scholar 

  39. Pesci A, Rossi GA, Bertorelli G, et al. Mast cells in the airway lumen and bronchial mucosa of patients with chronic bronchitis. Am J Respir Crit Care Med. 1994;149:1311–6.

    PubMed  CAS  Google Scholar 

  40. Grotte D, Stanley MW, Swanson PE, et al. Reactive type II pneumocytes in bronchoalveolar lavage fluid from adult respiratory distress syndrome can be mistaken for cells of adenocarcinoma. Diagn Cytopathol. 1990;6:317–22.

    Article  PubMed  CAS  Google Scholar 

  41. Linssen KC, Jacobs JA, Poletti VE, et al. Reactive type II pneumocytes in bronchoalveolar lavage fluid. Acta Cytol. 2004;48:497–504.

    Article  PubMed  Google Scholar 

  42. Meyer KC. Bronchoalveolar lavage as a diagnostic tool. Semin Respir Crit Care Med. 2007;28:546–60.

    Article  PubMed  Google Scholar 

  43. Costabel U, Uzaslan E, Guzman J. Bronchoalveolar lavage in drug-induced lung disease. Clin Chest Med. 2004;25:25–35.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Respiratory Medicine, ild care consultancy, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands

    Marjolein Drent MD, PhD

  2. Department of Medical Microbiology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands

    Catharina F. M. Linssen MD, PhD

Authors
  1. Marjolein Drent MD, PhD
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  2. Catharina F. M. Linssen MD, PhD
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Correspondence to Marjolein Drent MD, PhD .

Editor information

Editors and Affiliations

  1. University of Cincinnati, College of Medicine, Department of Internal Medicine, Eden Ave, Cincinnati, 45267-0565, Ohio, USA

    Robert P. Baughman

  2. of Respiratory Medicine, Imperial College, Emeritus Professor, Grand Ave 14, London, N10 3BB, United Kingdom

    Roland M. du Bois

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© 2012 Springer Science+Business Media, LLC

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Drent, M., Linssen, C.F.M. (2012). Bronchoalveolar Lavage. In: Baughman, R., du Bois, R. (eds) Diffuse Lung Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-9771-5_3

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  • DOI: https://doi.org/10.1007/978-1-4419-9771-5_3

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  • Print ISBN: 978-1-4419-9770-8

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