Skip to main content
Log in

Bronchoalveoläre Lavage

Bronchoalveolar lavage

  • Schwerpunkt: Zytopathologie
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Die bronchoalveoläre Lavage (BAL) ist eine etablierte Methode, um mit Hilfe eines Bronchoskops Material von den peripheren Atemwegen wie den terminalen Bronchiolen und den Alveolen zu gewinnen. Bei Beachtung der Standardprotokolle wird sie vom Patienten gut vertragen und spielt daher eine wichtige Rolle bei der Diagnose von interstitiellen Lungenerkrankungen und auch von Infektionskrankheiten. Bei bestimmten Krankheitsbildern wie z. B. der Alveolarproteinose oder einer Langerhans-Zell-Histiozytose erlauben spezifische Befunde, auf eine invasive Diagnostik zu verzichten. Bei anderen Erkrankungen ist in vielen Fällen eine Einengung der Differenzialdiagnosen möglich. Dennoch kann bis heute häufig nicht gänzlich auf die Biopsie verzichtet werden. Die Kombination beider Methoden erlaubt in Zusammenschau mit den klinisch erhobenen Befunden eine zuverlässige Diagnostik sowie die Erforschung der pathologischen Veränderungen bei Entzündungen und fibrosierenden Lungenerkrankungen.

Abstract

Bronchoalveolar lavage (BAL) has become an established method for the diagnosis of infectious and interstitial lung diseases. Using a bronchoscope material from the peripheral airways and aleveolar spaces can be obtained. When standard protocols are followed the procedure is generally well tolerated and in combination with clinical tests allows a reliable diagnosis in many cases. Certain clinical entities, e.g. alveolar proteinosis and Langerhans cell histiocytosis can be diagnosed by BAL alone without resorting to invasive diagnostic tests. In other diseases, BAL allows to narrow the range of the differential diagnosis. However, biopsies can often still not be avoided completely. A combination of both methods together with the clinical findings represents a powerful tool for diagnosis and research into the pathologic alterations in inflammatory and fibroising lung diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

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

    Google Scholar 

  2. Baughman RP, Dohn MN, Frame PT (1994) The continuing utility of bronchoalveolar lavage to diagnose opportunistic infection in AIDS patients. Am J Med 97: 515–522

    Article  PubMed  CAS  Google Scholar 

  3. Baughman RP, Drent M (2001) Role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med 22: 331–341

    Article  PubMed  CAS  Google Scholar 

  4. Benzer A, Ofner D, Totsch M, Klima G (1994) Early diagnosis of fat embolism syndrome by automated image analysis of alveolar macrophages. J Clin Monit 10: 213–215

    Article  PubMed  CAS  Google Scholar 

  5. Costabel U (1988) The alveolitis of hypersensitivity pneumonitis. Eur Respir J 1: 5–9

    PubMed  CAS  Google Scholar 

  6. Costabel U (1994) Atlas der bronchoalveolären Lavage. Thieme, Stuttgart

  7. Costabel U, Guzman J (2003) Bronchoalveolar lavage. In: Gobson GJ, Geddes DM, Costabel U et al. (eds) Respiratory Medecine. 3rd edn. Saunders, London, pp 438–448

  8. Costabel U, Guzman J (1996) Die klinische Bedeutung der bronchoalveolären Lavage. Atemw Lungenerkrankungen 22: 110–114

    Google Scholar 

  9. Costabel U, Guzman J (2001) Bronchoalveolar lavage in interstitial lung disease. Curr Opin Pulm Med 7: 255–261

    Article  PubMed  CAS  Google Scholar 

  10. Costabel U, Teschler H, Guzman J (1992) Bronchiolitis obliterans organizing pneumonia (BOOP): The cytological and immunocytological profile of bronchoalveolar lavage. Eur Respir J 5: 791–797

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  12. Costabel U, Zaiss AW, Guzman J (1992) Sensitivity and specificity of BAL findings in sarcoidosis. Sarcoidosis 9: 211–214

    Google Scholar 

  13. Blic J de, McKelvie P, Le BM et al. (1987) Value of bronchoalveolar lavage in the management of severe acute pneumonia and interstitial pneumonitis in the immunocompromised child. Thorax 42: 759–765

    PubMed  Google Scholar 

  14. Blic J de, Midulla F, Barbato A et al. (2000) Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur Respir J 15: 217–231

    PubMed  Google Scholar 

  15. Fend F, Mikuz G, Ott G, Rothmund J (1989) Diagnostic value of combined bronchoalveolar lavage and transbronchial lung biopsy. Pathol Res Pract 184: 312–317

    PubMed  CAS  Google Scholar 

  16. Finley TN, Swenson EW, Curran WS (1967) Broncho-pulmonary lavage in normal subjects and patients with obstructive lung disease. Ann Intern Med 66: 651–658

    PubMed  CAS  Google Scholar 

  17. Garcia JG, Wolven RG, Garcia PL, Keogh BA (1986) Assessment of interlobar variation of bronchoalveolar lavage cellular differentials in interstitial lung diseases. Am Rev Respir Dis 133: 444–449

    PubMed  CAS  Google Scholar 

  18. Golde DW, Drew WL, Klein HZ et al. (1975) Occult pulmonary haemorrhage in leukemia. Brit Med J II: 166–168

    Article  Google Scholar 

  19. Harbeck RJ (1998) Immunophenotyping of bronchoalveolar lavage lymphocytes. Clin Diagn Lab Immunol 5: 271–277

    PubMed  CAS  Google Scholar 

  20. Haslam PL, Baughman RP (1999) Report of ERS Task Force: Guidelines for measurement of acellular components and standardization of BAL. Eur Respir J 14: 245–248

    Article  PubMed  CAS  Google Scholar 

  21. Haslam PL, Dewar A, Butchers P et al. (1987) Mast cells, atypical lymphocytes, and neutrophils in bronchoalveolar lavage in extrinsic allergic alveolitis. Comparison with other interstitial lung diseases. Am Rev Respir Dis 135: 35–47

    PubMed  CAS  Google Scholar 

  22. Jamnig R, Sideroff G, Puelacher C et al. (1991) Bronchoalveoläre Lavage und Tuberkulose: Vergleich zwischen Immunzytologie und Klinik. Mitt Öst Sanit Verwalt 92: 253–254

    Google Scholar 

  23. Keimowitz RI (1964) Immunoglobulins in normal human tracheobronchial washings. A quallitative and quantitative study. J Lab Clin Med 63: 54–59

    PubMed  CAS  Google Scholar 

  24. Klech H, Hutter C (1990) Clinical guidelines and indications for bronchoalveolar lavage (BAL): report of the European Society of Pneumology Task Force on BAL. Eur Respir J 3: 937–974

    Google Scholar 

  25. Klech H, Pohl W (1989) Technical recommendations and guidelines for bronchoalveolar lavage (BAL). Report of the ERS Task Group. Eur Respir J 2: 561–585

    Google Scholar 

  26. Mairinger T, Gschwendtner A, Toetsch M et al. (1996) Automated cell differentiation of bronchoalveolar lavage samples with two-step image analysis. Anal Quant Cytol Histol 18: 453–460

    PubMed  CAS  Google Scholar 

  27. Myrvik QN, Leake ES, Farris B (1961) Studies on pulmonary alveolar macrophages from the normal rabbit: A technique to procure them in a high state of purity. J Immunol 86: 128–132

    PubMed  CAS  Google Scholar 

  28. Peterson MW, Nugent KM, Jolles H et al. (1988) Uniformity of bronchoalveolar lavage in patients with pulmonary sarcoidosis. Am Rev Respir Dis 137: 79–84

    PubMed  CAS  Google Scholar 

  29. Poletti V, Cazzato S, Minicuci N et al. (1996) The diagnostic value of bronchoalveolar lavage and transbronchial lung biopsy in cryptogenic organizing pneumonia. Eur Respir J 9: 2513–2516

    Article  PubMed  CAS  Google Scholar 

  30. Reynolds HY, Newball HH (1974) Analysis of proteins and respiratory cells obtained from human lungs by bronchial lavage. J Lab Clin Med 84: 559–573

    PubMed  CAS  Google Scholar 

  31. Rudd RM, Haslam PL, Turner-Warwick M (1981) Cryptogenic fibrosing alveolitis. Relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis. Am Rev Respir Dis 124: 1–8

    PubMed  CAS  Google Scholar 

  32. Schnabel A, Csernok E, Braun J, Gross WL (2000) Activation of neutrophils, eosinophils, and lymphocytes in the lower respiratory tract in Wegener’s granulomatosis. Am J Respir Crit Care Med 161: 399–405

    PubMed  CAS  Google Scholar 

  33. Schwaiger A, Prior C, Weyrer K et al. (1991) Non-Hodgkin’s lymphoma of the lung diagnosed by gene rearrangement from bronchoalveolar lavage fluid: a fast and noninvasive method. Blood 77: 2538–2539

    PubMed  CAS  Google Scholar 

  34. Semenzato G, Poletti V (1992) Bronchoalveolar lavage in lung cancer. Respiration (Suppl 1)59: 44–46

    Google Scholar 

  35. Turner-Warwick M, Haslam PL (1987) The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis. Am Rev Respir Dis 135: 26–34

    PubMed  CAS  Google Scholar 

  36. Winterbauer RH, Lammert J, Selland M et al. (1993) Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest 104: 352–361

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Tötsch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tötsch, M., Guzman, J., Theegarten, D. et al. Bronchoalveoläre Lavage. Pathologe 28, 346–353 (2007). https://doi.org/10.1007/s00292-007-0926-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00292-007-0926-6

Schlüsselwörter

Keywords

Navigation