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Die bronchoalveoläre Lavage aus klinischer Sicht

Bronchoalveolar lavage from a clinical viewpoint

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die bronchoalveoläre Lavage (BAL) bietet heute, neben einem hohen Sicherheitsprofil, eine Fülle von Befunden, die als diagnostische Marker eine Rolle spielen. Sie ist bei allen unklaren interstitiellen Lungenerkrankungen, auch bei solchen mit infektiöser Genese, zur diagnostischen Standarduntersuchung geworden. Bei relativ spezifischen Befunden wie der pulmonalen Alveolarproteinose, Langerhans-Zell-Histiozytose, der diffusen alveolären Blutung, diffusen malignen Infiltraten oder bei Staubexposition ist eine Lungenbiopsie meist nicht mehr erforderlich. Bei anderen Erkrankungen wie der Sarkoidose oder der exogen-allergischen Alveolitis kann bei entsprechender Klinik und radiologischem Befund das differenzialdiagnostische Spektrum stark eingeschränkt werden und auch in vielen Fällen die Diagnose ohne Biopsie gestellt werden. Bei der idiopathischen Lungenfibrose trägt die BAL zur Ausschlussdiagnostik, vor allem von Erkrankungen mit einer lymphozytären BAL, bei.

Abstract

Nowadays, bronchoalveolar lavage (BAL) offers a high safety profile and a wide range of findings which play a role as diagnostic markers. This has become the standard diagnostic procedure for all unclear interstitial lung diseases, even for those originating from infections. For relatively specific findings, such as pulmonary alveolar proteinosis, Langerhans cell histiocytosis, diffuse alveolar hemorrhaging, diffuse malignant infiltrates or exposure to dust, a pulmonary biopsy is no longer necessary. For other diseases such as sarcoidosis or extrinsic allergic alveolitis, a bronchoalveolar lavage can complement the corresponding clinical and radiological findings by limiting the differential diagnostic spectrum and in many cases the diagnosis can be made without a biopsy. In cases of idiopathic pulmonary fibrosis bronchoalveolar lavage can contribute to exclude other diagnoses, especially those with an increase of BAL lymphocytes.

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Authors and Affiliations

  1. Abteilung Pneumologie/Allergologie Ruhrlandklinik, Universitätsklinikum Essen, Tüschener Weg 40, 45239, Essen , Deutschland

    P.C. Bauer, F. Bonella & U. Costabel

  2. Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, WestdeutschesTumorzentrum Essen, Essen , Deutschland

    M. Tötsch & D. Theegarten

  3. Allgemeine, insbesondere Experimentelle Pathologie, Ruhr-Universität Bochum, Bochum, Deutschland

    J. Guzman

Authors
  1. P.C. Bauer
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  2. F. Bonella
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  3. M. Tötsch
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  4. D. Theegarten
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  5. J. Guzman
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  6. U. Costabel
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Correspondence to P.C. Bauer.

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Bauer, P., Bonella, F., Tötsch, M. et al. Die bronchoalveoläre Lavage aus klinischer Sicht. Pneumologe 6, 233–242 (2009). https://doi.org/10.1007/s10405-008-0304-y

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