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. 2013 Jul;8(3):153-9.
doi: 10.4103/1817-1737.114302.

Association of bronchoalveolar lavage yield with chest computed tomography findings and symptoms in immunocompromised patients

Kyle R Brownback  1 , Steven Q Simpson
Affiliations

Association of bronchoalveolar lavage yield with chest computed tomography findings and symptoms in immunocompromised patients

Kyle R Brownback et al. Ann Thorac Med. 2013 Jul.

Abstract

Introduction: Fiber-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) is a common procedure performed in immunocompromised patients with undiagnosed pulmonary pathology. Identifying patients with the highest potential diagnostic yield may help to avoid morbidity in patients unlikely to benefit from the procedure. We sought to determine which patient factors, specifically chest computed tomography (CT) findings, affected diagnostic yield of BAL.

Methods: Retrospective chart review of immunocompromised patients who underwent FOB with BAL from 01/01/2010 to 12/31/2011 at an academic medical center was performed. The lung lobe lavaged, characteristics of pulmonary infiltrate on radiograph, patient symptoms, and diagnostic yield were collected. A positive diagnostic yield was defined as a positive microbiological culture, finding on cytopathologic staining, diffuse alveolar hemorrhage, alveolar eosinophilia or a positive immunologic or nucleic acid assay.

Results: The overall diagnostic yield was 52.6%. Infiltrates that were predominantly reticular or nodular by CT had a lower diagnostic yield than predominantly consolidated, ground-glass, or tree-in-bud infiltrates (36.5% vs. 61.2%, P = 0.0058). The diagnostic yield was significantly improved in patients with both fever and chest symptoms compared to patients without symptoms (61.3% vs. 29.6%, P = 0.0066).

Conclusion: CT findings of reticular and nodular infiltrates portend a worse diagnostic yield from BAL than those that are alveolar in nature. Symptomatic patients are more likely to have diagnostic FOB with BAL than asymptomatic patients.

Keywords: Bronchoscopy; computed tomography; immunodeficiency; respiratory infection; respiratory symptoms.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
A higher diagnostic yield was demostrated in patients whose predominant radiographic infiltrate is within the alveoli or airways, as compared to infiltrates were the abnormality is predominantly extra-alveolar
Figure 2
Figure 2
There is significantly higher diagnostic yield of bronchoscopy with bronchoalveolar lavage in the lower lobes than in the middle or upper lobes in immunocompromised patients
Figure 3
Figure 3
Immunocompromised patients with fever and chest symptoms have a higher diagnostic yield from fiber-optic bronchoscopy with bronchoalveolar lavage than asymptomatic patients
See this image and copyright information in PMC

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